Department of Community Health, Epidemiology Section, Center for Population Health and Clinical Epidemiology, Brown University, Providence, Rhode Island, USA.
BMC Public Health. 2011 Feb 28;11:139. doi: 10.1186/1471-2458-11-139.
Education is inversely associated with cardiovascular disease incidence in developed countries. Blood pressure may be an explanatory biological mechanism. However few studies have investigated educational gradients in longitudinal blood pressure trajectories, particularly over substantial proportions of the life course. Study objectives were to determine whether low education was associated with increased blood pressure from multiple longitudinal assessments over 30 years. Furthermore, we aimed to separate antecedent effects of education, and other related factors, that might have caused baseline differences in blood pressure, from potential long-term effects of education on post-baseline blood pressure changes.
The study examined 3890 participants of the Framingham Offspring Study (mean age 36.7 years, 52.0% females at baseline) from 1971 through 2001 at up to 7 separate examinations using multivariable mixed linear models.
Mixed linear models demonstrated that mean systolic blood pressure (SBP) over 30 years was higher for participants with ≤12 vs. ≥17 years education after adjusting for age (3.26 mmHg, 95% CI: 1.46, 5.05 in females, 2.26 mmHg, 95% CI: 0.87, 3.66 in males). Further adjustment for conventional covariates (antihypertensive medication, smoking, body mass index and alcohol) reduced differences in females and males (2.86, 95% CI: 1.13, 4.59, and 1.25, 95% CI: -0.16, 2.66 mmHg, respectively). Additional analyses adjusted for baseline SBP, to evaluate if there may be educational contributions to post-baseline SBP. In analyses adjusted for age and baseline SBP, females with ≤12 years education had 2.69 (95% CI: 1.09, 4.30) mmHg higher SBP over follow-up compared with ≥17 years education. Further adjustment for aforementioned covariates slightly reduced effect strength (2.53 mmHg, 95% CI: 0.93, 4.14). Associations were weaker in males, where those with ≤12 years education had 1.20 (95% CI: -0.07, 2.46) mmHg higher SBP over follow-up compared to males with ≥17 years of education, after adjustment for age and baseline blood pressure; effects were substantially reduced after adjusting for aforementioned covariates (0.34 mmHg, 95% CI: -0.90, 1.68). Sex-by-education interaction was marginally significant (p = 0.046).
Education was inversely associated with higher systolic blood pressure throughout a 30-year life course span, and associations may be stronger in females than males.
在发达国家，教育与心血管疾病发病率呈负相关。血压可能是一个解释性的生物学机制。然而，很少有研究调查过纵向血压轨迹中的教育梯度，特别是在生命过程的大部分时间内。研究目的是确定低教育水平是否与 30 年来多次纵向评估中的血压升高有关。此外，我们旨在将教育的先行效应与其他相关因素分开，这些因素可能导致血压的基线差异，与教育对基线后血压变化的潜在长期影响分开。
该研究使用多变量混合线性模型，从 1971 年至 2001 年，在多达 7 次单独检查中，对弗雷明汉后代研究（平均年龄 36.7 岁，基线时 52.0%为女性）的 3890 名参与者进行了检查。
混合线性模型表明，在调整年龄后，≤12 岁 vs. ≥17 岁的参与者的平均收缩压（SBP）在 30 年内更高（女性为 3.26mmHg，95%CI：1.46，5.05，男性为 2.26mmHg，95%CI：0.87，3.66）。进一步调整常规协变量（抗高血压药物、吸烟、体重指数和酒精）降低了女性和男性的差异（女性为 2.86mmHg，95%CI：1.13，4.59，男性为 1.25mmHg，95%CI：-0.16，2.66mmHg）。进一步分析调整了基线 SBP，以评估教育是否对基线后 SBP 有贡献。在调整年龄和基线 SBP 的分析中，≤12 岁的女性在随访期间的 SBP 比≥17 岁的女性高 2.69mmHg（95%CI：1.09，4.30）。进一步调整上述协变量略微降低了效应强度（2.53mmHg，95%CI：0.93，4.14）。在男性中，关联较弱，与≥17 岁的男性相比，≤12 岁的男性在随访期间的 SBP 高 1.20mmHg（95%CI：-0.07，2.46），调整年龄和基线血压后；在调整上述协变量后，效果明显降低（0.34mmHg，95%CI：-0.90，1.68）。性别-教育的交互作用具有边缘显著性（p=0.046）。
教育与 30 年生命过程中的收缩压升高呈负相关，且在女性中的关联可能强于男性。
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