1 Division for Mental and Physical Health, Norwegian Institute of Public Health, Norway.
2 Department of Community Medicine and Global Health, University of Oslo, Norway.
Eur J Prev Cardiol. 2019 Jul;26(10):1096-1103. doi: 10.1177/2047487319826274. Epub 2019 Jan 28.
Educational inequality in cardiovascular disease and in modifiable risk factors changes over time and between birth cohorts. We aimed to assess how cardiovascular disease risk factors mediate educational differences in premature cardiovascular disease mortality and how this varies over birth cohorts and sex.
We followed 360,008 40-45-year-olds born in the 1930s, 1940s or 1950s from Norwegian health examination surveys (1974-1997) for premature cardiovascular disease mortality. Cox proportional hazard and Aalen's additive survival analyses provided hazard ratios and rate differences of excess deaths in participants with basic versus tertiary education.
Relative educational differences in premature cardiovascular disease mortality were stable, whereas absolute differences narrowed from the 1930s to the 1950s cohorts; rate differences per 100 000 person years declined from 170 (95% confidence interval 117, 224) to 49 (36, 61) in men and from 60 (34, 85) to 23 (16, 29) in women. Cardiovascular disease risk factors attenuated rate differences by 69% in both cohorts in men, and in women by 102% in 1930s and 61% in 1950s cohorts. Smoking had the single strongest influence on the educational differences for men in all three cohorts, and for women in the two most recent cohorts.
Smoking appeared to be the driving force behind educational differences in premature cardiovascular disease mortality in the 1930s to 1950s birth cohorts for men and in the two recent birth cohorts for women. This suggests that strategies for smoking prevention and cessation might have the strongest impact for reducing educational inequality in premature cardiovascular disease mortality.
心血管疾病和可改变的危险因素方面的教育不平等会随时间推移和出生队列而变化。我们旨在评估心血管疾病风险因素如何调节早发性心血管疾病死亡率方面的教育差异，以及这种差异如何随出生队列和性别而变化。
我们随访了来自挪威健康检查调查（1974-1997 年）的 360008 名 40-45 岁的 30 年代、40 年代和 50 年代出生者，以研究早发性心血管疾病死亡率。Cox 比例风险和 Aalen 的加法生存分析提供了具有基本和高等教育参与者的超额死亡的危险比和率差异。
早发性心血管疾病死亡率方面的相对教育差异是稳定的，而绝对差异从 30 年代队列缩小到 50 年代队列；每 100000 人年的率差异从男性的 170（95%置信区间 117，224）下降到 49（36，61），从女性的 60（34，85）下降到 23（16，29）。心血管疾病风险因素在男性两个队列中分别将率差异降低了 69%，在女性 30 年代队列中降低了 102%，在 50 年代队列中降低了 61%。吸烟对男性所有三个队列中的教育差异以及女性最近两个队列中的教育差异影响最大。
吸烟似乎是导致男性 30 年代至 50 年代出生队列和女性最近两个出生队列中早发性心血管疾病死亡率方面教育差异的主要原因。这表明，预防和戒烟策略可能对降低早发性心血管疾病死亡率方面的教育不平等产生最强的影响。
