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Education and risk of coronary heart disease: assessment of mediation by behavioral risk factors using the additive hazards model

  • CARDIOVASCULAR DISEASE
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An Erratum to this article was published on 19 April 2014

Abstract

Educational-related gradients in coronary heart disease (CHD) and mediation by behavioral risk factors are plausible given previous research; however this has not been comprehensively addressed in absolute measures. Questionnaire data on health behavior of 69,513 participants, 52 % women, from seven Danish cohort studies were linked to registry data on education and incidence of CHD. Mediation by smoking, low physical activity, and body mass index (BMI) on the association between education and CHD were estimated by applying newly proposed methods for mediation based on the additive hazards model, and compared with results from the Cox proportional hazards model. Short (vs. long) education was associated with 277 (95 % CI: 219, 336) additional cases of CHD per 100,000 person-years at risk among women, and 461 (95 % CI: 368, 555) additional cases among men. Of these additional cases 17 (95 % CI: 12, 22) for women and 37 (95 % CI: 28, 46) for men could be ascribed to the pathway through smoking. Further, 39 (95 % CI: 30, 49) cases for women and 94 (95 % CI: 79, 110) cases for men could be ascribed to the pathway through BMI. The effects of low physical activity were negligible. Using contemporary methods, the additive hazards model, for mediation we indicated the absolute numbers of CHD cases prevented when modifying smoking and BMI. This study confirms previous claims based on the Cox proportional hazards model that behavioral risk factors partially mediates the effect of education on CHD, and the results seems not to be particularly model dependent.

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Acknowledgments

We thank the collaborators behind the SIC Cohort Study: the Copenhagen City Heart Study, the Diet, Cancer and Health Study, and the cohorts at the Research Center for Prevention and Health. This work was supported by the Commission of Social Inequality in Cancer [Grant Number SU08004].

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Section of Social Medicine, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark

    Helene Nordahl, Naja Hulvej Rod, Ingelise Andersen & Finn Diderichsen

  2. Research Center for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark

    Birgitte Lidegaard Frederiksen & Merete Osler

  3. National Board of Health, Hospital Services and Emergency Management, Copenhagen, Denmark

    Birgitte Lidegaard Frederiksen

  4. Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

    Theis Lange

  5. Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark

    Eva Prescott

  6. The Copenhagen City Heart Study, Bispebjerg University Hospital, Copenhagen, Denmark

    Eva Prescott

  7. Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark

    Kim Overvad

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  1. Helene Nordahl
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  2. Naja Hulvej Rod
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Correspondence to Helene Nordahl.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s10654-014-9897-0.

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Nordahl, H., Rod, N.H., Frederiksen, B.L. et al. Education and risk of coronary heart disease: assessment of mediation by behavioral risk factors using the additive hazards model. Eur J Epidemiol 28, 149–157 (2013). https://doi.org/10.1007/s10654-012-9745-z

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  • DOI: https://doi.org/10.1007/s10654-012-9745-z

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