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Quantifying the contributions of behavioral and biological risk factors to socioeconomic disparities in coronary heart disease incidence: the MORGEN study.
Eur J Epidemiol 2013; 28(10):807-14EJ

Abstract

Quantifying the impact of different modifiable behavioral and biological risk factors on socioeconomic disparities in coronary heart disease (CHD) may help inform targeted, population-specific strategies to reduce the unequal distribution of the disease. Previous studies have used analytic approaches that limit our ability to disentangle the relative contributions of these risk factors to CHD disparities. The goal of this study was to assess mediation of the effect of low education on incident CHD by multiple risk factors simultaneously. Analyses are based on 15,067 participants of the Dutch Monitoring Project on Risk Factors for Chronic Diseases aged 20-65 years examined 1994-1997 and followed for events until January 1, 2008. Path analysis was used to quantify and test mediation of the low education-CHD association by behavioral (current cigarette smoking, heavy alcohol use, poor diet, and physical inactivity) and biological (obesity, hypertension, diabetes, and hypercholesterolemia) risk factors. Behavioral and biological risk factors accounted for 56.6 % (95 % CI 42.6-70.8 %) of the low education-incident CHD association. Smoking was the strongest mediator, accounting for 27.3 % (95 % CI 17.7-37.4 %) of the association, followed by obesity (10.2 %; 95 % CI 4.5-16.1 %), physical inactivity (6.3 %; 95 % CI 2.7-10.0 %), and hypertension (5.3 %; 95 % CI: 2.8-8.0 %). In summary, in a Dutch cohort, the majority of the relationship between low education and incident CHD was mediated by traditional behavioral and biological risk factors. Addressing barriers to smoking cessation, blood pressure and weight management, and physical activity may be the most effective approaches to eliminating socioeconomic inequalities in CHD.

Authors+Show Affiliations

Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA, k-kershaw@northwestern.edu.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24037117

Citation

Kershaw, Kiarri N., et al. "Quantifying the Contributions of Behavioral and Biological Risk Factors to Socioeconomic Disparities in Coronary Heart Disease Incidence: the MORGEN Study." European Journal of Epidemiology, vol. 28, no. 10, 2013, pp. 807-14.
Kershaw KN, Droomers M, Robinson WR, et al. Quantifying the contributions of behavioral and biological risk factors to socioeconomic disparities in coronary heart disease incidence: the MORGEN study. Eur J Epidemiol. 2013;28(10):807-14.
Kershaw, K. N., Droomers, M., Robinson, W. R., Carnethon, M. R., Daviglus, M. L., & Monique Verschuren, W. M. (2013). Quantifying the contributions of behavioral and biological risk factors to socioeconomic disparities in coronary heart disease incidence: the MORGEN study. European Journal of Epidemiology, 28(10), pp. 807-14. doi:10.1007/s10654-013-9847-2.
Kershaw KN, et al. Quantifying the Contributions of Behavioral and Biological Risk Factors to Socioeconomic Disparities in Coronary Heart Disease Incidence: the MORGEN Study. Eur J Epidemiol. 2013;28(10):807-14. PubMed PMID: 24037117.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Quantifying the contributions of behavioral and biological risk factors to socioeconomic disparities in coronary heart disease incidence: the MORGEN study. AU - Kershaw,Kiarri N, AU - Droomers,Mariël, AU - Robinson,Whitney R, AU - Carnethon,Mercedes R, AU - Daviglus,Martha L, AU - Monique Verschuren,W M, Y1 - 2013/09/14/ PY - 2012/10/04/received PY - 2013/08/30/accepted PY - 2013/9/17/entrez PY - 2013/9/17/pubmed PY - 2013/12/24/medline SP - 807 EP - 14 JF - European journal of epidemiology JO - Eur. J. Epidemiol. VL - 28 IS - 10 N2 - Quantifying the impact of different modifiable behavioral and biological risk factors on socioeconomic disparities in coronary heart disease (CHD) may help inform targeted, population-specific strategies to reduce the unequal distribution of the disease. Previous studies have used analytic approaches that limit our ability to disentangle the relative contributions of these risk factors to CHD disparities. The goal of this study was to assess mediation of the effect of low education on incident CHD by multiple risk factors simultaneously. Analyses are based on 15,067 participants of the Dutch Monitoring Project on Risk Factors for Chronic Diseases aged 20-65 years examined 1994-1997 and followed for events until January 1, 2008. Path analysis was used to quantify and test mediation of the low education-CHD association by behavioral (current cigarette smoking, heavy alcohol use, poor diet, and physical inactivity) and biological (obesity, hypertension, diabetes, and hypercholesterolemia) risk factors. Behavioral and biological risk factors accounted for 56.6 % (95 % CI 42.6-70.8 %) of the low education-incident CHD association. Smoking was the strongest mediator, accounting for 27.3 % (95 % CI 17.7-37.4 %) of the association, followed by obesity (10.2 %; 95 % CI 4.5-16.1 %), physical inactivity (6.3 %; 95 % CI 2.7-10.0 %), and hypertension (5.3 %; 95 % CI: 2.8-8.0 %). In summary, in a Dutch cohort, the majority of the relationship between low education and incident CHD was mediated by traditional behavioral and biological risk factors. Addressing barriers to smoking cessation, blood pressure and weight management, and physical activity may be the most effective approaches to eliminating socioeconomic inequalities in CHD. SN - 1573-7284 UR - https://www.unboundmedicine.com/medline/citation/24037117/Quantifying_the_contributions_of_behavioral_and_biological_risk_factors_to_socioeconomic_disparities_in_coronary_heart_disease_incidence:_the_MORGEN_study_ L2 - https://doi.org/10.1007/s10654-013-9847-2 DB - PRIME DP - Unbound Medicine ER -