Potential explanations for the educational gradient in coronary heart disease:: A population-based case-control study of Swedish women

Objectives. This study examined the association between educational attainment and coronary heart disease (CHD) and the factors that may explain this association. Methods. This population-based case-control study included 292 women with CHD who were 65 years or younger and 292 age-matched controls. Results. Compared with the adjusted odds ratio for CHD associated with college education, the age-adjusted odds ratio associated with mandatory education (less than or equal to 9 years) was 1.87 (95% confidence interval [CI] = 1.23, 2.84) and the odds ratio for high school education was 1.35 (95% CI = 0.81, 2.25) (P for trend <.01). The odds ratio for mandatory education was reduced by 82%, to 1.16 (95% CI = 0.69, 2.09), after adjustment for psychosocial stress, unhealthy lifestyle patterns, hemostatic factors, hypertension; and lipids. Conclusions. Much of the increased risk of CHD in women with low education appears to be linked to psychosocial stress and lifestyle factors. Hemostatic factors, lipids, and hypertension also contribute to a lesser extent These factors may be considered in strategies geared to reducing socioeconomic inequalities in cardiovascular health.