Abstract
BackgroundEducation is associated with health related lifestyle choices including leisure-time physical inactivity. However, the longitudinal associations between education and inactivity merit further studies. We investigated the association between education and leisure-time physical inactivity over a 35-year follow-up with four time points controlling for multiple covariates including familial confounding.MethodsThis study of the population-based Finnish Twin Cohort consisted of 5254 twin individuals born in 1945–1957 (59 % women), of which 1604 were complete same-sexed twin pairs. Data on leisure-time physical activity and multiple covariates was available from four surveys conducted in 1975, 1981, 1990 and 2011 (response rates 72 to 89 %). The association between years of education and leisure-time physical inactivity (<1.5 metabolic equivalent hours/day) was first analysed for each survey. Then, the role of education was investigated for 15-year and 35-year inactivity periods in the longitudinal analyses. The co-twin control design was used to analyse the potential familial confounding of the effects. All analyses were conducted with and without multiple covariates. Odds Ratios (OR) with 95 % Confidence Intervals (CI) were calculated using logistic and conditional (fixed-effects) regression models.ResultsEach additional year of education was associated with less inactivity (OR 0.94 to 0.95, 95 % CI 0.92, 0.99) in the cross-sectional age- and sex-adjusted analyses. The associations of education with inactivity in the 15- and 35-year follow-ups showed a similar trend: OR 0.97 (95 % CI 0.93, 1.00) and OR 0.94 (95 % CI 0.91, 0.98), respectively. In all co-twin control analyses, each year of higher education was associated with a reduced likelihood of inactivity suggesting direct effect (i.e. independent from familial confounding) of education on inactivity. However, the point estimates were lower than in the individual-level analyses. Adjustment for multiple covariates did not change these associations.ConclusionsHigher education is associated with lower odds of leisure-time physical inactivity during the three-decade follow-up. The association was found after adjusting for several confounders, including familial factors. Hence, the results point to the conclusion that education has an independent role in the development of long-term physical inactivity and tailored efforts to promote physical activity among lower educated people would be needed throughout adulthood.
Highlights
Education is associated with health related lifestyle choices including leisure-time physical inactivity
A study with a 10-year follow-up among Dutch adults indicated that higher education was related to remaining active compared to becoming inactive [22], and another Dutch study with a 6-year follow-up among the 15–74-year old population showed that those with a lower education were more likely to decrease their level of leisuretime physical activity (LTPA) than those with a higher education [21]
Our results indicated that each additional year of education was associated with a lesser likelihood of being physically inactive at each time point, and the association remained in the prospective 15- and 35-year follow-ups
Summary
Education is associated with health related lifestyle choices including leisure-time physical inactivity. Education has shown to be strongly associated with health-related behaviours, including time spent in LTPA [13, 14]. Compared to those with lower education, highly educated individuals are more likely to have better adult health and a healthier lifestyle [13, 15, 16], including more LTPA [17,18,19,20].
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