Abstract
BackgroundVarious indicators of childhood socioeconomic position have been related to cardiovascular disease (CVD) risk in adulthood. We investigated the impact of shared family factors on the educational gradient in midlife CVD risk factors by assessing within sibling similarities in the gradient using a discordant sibling design.MethodsNorwegian health survey data (1980–2003) was linked to educational and generational data. Participants with a full sibling in the health surveys (228,346 individuals in 98,046 sibships) were included. Associations between attained educational level (7–9 years, 10–11 years, 12 years, 13–16 years, or >16 years) and CVD risk factor levels in the study population was compared with the corresponding associations within siblings.ResultsEducational gradients in risk factors were attenuated when factors shared by siblings was taken into account: A one category lower educational level was associated with 0.7 (95% confidence interval 0.6 to 0.8) mm Hg higher systolic blood pressure (27% attenuation), 0.4 (0.4 to 0.5) mmHg higher diastolic blood pressure (30%), 1.0 (1.0 to 1.1) more beats per minute higher heart rate (21%), 0.07 (0.06 to 0.07) mmol/l higher serum total cholesterol (32%), 0.2 (0.2 to 0.2) higher smoking level (5 categories) (30%), 0.15 (0.13 to 0.17) kg/m2 higher BMI (43%), and 0.2 (0.2 to 0.2) cm lower height (52%). Attenuation increased with shorter age-difference between siblings.ConclusionAbout one third of the educational gradients in modifiable CVD risk factors may be explained by factors that siblings share. This implies that childhood environment is important for the prevention of CVD.
Highlights
Various indicators of childhood socioeconomic position have been related to cardiovascular disease (CVD) risk in adulthood
This socioeconomic gradient in CVD represent a potential for disease prevention, and it is of great policy interest to determine which periods during the life course are important for development of the cardiovascular disease risk factors; elevated blood pressure
We investigated the educational gradient in CVD risk factors between siblings in a large sample from the Norwegian general population, being in their early 40s
Summary
Various indicators of childhood socioeconomic position have been related to cardiovascular disease (CVD) risk in adulthood. A substantial proportion of the inverse associations between SEP and CVD are driven by the higher prevalence of CVD risk factors by lower SEP [3, 4] This socioeconomic gradient in CVD represent a potential for disease prevention, and it is of great policy interest to determine which periods during the life course are important for development of the cardiovascular disease risk factors; elevated blood pressure, Childhood SEP, usually indicated by parental level of education or occupational class, is associated with adult CVD risk factors in several populations [6,7,8,9,10]. In this context, sibling similarity in the educational gradient in height
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