Educational differences in cardiovascular mortality: The role of shared family factors and cardiovascular risk factors

MKR Kjollesdal, I Ariansen, LH Mortensen, George Davey Smith, O Naess

Research output: Contribution to journalArticle (Academic Journal)peer-review

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To explore the confounding effects of early family factors shared by siblings and cardiovascular risk factors in midlife on the educational differences in CVD mortality.


Data from national and regional health surveys in Norway (1974-2003) was linked with data from the Norwegian Family Based Life Course Study, the National Educational Registry and the Cause of Death Registry. The study population consisted of participants with at least one full sibling among health survey participants (n=271.310). Data were available on CVD risk factors; weight, height, blood pressure, total cholesterol and smoking.


Hazard Ratio (HR) of CVD mortality was 3.44 (95 % CI 2.98, 3.96) in the lowest educationalgroup relative to the highest. In within sibship analyses, the HRs were little altered. Adjusted for risk factors, HR for CVD mortality in cohort analyses was 2.05 (1.77, 2.37) in the lowest educational group, relative to the highest. The respective HR in within sibship analyses was 2.46 (1.48, 2.24).


Using a sibling design, we did not find the association between education and CVD mortality to be considerably confounded by early life factors shared by siblings, but to a large extent explained by CVD risk factors. Results suggest that reducing levels of CVD risk factors could have the greatest effect on mortality risk in less-well educated individuals.
Original languageEnglish
Pages (from-to)744-750
Number of pages7
JournalScandinavian Journal of Public Health
Issue number8
Early online date21 Sep 2016
Publication statusPublished - Dec 2016


  • early life
  • sibling
  • social inequalities
  • cardiovascular mortality
  • cardiovascular risk factors


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  • MRC UoB UNITE Unit - Programme 1

    Davey Smith, G.


    Project: Research

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