TY - JOUR
T1 - Decomposing the educational gradient in allostatic load across European populations. What matters the most
T2 - differentials in exposure or in susceptibility?
AU - Veronesi, Giovanni
AU - Kee, Frank
AU - Hicks, Blanaid
AU - Forrest, Hannah
AU - Tunstall-Pedoe, Hugh
AU - Kuulasmaa, Kari
AU - Sans, Susana
AU - Salomaa, Veikko
AU - Thorand, Barbara
AU - Di Castelnuovo, Augusto
AU - Soderberg, Stefan
AU - Cesana, Giancarlo
AU - Bobak, Martin
AU - De Ponti, Roberto
AU - Iacoviello, Licia
AU - Palmieri, Luigi
AU - Zeller, Tanja
AU - Blankenberg, Stefan
AU - Ferrario, Marco M.
N1 - Funding Information:
Funding The BiomarCaRE Project is funded by the EU Seventh Framework Programme (FP7/2007–2013) under grant agreement HEALTH-F2-2011-278913. The activities of the MORGAM Data Centre have also been sustained by recent funding from EU FP7 project CHANCES (HEALTH-F3-2010-242244). A part of the biomarker determinations in the population cohorts was funded by the Medical Research Council London (G0601463, identification No. 80983: Biomarkers in the MORGAM Populations).
Publisher Copyright:
© 2020 BMJ Publishing Group. All rights reserved.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/12/1
Y1 - 2020/12/1
N2 - Background: We investigate whether socially disadvantaged individuals are more susceptible to the detrimental effects of smoking and alcohol intake on allostatic load (AL), a marker of physiological 'wear and tear', resulting from adaptation to chronic stress.Methods: In a cross-sectional analysis, 27 019 men and 26 738 women aged 35-74 years were identified from 21 European cohorts in the BiomarCaRE consortium. We defined three educational classes (EDs) according to years of schooling and an AL score as the sum of z-scores of eight selected biomarkers from the cardiovascular, metabolic and inflammatory systems. We used the Oaxaca-Blinder decomposition to disentangle the ED gradient in AL score into the differential exposure (DE, attributable to different distribution of smoking and alcohol intake across EDs) and the differential susceptibility (DS, attributable to a different effect of risk factors on AL across EDs) components.Results: Less-educated men (mean AL difference: 0.68, 95% CI 0.57 to 0.79) and women (1.52, 95% CI 1.40 to 1.64) had higher AL scores. DE accounted for 7% and 6% of the gradient in men and women, respectively. In men, combining smoking and alcohol intake, DS accounted for 42% of the gradient (smoking DS coefficient=0.177, 26% of the gradient; alcohol DS coefficient=0.109; 16%, not statistically significant). DS contribution increased to 69% in metabolic markers. DS estimates were consistent across age groups, irrespective of comorbidities and robust to unmeasured confounding. No DS was observed in women.Conclusions: In men, a DS mechanism substantially contributes to the educational class gradient in allostatic load.
AB - Background: We investigate whether socially disadvantaged individuals are more susceptible to the detrimental effects of smoking and alcohol intake on allostatic load (AL), a marker of physiological 'wear and tear', resulting from adaptation to chronic stress.Methods: In a cross-sectional analysis, 27 019 men and 26 738 women aged 35-74 years were identified from 21 European cohorts in the BiomarCaRE consortium. We defined three educational classes (EDs) according to years of schooling and an AL score as the sum of z-scores of eight selected biomarkers from the cardiovascular, metabolic and inflammatory systems. We used the Oaxaca-Blinder decomposition to disentangle the ED gradient in AL score into the differential exposure (DE, attributable to different distribution of smoking and alcohol intake across EDs) and the differential susceptibility (DS, attributable to a different effect of risk factors on AL across EDs) components.Results: Less-educated men (mean AL difference: 0.68, 95% CI 0.57 to 0.79) and women (1.52, 95% CI 1.40 to 1.64) had higher AL scores. DE accounted for 7% and 6% of the gradient in men and women, respectively. In men, combining smoking and alcohol intake, DS accounted for 42% of the gradient (smoking DS coefficient=0.177, 26% of the gradient; alcohol DS coefficient=0.109; 16%, not statistically significant). DS contribution increased to 69% in metabolic markers. DS estimates were consistent across age groups, irrespective of comorbidities and robust to unmeasured confounding. No DS was observed in women.Conclusions: In men, a DS mechanism substantially contributes to the educational class gradient in allostatic load.
KW - Epidemiological methods
KW - Epidemiology of cardiovascular disease
KW - Social inequalities
KW - Stress
UR - http://www.scopus.com/inward/record.url?scp=85091832522&partnerID=8YFLogxK
U2 - 10.1136/jech-2020-213946
DO - 10.1136/jech-2020-213946
M3 - Article
C2 - 32855263
SN - 0143-005X
VL - 74
SP - 1008
EP - 1015
JO - Journal of Epidemiology and Community Health
JF - Journal of Epidemiology and Community Health
IS - 12
ER -
