Abstract P306: Combined Impact Of Income And Education On All-Cause And Cardiovascular Mortality In Men And Women. Prospective Results From The Moli-Sani Study.
Background: Education and income have been reportedly associated with mortality but their combined impact has not been extensively investigated. This study aims at evaluating the combined impact of income and education on overall and cardiovascular mortality in men and women.
Methods: A prospective cohort study on a large sample of individuals (N=20,600, age ≥35) free from cardiovascular or cancer disease randomly enrolled in the Moli-sani study. The cohort was followed-up for overall mortality for 6.8 years (median 4.3 years). Education was considered as low (≤8 years of study) or high (>8 years). Low income group was defined as gross income ≤25,000euros/year while high income category included subjects reporting >25,000euro/years. A four-level variable was constructed to account for the combination of the two measurements: a) low income and low education group (reference group); b) high income and low education; c) low income and high education; d) high income and high education group. Hazard ratios were calculated using Cox-proportional hazard models.
Results: During follow-up, 354 all-cause deaths occurred, 61 from cardiovascular causes. In a fully adjusted model, income, but not education, was significantly associated with a reduction of overall mortality. However, the group having both high income and high education levels showed a reduced risk of 54%(HR=0.46; 95CI: 0.32-0.66) compared to the reference group. Cardiovascular mortality was also reduced by 63%. Analyses stratified by sex showed that the highest combination of income and education had a stronger impact on overall mortality among women (HR=0.27; 95CI: 0.10-0.79) than among men (HR=0.50; 95CI:0.34-0.76).
Conclusions: The combination of high education and high income is associated with a consistent significant reduction of either overall or cardiovascular mortality. The protective effect of the combination is apparent in both genders but is stronger in women than in men.
Author Disclosures: M. Bonaccio: None. A. Di Castelnuovo: None. S. Costanzo: None. M. Persichillo: None. M. Donati: None. G. de Gaetano: None. L. Iacoviello: None. O. Moli-sani Study Investigators: None.
- © 2014 by American Heart Association, Inc.