The impact of education inequality on rheumatoid arthritis risk is mediated by smoking and body mass index: Mendelian randomization study

Rheumatology ◽  
2021 ◽  
Author(s):  
Sizheng Steven Zhao ◽  
Michael V Holmes ◽  
Jie Zheng ◽  
Eleanor Sanderson ◽  
Alice R Carter
Keyword(s):  
Risk Factors ◽  
Educational Attainment ◽  
Mendelian Randomization ◽  
Total Effect ◽  
Genome Wide Association Studies ◽  
Rheumatoid Arthritis Risk ◽  
Smoking Exposure ◽  
Higher Educational ◽  
Higher Educational Attainment ◽  
The Impact

Abstract Objective To estimate the causal relationship between educational attainment—as a proxy for socioeconomic inequality—and risk of RA, and quantify the roles of smoking and BMI as potential mediators. Methods Using the largest genome-wide association studies (GWAS), we performed a two-sample Mendelian randomization (MR) study of genetically predicted educational attainment (instrumented using 1265 variants from 766 345 individuals) and RA (14 361 cases, 43 923 controls). We used two-step MR to quantify the proportion of education’s effect on RA mediated by smoking exposure (as a composite index capturing duration, heaviness and cessation, using 124 variants from 462 690 individuals) and BMI (517 variants, 681 275 individuals), and multivariable MR to estimate proportion mediated by both factors combined. Results Each S.d. increase in educational attainment (4.2 years of schooling) was protective of RA (odds ratio 0.37; 95% CI: 0.31, 0.44). Higher educational attainment was also protective for smoking exposure (β = −0.25 S.d.; 95% CI: −0.26, −0.23) and BMI [β = −0.27 S.d. (∼1.3 kg/m2); 95% CI: −0.31, −0.24]. Smoking mediated 24% (95% CI: 13%, 35%) and BMI 17% (95% CI: 11%, 23%) of the total effect of education on RA. Combined, the two risk factors explained 47% (95% CI: 11%, 82%) of the total effect. Conclusion Higher educational attainment has a protective effect on RA risk. Interventions to reduce smoking and excess adiposity at a population level may reduce this risk, but a large proportion of education’s effect on RA remains unexplained. Further research into other risk factors that act as potentially modifiable mediators are required.

scholarly journals The impact of education inequality on rheumatoid arthritis risk is mediated by smoking and body mass index: mendelian randomization study

2021 ◽  
Author(s):  
Sizheng Steven Zhao ◽  
Michael V Holmes ◽  
Jie Zheng ◽  
Eleanor Sanderson ◽  
Alice R Carter
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Educational Attainment ◽  
Body Mass ◽  
Mendelian Randomization ◽  
Total Effect ◽  
Smoking Exposure ◽  
Higher Educational ◽  
Higher Educational Attainment ◽  
The Impact

Objective. To estimate the causal relationship between educational attainment - as a proxy for socioeconomic inequality - and risk of RA and quantify the roles of cigarette smoking and body mass index (BMI) as potential mediators. Methods. Using the largest genome-wide association studies (GWAS), we performed a two-sample Mendelian randomization (MR) study of genetically predicted educational attainment (instrumented using 1265 variants from GWAS of 766,345 individuals) and RA (14,361 cases, 43,923 controls). We used two-step MR to quantify the proportion of education's effect on RA mediated by smoking exposure (as a composite index capturing duration, heaviness and cessation, using 124 variants from 462,690 individuals) and BMI (517 variants, 681,275 individuals), and multivariable MR to estimate proportion mediated by both factors combined. Results. Each standard deviation (SD) increase in educational attainment (4.2 years of schooling) was protective of RA (OR 0.37; 95%CI 0.31, 0.44). Higher educational attainment was also protective for smoking exposure (b= -0.25 SD; 95%CI -0.26, -0.23) and BMI (b= -0.27 SD (~1.3kg/m2); 95%CI -0.31, -0.24). Smoking mediated 24% (95%CI 13%, 35%) and BMI 17% (95%CI 11%, 23%) of the total effect of education on RA. Combined, the two risk factors explained 47% (95%CI 11%, 82%) of the total effect. Conclusion. Higher educational attainment has a protective effect on RA risk. Interventions to reduce smoking and excess adiposity at a population level may reduce this risk, but a large proportion of education's effect on RA remains unexplained. Further research into other risk factors that act as potentially modifiable mediators are required.

scholarly journals Causal Associations Between Educational Attainment and 14 Urological and Reproductive Health Outcomes: A Mendelian Randomization Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Menghua Wang ◽  
Zhongyu Jian ◽  
Xiaoshuai Gao ◽  
Chi Yuan ◽  
Xi Jin ◽  
...  
Keyword(s):  
Reproductive Health ◽  
Educational Attainment ◽  
Health Outcomes ◽  
Lower Risk ◽  
Mendelian Randomization ◽  
Association Studies ◽  
Causal Effects ◽  
Genome Wide Association Studies ◽  
Bonferroni Correction ◽  
The Impact

Background: The impact of educational attainment (EA) on multiple urological and reproductive health outcomes has been explored in observational studies. Here we used Mendelian randomization (MR) to investigate whether EA has causal effects on 14 urological and reproductive health outcomes.Methods: We obtained summary statistics for EA and 14 urological and reproductive health outcomes from genome-wide association studies (GWAS). MR analyses were applied to explore the potential causal association between EA and them. Inverse variance weighted was the primary analytical method.Results: Genetically predicted one standard deviation (SD) increase in EA was causally associated with a higher risk of prostate cancer [odds ratio (OR) 1.14, 95% confidence interval (CI) 1.05–1.25, P = 0.003] and a reduced risk of kidney stone (OR 0.73, 95% CI 0.62–0.87, P < 0.001) and cystitis (OR 0.76, 95% CI 0.67–0.86, P < 0.001) after Bonferroni correction. EA was also suggestively correlated with a lower risk of prostatitis (OR 0.76, 95% CI 0.59–0.98, P = 0.037) and incontinence (OR 0.64, 95% CI 0.47–0.87, P = 0.004). For the bioavailable testosterone levels and infertility, sex-specific associations were observed, with genetically determined increased EA being related to higher levels of testosterone in men (β 0.07, 95% CI 0.04–0.10, P < 0.001), lower levels of testosterone in women (β −0.13, 95% CI−0.16 to−0.11, P < 0.001), and a lower risk of infertility in women (OR 0.74, 95% CI 0.64–0.86, P < 0.001) but was not related to male infertility (OR 0.79, 95% CI 0.52–1.20, P = 0.269) after Bonferroni correction. For bladder cancer, kidney cancer, testicular cancer, benign prostatic hyperplasia, and erectile dysfunction, no causal effects were observed.Conclusions: EA plays a vital role in urological diseases, especially in non-oncological outcomes and reproductive health. These findings should be verified in further studies when GWAS data are sufficient.

scholarly journals The identification of established modifiable mid-life risk factors for cardiovascular disease which contribute to cognitive decline: Korean Longitudinal Study of Aging (KLoSA)

2021 ◽  
Author(s):  
Yebeen Ysabelle Boo ◽  
Otto-Emil Jutila ◽  
Meghan A. Cupp ◽  
Logan Manikam ◽  
Sung-Il Cho
Keyword(s):  
Risk Factors ◽  
Longitudinal Study ◽  
Educational Attainment ◽  
Protective Factors ◽  
Cognitive Decline ◽  
Cognitive Ability ◽  
Protective Factor ◽  
Regular Exercise ◽  
Higher Educational ◽  
Higher Educational Attainment

Abstract Introduction We explored how different chronic diseases, risk factors, and protective factors highly associated with cardiovascular diseases (CVD) are associated with dementia or Mild Cognitive Impairment (MCI) in Korean elders, with a focus on those that manifest in mid-life. Methods A CVD-free cohort (n = 4289) from the Korean Longitudinal Study of Aging was selected to perform Cox mixed-effects proportional hazard regressions. Eighteen control variables with strong associations to CVD were chosen as explanatory variables, and Mini-Mental State Examination (MMSE) score cut-off for dementia and MCI were used as outcome variables. Results The statistically significant (P < 0.05) adverse factors that contribute in developing dementia were age (aHR 1.07, 1.05–1.09), Centre for Epidemiological Studies Depression Scale (CESD-10) (aHR 1.17, 1.12–1.23), diagnosis with cerebrovascular disease (aHR 3.73, 1.81–7.66), living with diabetes (aHR 2.30, 1.22–4.35), and living with high blood pressure (HBP) (aHR 2.05, 1.09–3.87). In contrast, the statistically significant protective factors against developing dementia were current alcohol consumption (aHR 0.67, 0.46–0.99), higher educational attainment (aHR 0.36, 0.26–0.56), and regular exercise (aHR 0.37, 0.26–0.51). The factors with a statistically significant adverse association with progression to MCI were age (aHR 1.02, 1.01–1.03) and CESD-10 (aHR 1.17, 1.14–1.19). In contrast, the statistically significant protective factors against developing MCI were BMI (aHR 0.96, 0.94–0.98), higher educational attainment (aHR 0.33, 0.26–0.43), and regular exercise (aHR 0.83, 0.74–0.92). Conclusion In lieu of the protective factor of MCI and dementia, implementing regular exercise routine well before mid-life and cognitive decline is significant, with adjustments made for those suffering from health conditions, so they can continue exercising despite their morbidity. Further attention in diabetes care and management is needed for patients who already show decline in cognitive ability as it is likely that their MCI impacts their ability to manage their existing chronic conditions, which may adversely affect their cognitive ability furthermore.

scholarly journals Investigating causality in associations between education and smoking: A two-sample Mendelian randomization study

2017 ◽  
Author(s):  
Suzanne H. Gage ◽  
Jack Bowden ◽  
George Davey Smith ◽  
Marcus R. Munafo
Keyword(s):  
Smoking Cessation ◽  
Educational Attainment ◽  
Mendelian Randomization ◽  
Association Studies ◽  
Smoking Initiation ◽  
Self Report ◽  
Genome Wide Association Studies ◽  
Summary Statistics ◽  
Increased Risk ◽  
Higher Educational Attainment

AbstractBackgroundLower educational attainment is associated with increased rates of smoking, but ascertaining causality is challenging. We used two-sample Mendelian randomization (MR) analyses of summary statistics to examine whether educational attainment is causally related to smoking.Methods and FindingsWe used summary statistics from genome-wide association studies of educational attainment and a range of smoking phenotypes (smoking initiation, cigarettes per day, cotinine levels and smoking cessation). Various complementary MR techniques (inverse-variance weighted regression, MR Egger, weighted-median regression) were used to test the robustness of our results. We found broadly consistent evidence across these techniques that higher educational attainment leads to reduced likelihood of smoking initiation, reduced heaviness of smoking among smokers (as measured via self-report and cotinine levels), and greater likelihood of smoking cessation among smokers.ConclusionsOur findings indicate a causal association between low educational attainment and increased risk of smoking, and may explain the observational associations between educational attainment and adverse health outcomes such as risk of coronary heart disease.

scholarly journals The Impact of the Hazard Correlation between Risk Factors and Diabetes

2018 ◽  
Vol 15 (10) ◽  
pp. 2213
Author(s):  
Huan-Cheng Chang ◽  
Mei-Chin Wang ◽  
Meng-Hao Chen ◽  
Hung-Chang Liao ◽  
Ya-huei Wang
Keyword(s):  
Risk Factors ◽  
Body Fat ◽  
Environmental Variables ◽  
Demographic Variables ◽  
Second Hand Smoke ◽  
Male Population ◽  
Educational Levels ◽  
Healthy Behavior ◽  
Higher Educational ◽  
The Impact

This study examined the occurrence of diabetes and sustainable risk factors in residents aged 30 and above of a community in Taoyuan County, Taiwan. The main purpose of this research was to explore the correlations between related variables and the occurrence of diabetes. The demographic variables, health exam variables, healthy behavior variables, and environmental variables had obvious impacts on the risk of diabetes. As age increased, the risk of developing the disease also increased; higher educational levels lowered risk, while unemployment raised it. Also, analysis of the health exam variables showed that abnormal BMIs, waist-hip ratios, and body fat percentages had significant impacts on individuals’ risk of diabetes. Moreover, it was found that smoking affected the risk of having diabetes: smokers, particularly male smokers, had a relatively higher risk of developing the disease. Lastly, the results showed that exposure to second-hand smoke did not have a significant effect on the diabetes proportion in the male population. However, a significantly higher proportion of females who had been exposed to second-hand smoke had diabetes.

scholarly journals Evaluating the effects of alcohol and tobacco use on cardiovascular disease using multivariable Mendelian randomization

2019 ◽  
Author(s):  
Daniel B. Rosoff ◽  
George Davey Smith ◽  
Nehal Mehta ◽  
Toni-Kim Clarke ◽  
Falk W. Lohoff
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Alcohol Use ◽  
Tobacco Use ◽  
Mendelian Randomization ◽  
Association Studies ◽  
Density Lipoprotein ◽  
Genome Wide Association Studies ◽  
Cvd Risk ◽  
Increased Risk

ABSTRACTAlcohol and tobacco use, two major modifiable risk factors for cardiovascular disease (CVD), are often consumed together. Using large publicly available genome-wide association studies (results from > 940,000 participants), we conducted two-sample multivariable Mendelian randomization (MR) to simultaneously assess the independent effects of alcohol and tobacco use on CVD risk factors and events. We found genetic instruments associated with increased alcohol use, controlling for tobacco use, associated with increased high-density-lipoprotein-cholesterol (HDL-C), decreased triglycerides, but not with coronary heart disease (CHD), myocardial infarction (MI), nor stroke; and instruments for increased tobacco use, controlling for alcohol use, associated with decreased HDL-C, increased triglycerides, and increased risk of CHD and MI. Exploratory analysis found associations with HDL-C, LDL-C, and intermediate-density-lipoprotein metabolites. Consistency of results across complementary methods accommodating different MR assumptions strengthened causal inference, providing strong genetic evidence for the causal effects of modifiable lifestyle risk factors on CVD risk.

Abstract 031: Socioeconomic Trajectories Across the Life Course and Risk of All-cause and Cardiovascular Mortality: Prospective Findings From the Moli-sani Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Marialaura Bonaccio ◽  
Augusto Di Castelnuovo ◽  
Simona Costanzo ◽  
Mariarosaria Persichillo ◽  
Chiara Cerletti ◽  
...  
Keyword(s):  
General Population ◽  
Educational Attainment ◽  
Life Course ◽  
Lower Risk ◽  
Cox Regression ◽  
Low Ses ◽  
Increased Risk ◽  
Higher Educational ◽  
Higher Educational Attainment ◽  
The Life Course

Introduction: A life course approach has been suggested as the most appropriated to establish the actual impact of socioeconomic status (SES) on health outcomes. Hypothesis: We assessed the hypothesis that SES trajectories from childhood to adulthood are useful to better evaluate the role of SES towards mortality risk in a large general population-based cohort. Methods: Longitudinal analysis on 22,194 subjects recruited in the general population of the Moli-sani study, Italy (2005-2010). Educational attainment (low/high) and SES in adulthood (measured by a score including occupational social class, housing and overcrowding, and dichotomized as low/high) were used to define four possible trajectories both in low and high SES in childhood (age of 8). Hazard ratios (HR) with 95% confidence intervals (95%CI) were calculated by multivariable Cox regression and competing risk models. Results: Over a median follow-up of 8.3 years (182,924 person-years), 1155 all-cause, of which 414 cardiovascular (CVD), deaths were ascertained. In the group with low SES in childhood, as opposed to those stably low (low education and low SES in adulthood), an upward in both educational attainment and material factors in adulthood was associated with lower risk of both all-cause (HR=0.64; 95%CI 0.52-0.79; Table) and CVD mortality (HR=0.62; 0.43-0.88), respectively. Subjects with high childhood SES experienced an increased risk of total and CVD death in absence of higher educational attainment despite a higher SES in adulthood (HR=1.47; 1.04-2.07 and HR=1.75;1.00-3.05, respectively) as compared to the group with both high education and high SES in adulthood. Conclusions: In conclusion, for individuals with low SES in childhood, an upward of both educational attainment and material factors over the life course is associated with lower risk of total and CVD death. In advantaged groups in childhood, lack of a higher educational attainment, rather than material factors, over the life course appears to be unfavourably associated with survival.

scholarly journals Health behaviours reported by adults with congenital heart disease across 15 countries

2019 ◽  
Vol 27 (10) ◽  
pp. 1077-1087 ◽  
Author(s):  
Christina E Holbein ◽  
James Peugh ◽  
Gruschen R Veldtman ◽  
Silke Apers ◽  
Koen Luyckx ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Educational Attainment ◽  
Health Behaviour ◽  
Congenital Heart ◽  
Health Behaviours ◽  
Self Report ◽  
Optimal Health ◽  
Higher Educational ◽  
Higher Educational Attainment

Background Health behaviours are essential to maintain optimal health and reduce the risk of cardiovascular complications in adults with congenital heart disease. This study aimed to describe health behaviours in adults with congenital heart disease in 15 countries and to identify patient characteristics associated with optimal health behaviours in the international sample. Design This was a cross-sectional observational study. Methods Adults with congenital heart disease ( n = 4028, median age = 32 years, interquartile range 25–42 years) completed self-report measures as part of the Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study (APPROACH-IS). Participants reported on seven health behaviours using the Health Behaviors Scale-Congenital Heart Disease. Demographic and medical characteristics were assessed via medical chart review and self-report. Multivariate path analyses with inverse sampling weights were used to investigate study aims. Results Health behaviour rates for the full sample were 10% binge drinking, 12% cigarette smoking, 6% recreational drug use, 72% annual dental visit, 69% twice daily tooth brushing, 27% daily dental flossing and 43% sport participation. Pairwise comparisons indicated that rates differed between countries. Rates of substance use behaviours were higher in younger, male participants. Optimal dental health behaviours were more common among older, female participants with higher educational attainment while sports participation was more frequent among participants who were younger, male, married, employed/students, with higher educational attainment, less complex anatomical defects and better functional status. Conclusions Health behaviour rates vary by country. Predictors of health behaviours may reflect larger geographic trends. Our findings have implications for the development and implementation of programmes for the assessment and promotion of optimal health behaviours in adults with congenital heart disease.

Sign in / Sign up

Export Citation Format

Share Document