Differences in the association of cardiovascular risk factors with education: a comparison of Costa Rica (CRELES) and the USA (NHANES)

• Published in: Journal of epidemiology and community health (1979) Vol. 64; no. 9; pp. 821 - 828
• Main Authors: Rehkopf, David H, Dow, William H, Rosero-Bixby, Luis
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01-09-2010; BMJ Publishing Group; BMJ Publishing Group LTD; BMJ Group
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Blood pressure; Carbohydrates; Cardiovascular diseases; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Cholesterol; Cholesterols; Costa Rica; Cross-Sectional Studies; Diabetes. Impaired glucose tolerance; Diet - adverse effects; Economic development; Education; Educational attainment; Educational Status; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Epidemiology; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Gender differences; General aspects; Health Behavior; Health risk assessment; Health risks; Health Status Indicators; Heart disease; Humans; international collaboration; Longevity; Male; Medical sciences; Men; Middle Aged; Miscellaneous; Mortality; Nutrition Surveys; Obesity; Predisposing factors; Public health. Hygiene; Public health. Hygiene-occupational medicine; Research Report; Risk Factors; Sedentary Lifestyle; Sex Factors; Smoking - adverse effects; social differences; social inequalities; Socioeconomics; Surveys and Questionnaires; United States; Womens health; Central America; United States; North America; America; Costa Rica; Endocrinopathy; Medicine; Association; Education; Diabetes mellitus; Risk factor; Cardiovascular risk; Cardiovascular disease; Comparative study; Public health; Teaching
• ISSN: 0143-005X; 1470-2738
• DOI: 10.1136/jech.2009.086926

Background Despite different levels of economic development, Costa Rica and the USA have similar mortalities among adults. However, in the USA there are substantial differences in mortality by educational attainment, and in Costa Rica there are only minor differences. This contrast motivates an examination of behavioural and biological correlates underlying this difference. Methods The authors used data on adults aged 60 and above from the Costa Rican Longevity and Healthy Ageing Study (CRELES) (n=2827) and from the US National Health and Nutrition Examination Survey (NHANES) (n=5607) to analyse the cross-sectional association between educational level and the following risk factors for cardiovascular disease (CVD): ever smoked, current smoker, sedentary, high saturated fat, high carbohydrates, high calorie diet, obesity, severe obesity, large waist circumference, HDL cholesterol, LDL cholesterol, triglycerides, hemoglobin A1c, fasting glucose, C-reactive protein, systolic blood pressure and BMI. Results There were significantly fewer hazardous levels of risk biomarkers at higher levels of education for more than half (10 out of 17) of the risk factors in the USA, but for less than a third of the outcomes in Costa Rica (five out of 17). Conclusions These results are consistent with the context-specific nature of educational differences in risk factors for CVD and with a non-uniform nature of association of CVD risk factors with education within countries. Our results also demonstrate that social equity in mortality is achieved without uniform equity in all risk factors.