Education Level and Self-Reported Cardiovascular Disease in Norway—The Tromsø Study, 1994–2016

Abstract

Background: Cardiovascular disease (CVD) is a leading source of morbidity and mortality, and research has shown education level to be a risk factor for the disease. The aim of this study was to investigate the association between education level and self-reported CVD in Tromsø, Norway. Methods: This prospective cohort study included 12,400 participants enrolled in the fourth and seventh surveys of the Tromsø Study (Tromsø4 and Tromsø7) in 1994–1995 and 2015–2016, respectively. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Results: For every 1-level increase in education, the age-adjusted risk of self-reported CVD decreased by 9% (OR = 0.91, 95% CI: 0.87–0.96), but after adjustment for covariates, the association was weaker (OR = 0.96, 95% CI: 0.92–1.01). The association was stronger for women (OR = 0.86, 95% CI: 0.79–0.94) than men (OR = 0.91, 95% CI: 0.86–0.97) in age-adjusted models. After adjustment for covariates, the associations for women and men were similarly weak (women: OR = 0.95, 95% CI: 0.87–1.04; men: OR = 0.97, 95% CI: 0.91–1.03). In age-adjusted-models, higher education level was associated with a lower risk of self-reported heart attack (OR = 0.90, 95% CI: 0.84–0.96), but not stroke (OR = 0.97, 95% CI: 0.90–1.05) or angina (OR = 0.98, 95% CI: 0.90–1.07). There were no clear associations observed in the multivariable models for CVD components (heart attack: OR = 0.97, 95% CI: 0.91–1.05; stroke: OR = 1.01, 95% CI: 0.93–1.09; angina: OR = 1.04, 95% CI: 0.95–1.14). Conclusions: Norwegian adults with a higher education level were at lower risk of self-reported CVD. The association was present in both genders, with a lower risk observed in women than men. After accounting for lifestyle factors, there was no clear association between education level and self-reported CVD, likely due to covariates acting as mediators.