Decomposing the educational gradient in allostatic load across European populations. What matters the most: differentials in exposure or in susceptibility?. Issue 12 (27th August 2020)

• Record Type: Journal Article
• Authors: Veronesi, Giovanni; Kee, Frank; Hicks, Blanaid; Forrest, Hannah; Tunstall-Pedoe, Hugh; Kuulasmaa, Kari; Sans, Susana; Salomaa, Veikko; Thorand, Barbara; Di Castelnuovo, Augusto; Soderberg, Stefan; Cesana, Giancarlo; Bobak, Martin; De Ponti, Roberto; Iacoviello, Licia; Palmieri, Luigi; Zeller, Tanja; Blankenberg, Stefan; Ferrario, Marco M
• Is Part Of: Journal of epidemiology and community health. Volume 74:Issue 12(2020)
• Page Start: 1008
• Page End: 1015
• Publication Date: 2020-08-27
• Subjects: Social inequalities -- Epidemiological methods -- Epidemiology of cardiovascular disease -- Stress; Public health -- Periodicals; Epidemiology -- Periodicals; 614.4
• DOI: 10.1136/jech-2020-213946
• Languages: English
• ISSNs: 0143-005X

Abstract

Abstract : 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.