Differences in the association of cardiovascular risk factors with education: a comparison of Costa Rica (CRELES) and the USA (NHANES)
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2009-08-12Autor
Rehkopf, David H.
Dow, William H.
Rosero Bixby, Luis
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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) (n¼2827) and from the US
National Health and Nutrition Examination Survey
(NHANES) (n¼5607) 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.
External link to the item
10.1136/jech.2009.086926
artículo (arbitrado)--Universidad de Costa Rica. Instituto de Investigaciones en Salud, 2009
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