Intermediation of behavioural and biological risk factors in relation between educational level and mortality among middle-aged Kaunas population

Background. Educational differences have been assessed as explanations for health behaviour and all-cause and CVD mortality. In Lithuania, in the years 2000–2007, mortality increased from 1406 to 1620 deaths / 100000 / year for men and from 654 to 744 deaths / 100000 / year for women (1). Health behaviour may have a potential role in explaining the relation between risk factors and education. The objective of the study was to examine the extent to which health behaviour and biological risk factors can account for relative differences in all-cause and CVD mortality by educational level among middle-aged population. Materials and methods. In 1983–1992, three independent surveys were carried out in random samples of men and women aged 35–64, involving 5403 persons. The mean response rate was 65.1%. Behavioural and biological risk factors were defined within the framework of the WHO MONICA study. A total of 1320 individuals died from all causes and 654 from CVD. The Cox proportional hazards model was used to evaluate the risk of all-cause and CVD mortality. Results. The prognostic value of behavioural factors (risk ratio, RR) in the low-educated group as compared with high for mortality from all causes was RR = 1.36 (95% CI, 1.16–1.59) and from CVD RR = 1.25 (95% CI, 1.35–2.00). The risk of biological factors and all-causes mortality in the low-educated group as compared with high was assessed as RR = 1.54 (95% CI, 1.30–1.83) and from CVD as RR = 1.42 (95% CI, 1.12–1.81). Conclusions. Mortality from all causes and CVD among the middle-aged population was higher in the low-educates group. The population strategy in the low-educated group should be encouraged to reduce the behavioural and biological risk factors.