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Mental health as a mediator of the association between educational inequality and cardiovascular disease: a mendelian randomization study

Jones, Daniel P., Wootton, Robyn E., Gill, Dipender, Carter, Alice R., Gunnell, David, Munafo, Marcus R. and Sallis, Hannah M. 2021. Mental health as a mediator of the association between educational inequality and cardiovascular disease: a mendelian randomization study. Journal of the American Heart Association Cardiovascular and Cerebrovascular Disease 10 (17) , e019340. 10.1161/JAHA.120.019340

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Background: Education is inversely associated with cardiovascular disease (CVD). Several mediators of this have been established; however, a proportion of the protective effect remains unaccounted for. Mental health is a proposed mediator, but current evidence is mixed and subject to bias from confounding factors and reverse causation. Mendelian randomization is an instrumental variable technique that uses genetic proxies for exposures and mediators to reduce such bias. Methods and Results: We performed logistic regression and 2‐step Mendelian randomization analyses using UK Biobank data and genetic summary statistics to investigate whether educational attainment affects risk of mental health disorders. We then performed mediation analyses to explore whether mental health disorders mediate the association between educational attainment and cardiovascular risk. Higher levels of educational attainment were associated with reduced depression, anxiety, and CVD in observational analyses (odds ratio [OR], 0.79 [95% CI, 0.77–0.81], 0.76 [95% CI, 0.73–0.79], and 0.75 [95% CI, 0.74–0.76], respectively), and Mendelian randomization analyses provided evidence of causality (OR, 0.72 [95% CI, 0.67–0.77], 0.50 [95% CI, 0.42–0.59], and 0.62 [95% CI, 0.58–0.66], respectively). Both anxiety and depression were associated with CVD in observational analyses (OR, 1.63 [95% CI, 1.49–1.79] and 1.70 [95% CI, 1.59–1.82], respectively) but only depression showed evidence of causality in the Mendelian randomization analyses (OR, 1.09; 95% CI, 1.03–1.15). An estimated 2% of the total protective effect of education on CVD was mediated by depression. Conclusions:Higher levels of educational attainment protect against mental health disorders, and reduced depression accounts for a small proportion of the total protective effect of education on CVD.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Additional Information: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Publisher: American Heart Association
ISSN: 2047-9980
Funders: MRC, NIHR, Wellcome
Date of First Compliant Deposit: 23 November 2021
Date of Acceptance: 26 April 2021
Last Modified: 23 Nov 2021 13:00

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