Does lower educational attainment increase the risk of osteoarthritis surgery? a Swedish twin study
Lindéus, Maria LU ; Turkiewicz, Aleksandra LU ; Magnusson, Karin LU ; Englund, Martin LU
and Kiadaliri, Ali
LU
(2023)
In BMC Musculoskeletal Disorders
24(1).
- Abstract
Background: Previous studies have reported an inverse association between educational attainment and different osteoarthritis (OA) outcomes. However, none of the previous studies have accounted for potential confounding by early-life environment and genetics. Thus, we aimed to examine the association between educational attainment and knee and hip OA surgery using twin data. Methods: From the Swedish Twin Registry (STR), we identified dizygotic (DZ) and monozygotic (MZ) twins. All twins in the STR aged 35 to 64 years were followed from January the 1st 1987 or the date they turned 35 years until OA surgery, relocation outside Sweden, death or the end of 2016 (18,784 DZ and 8,657 MZ complete twin pairs). Associations between... (More)
Background: Previous studies have reported an inverse association between educational attainment and different osteoarthritis (OA) outcomes. However, none of the previous studies have accounted for potential confounding by early-life environment and genetics. Thus, we aimed to examine the association between educational attainment and knee and hip OA surgery using twin data. Methods: From the Swedish Twin Registry (STR), we identified dizygotic (DZ) and monozygotic (MZ) twins. All twins in the STR aged 35 to 64 years were followed from January the 1st 1987 or the date they turned 35 years until OA surgery, relocation outside Sweden, death or the end of 2016 (18,784 DZ and 8,657 MZ complete twin pairs). Associations between educational attainment and knee and hip OA surgery were estimated in models matched on twin pairs, using Weibull within-between (WB) shared frailty model. Results: For knee OA surgery, the analysis matched on MZ twins yielded a within-estimate hazard ratio (HR) per 3 years of education, of 1.06 (95% CI: 0.81, 1.32), suggesting no association between the outcome and the individual´s education. Rather, there seemed to be a so called familial effect of education, with a between-pair estimate of HR = 0.71 (95% CI: 0.41, 1.01). For hip OA surgery, the within- and between-pair estimates for MZ twins were 0.92 (95% CI: 0.69, 1.14) and 1.15 (95% CI: 0.87, 1.42), respectively. Conclusions: Our results suggest that the inverse associations between education and knee/hip OA surgery observed in cohort studies are potentially confounded by unobserved familial factors like genetics and/or early life exposures.
(Less)
- author
- Lindéus, Maria
LU
; Turkiewicz, Aleksandra
LU
; Magnusson, Karin
LU
; Englund, Martin
LU
and Kiadaliri, Ali
LU
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Education, Inequalities, Osteoarthritis surgery, Twin study
- in
- BMC Musculoskeletal Disorders
- volume
- 24
- issue
- 1
- article number
- 72
- publisher
- BioMed Central (BMC)
- external identifiers
-
- pmid:36707830
- scopus:85146927934
- ISSN
- 1471-2474
- DOI
- 10.1186/s12891-023-06163-w
- project
- Quasi-experimental study design
- Socioeconomic inequalities in musculoskeletal disorders outcomes and care
- language
- English
- LU publication?
- yes
- id
- 0613e639-8c68-4b90-b2ad-8c44ca39c08f
- date added to LUP
- 2023-02-09 15:15:08
- date last changed
- 2024-06-11 13:14:55
@article{0613e639-8c68-4b90-b2ad-8c44ca39c08f,
abstract = {{<p>Background: Previous studies have reported an inverse association between educational attainment and different osteoarthritis (OA) outcomes. However, none of the previous studies have accounted for potential confounding by early-life environment and genetics. Thus, we aimed to examine the association between educational attainment and knee and hip OA surgery using twin data. Methods: From the Swedish Twin Registry (STR), we identified dizygotic (DZ) and monozygotic (MZ) twins. All twins in the STR aged 35 to 64 years were followed from January the 1<sup>st</sup> 1987 or the date they turned 35 years until OA surgery, relocation outside Sweden, death or the end of 2016 (18,784 DZ and 8,657 MZ complete twin pairs). Associations between educational attainment and knee and hip OA surgery were estimated in models matched on twin pairs, using Weibull within-between (WB) shared frailty model. Results: For knee OA surgery, the analysis matched on MZ twins yielded a within-estimate hazard ratio (HR) per 3 years of education, of 1.06 (95% CI: 0.81, 1.32), suggesting no association between the outcome and the individual´s education. Rather, there seemed to be a so called familial effect of education, with a between-pair estimate of HR = 0.71 (95% CI: 0.41, 1.01). For hip OA surgery, the within- and between-pair estimates for MZ twins were 0.92 (95% CI: 0.69, 1.14) and 1.15 (95% CI: 0.87, 1.42), respectively. Conclusions: Our results suggest that the inverse associations between education and knee/hip OA surgery observed in cohort studies are potentially confounded by unobserved familial factors like genetics and/or early life exposures.</p>}},
author = {{Lindéus, Maria and Turkiewicz, Aleksandra and Magnusson, Karin and Englund, Martin and Kiadaliri, Ali}},
issn = {{1471-2474}},
keywords = {{Education; Inequalities; Osteoarthritis surgery; Twin study}},
language = {{eng}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{BMC Musculoskeletal Disorders}},
title = {{Does lower educational attainment increase the risk of osteoarthritis surgery? a Swedish twin study}},
url = {{http://dx.doi.org/10.1186/s12891-023-06163-w}},
doi = {{10.1186/s12891-023-06163-w}},
volume = {{24}},
year = {{2023}},
}