Does lower educational attainment increase the risk of osteoarthritis surgery? a Swedish twin study

BMC Musculoskeletal Disorders

Research

Maria Lindéus¹  Aleksandra Turkiewicz¹  Martin Englund¹  Ali Kiadaliri²  Karin Magnusson³ 

[1] Faculty of Medicine, Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, OrthopaedicsLund, Sweden;Faculty of Medicine, Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, OrthopaedicsLund, Sweden;Centre for Economic Demography, Lund University, Lund, Sweden;Faculty of Medicine, Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, OrthopaedicsLund, Sweden;Norwegian Institute of Public Health, Cluster for Health Services Research, Oslo, Norway;

关键词: Twin study;    Osteoarthritis surgery;    Inequalities;    Education;   

DOI  :  10.1186/s12891-023-06163-w

 received in 2022-08-17, accepted in 2023-01-16,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPrevious 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.MethodsFrom 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.ResultsFor 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.ConclusionsOur 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.

【 授权许可】

CC BY   
© The Author(s) 2023

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