Author

M.A. Ruiz

Abstract

This thesis investigates the association in Britain between education and coronary heart disease (CHD) in two birth cohort studies and repeated cross-sectional studies from which synthetic cohorts were constructed according to minimum school leaving age in adolescence, with a longitudinal element derived from death registration. The thesis aimed to examine the association between education and the natural history of CHD by assessing various markers of the development of atherosclerosis (i.e., biological risk factors, clinical presentation of myocardial infarction or angina, and death). This work sought to compare a life course model of education and CHD in British adults by periods of birth, which captured the secular changes that have taken place in both education and CHD. Data were drawn from three existing sources to meet these goals: The Health Survey for England (HSE), The MRC National Survey of Health and Development (NSHD) and The National Child Development Study (NCDS). The HSE provided cross-sectional and longitudinal measures of education, CHD risk factors, myocardial infarction/angina, CHD mortality and potential mediators. The NSHD and NCDS provided prospective longitudinal measures of education, CHD risk factors, potential mediators and early life factors. The Relative/Slope Indices of Inequality suggested heightening inequalities in CHD mortality, myocardial infarction/angina and adiposity by particular birth periods in Britain, whereas blood pressure inequalities were found to have diminished. Unclear trends were shown for total cholesterol. Pathway models indicated that working life circumstances, family formation and health behavioural mechanisms explained educational inequalities in CHD risk factors in women. Significant pathways for men were shown for health behaviours only. Moreover, social circumstances and health from early life partly accounted for the direct effect of education on CHD risk. The relationship between education and CHD across different generations of British adults proved to be complex, driven by temporal changes in both education and CHD.