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. 2023 Jan 28;24(1):72.
doi: 10.1186/s12891-023-06163-w.

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

Maria Lindéus  1 , Aleksandra Turkiewicz  2 , Karin Magnusson  2   3 , Martin Englund  2 , Ali Kiadaliri  2   4
Affiliations

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

Maria Lindéus et al. BMC Musculoskelet Disord. .

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 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.

Keywords: Education; Inequalities; Osteoarthritis surgery; Twin study.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The hazard ratios (HR) per 3 years of education with 95% confidence intervals (CI) for knee and hip OA surgery, for unmatched and matched dizygotic (DZ) and monozygotic (MZ) twins. Models were adjusted for sex, birth cohort, and place of residence at age 18
Fig. 2
Fig. 2
The hazard ratios (HR) per 3 years of education with 95% confidence intervals (CI) for knee and hip OA surgery for male twins born 1951–1980, for matched dizygotic (DZ) and monozygotic (MZ) twins. *Adjusted for body mass index (BMI) at military conscription.**Adjusted for BMI and physical fitness at military conscription. *** Adjusted for BMI, physical fitness at military conscription, birth cohort and place of residence at age 18
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