title: Educational level of spouses and risk of mortality: the WHO Kaunas-Rotterdam Intervention Study (KRIS).
abstract: BACKGROUND
  A 9.5-year follow-up of the Kaunas-Rotterdam Intervention Study (KRIS) provided the opportunity of investigating whether the educational level of wives was associated with their husbands' risk of mortality and coronary heart disease (CHD), independently of the educational level of the husbands themselves.
  
  
  METHODS
  The data represent populations consisting of 2452 Lithuanian men and 3365 Dutch men. These men were extensively screened for cardiovascular risk factors in the period 1972-1974. During the follow-up 303 Kaunasians and 350 Rotterdammers died. We used the Cox proportional hazards and the logistic regression models to analyse the data.
  
  
  RESULTS
  We found that men whose spouses had little education apparently had an increased risk of all-cause mortality, even when their own educational level was taken into account. The relative risks (RR) were 1.57 in Kaunas and 2.15 in Rotterdam. The results for fatal and non-fatal myocardial infarctions were compatible with this finding, especially in Rotterdam. The prevalence of smoking was higher among men whose wives had primary schooling only. Nonetheless, adjusting the effect of the wife's educational level on her husband's mortality risk for all coronary risk factors in the husband only partially explained the association.
  
  
  CONCLUSIONS
  The spouse's educational level appears to have independent effects on a man's risk of mortality in both eastern and western European communities. The results strongly suggest that including characteristics of the socioeconomic status of an individual's spouse would improve studies of socioeconomic differences in health.
authors.affiliation: Department of Medical Psychology, University of Limburg, Maastricht, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Bosma
authors.forename: A
authors.initials: A
authors.lastname: Appels
authors.forename: F
authors.initials: F
authors.lastname: Sturmans
authors.forename: V
authors.initials: V
authors.lastname: Grabauskas
authors.forename: A
authors.initials: A
authors.lastname: Gostautas
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality; D003327:Coronary Disease / Q000401:mortality; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008097:Lithuania; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000401:mortality; D009369:Neoplasms / Q000401:mortality; D009426:Netherlands; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D018454:Spouses; D013997:Time Factors; D014944:World Health Organization