Arrhythmias & electrophysiology
Educational level, mediators, and risk of atrial fibrillation by sex in The Tromsø Study 1994–2016
An erratum to this article was published (Eur J Prev Cardiol, 29 Jul 2026 ↗)
Authors' conclusion
We found protective indirect effect of education on AF through lifestyle and cardiovascular risk factors in women, but not in men. The direct effect in both women and men indicated increased risk by higher education, although non-significant.
Study context
- Population
- Adult women and men, Tromsø Study, 1994–2016
- Participants
- 25,796 women
- Exposure
- Higher vs primary educational level
- Outcome
- Incident atrial fibrillation (AF) (total, natural direct and natural indirect effects of education via BMI, hypertension, smoking, alcohol, physical activity)
- Follow-up
- Median 22 years
Methodological detailscounterfactual-based natural-effects mediation model
- Counterfactual-based natural-effects mediation model
Main finding
As reported in the abstract
Total effect small; significant only in women, upper secondary vs primary education: 19% lower hazard
19%
95% CI 4%, 32%
Natural indirect effect, women, upper secondary vs primary: lower hazard (4%, 17%)
11%
Natural indirect effect, women, university/college <4 years vs primary: lower hazard (7%, 28%)
18%
Natural indirect effect, women, university/college ≥4 years vs primary: lower hazard (12%, 34%)
25%
Observational data: associations, not effects.
Original publication
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