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@ARTICLE{Fiorito:181641,
      author       = {G. Fiorito and S. Pedron and C. Ochoa-Rosales and C.
                      McCrory and S. Polidoro and Y. Zhang$^*$ and P.-A. Dugué
                      and S. Ratliff and W. N. Zhao and G. J. McKay and G. Costa
                      and M. G. Solinas and K. M. Harris and R. Tumino and S.
                      Grioni and F. Ricceri and S. Panico and H. Brenner$^*$ and
                      L. Schwettmann and M. Waldenberger and P. R. Matias-Garcia
                      and A. Peters and A. Hodge and G. G. Giles and L. L. Schmitz
                      and M. Levine and J. A. Smith and Y. Liu and F. Kee and I.
                      S. Young and B. McGuinness and A. J. McKnight and J. van
                      Meurs and T. Voortman and R. A. Kenny and P. Vineis and C.
                      Carmeli},
      collaboration = {L. consortium},
      title        = {{T}he {R}ole of {E}pigenetic {C}locks in {E}xplaining
                      {E}ducational {I}nequalities in {M}ortality: {A}
                      {M}ulticohort {S}tudy and {M}eta-analysis.},
      journal      = {The journals of gerontology / A},
      volume       = {77},
      number       = {9},
      issn         = {1079-5006},
      address      = {Oxford [u.a.]},
      publisher    = {Oxford Univ. Pr.},
      reportid     = {DKFZ-2022-02135},
      pages        = {1750 - 1759},
      year         = {2022},
      abstract     = {Educational inequalities in all-cause mortality have been
                      observed for decades. However, the underlying biological
                      mechanisms are not well known. We aimed to assess the role
                      of DNA methylation changes in blood captured by epigenetic
                      clocks in explaining these inequalities. Data were from 8
                      prospective population-based cohort studies, representing 13
                      021 participants. First, educational inequalities and their
                      portion explained by Horvath DNAmAge, Hannum DNAmAge,
                      DNAmPhenoAge, and DNAmGrimAge epigenetic clocks were
                      assessed in each cohort via counterfactual-based mediation
                      models, on both absolute (hazard difference) and relative
                      (hazard ratio) scales, and by sex. Second, estimates from
                      each cohort were pooled through a random effect
                      meta-analysis model. Men with low education had excess
                      mortality from all causes of 57 deaths per 10 000
                      person-years $(95\%$ confidence interval [CI]: 38, 76)
                      compared with their more advantaged counterparts. For women,
                      the excess mortality was 4 deaths per 10 000 person-years
                      $(95\%$ CI: -11, 19). On the relative scale, educational
                      inequalities corresponded to hazard ratios of 1.33 $(95\%$
                      CI: 1.12, 1.57) for men and 1.15 $(95\%$ CI: 0.96, 1.37) for
                      women. DNAmGrimAge accounted for the largest proportion,
                      approximately $50\%,$ of the educational inequalities for
                      men, while the proportion was negligible for women. Most of
                      this mediation was explained by differential effects of
                      unhealthy lifestyles and morbidities of the World Health
                      Organization (WHO) risk factors for premature mortality.
                      These results support DNA methylation-based epigenetic aging
                      as a signature of educational inequalities in life
                      expectancy emphasizing the need for policies to address the
                      unequal social distribution of these WHO risk factors.},
      keywords     = {Educational Status / Epigenesis, Genetic / Epigenomics /
                      Female / Humans / Male / Mortality / Prospective Studies /
                      Risk Factors / Socioeconomic Factors / Biomarkers (Other) /
                      DNA methylation (Other) / Longevity (Other) / Social
                      inequalities (Other)},
      cin          = {C070},
      ddc          = {570},
      cid          = {I:(DE-He78)C070-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:35172329},
      doi          = {10.1093/gerona/glac041},
      url          = {https://inrepo02.dkfz.de/record/181641},
}