Low educational attainment is associated with higher all-cause and cardiovascular mortality in the United States adult population
Introduction: Educational attainment is an important social determinant of health (SDOH) for cardiovascular disease (CVD). However, the association between educational attainment and all-cause and CVD mortality has not been longitudinally evaluated on a population-level in the US, especially in indi...
| Autores: | , , , , , , , , , , , , , , , , , |
|---|---|
| Tipo de documento: | artigo |
| Estado: | Versão publicada |
| Data de publicação: | 2023 |
| País: | España |
| Recursos: | Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) |
| Repositório: | Recercat. Dipósit de la Recerca de Catalunya |
| OAI Identifier: | oai:recercat.cat:10230/59263 |
| Acesso em linha: | http://hdl.handle.net/10230/59263 http://dx.doi.org/10.1186/s12889-023-15621-y |
| Access Level: | Acceso aberto |
| Palavra-chave: | All-cause mortality Cardiovascular disease Educational attainment Health disparities |
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oai:recercat.cat:10230/59263 |
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Low educational attainment is associated with higher all-cause and cardiovascular mortality in the United States adult population |
| title |
Low educational attainment is associated with higher all-cause and cardiovascular mortality in the United States adult population |
| spellingShingle |
Low educational attainment is associated with higher all-cause and cardiovascular mortality in the United States adult population Khan, Najah All-cause mortality Cardiovascular disease Educational attainment Health disparities |
| title_short |
Low educational attainment is associated with higher all-cause and cardiovascular mortality in the United States adult population |
| title_full |
Low educational attainment is associated with higher all-cause and cardiovascular mortality in the United States adult population |
| title_fullStr |
Low educational attainment is associated with higher all-cause and cardiovascular mortality in the United States adult population |
| title_full_unstemmed |
Low educational attainment is associated with higher all-cause and cardiovascular mortality in the United States adult population |
| title_sort |
Low educational attainment is associated with higher all-cause and cardiovascular mortality in the United States adult population |
| dc.creator.none.fl_str_mv |
Khan, Najah Javed, Zulqarnain Acquah, Isaac Hagan, Kobina Khan, Madiha Valero-Elizondo, Javier Chang, Ryan Javed, Umair Taha, Mohamad B. Blaha, Michael J. Virani, Salim S. Sharma, Garima Blankstein, Ron Gulati, Martha Mossialos, Elias Hyder, Adnan A. Cainzos-Achirica, Miguel Nasir, Khurram |
| author |
Khan, Najah |
| author_facet |
Khan, Najah Javed, Zulqarnain Acquah, Isaac Hagan, Kobina Khan, Madiha Valero-Elizondo, Javier Chang, Ryan Javed, Umair Taha, Mohamad B. Blaha, Michael J. Virani, Salim S. Sharma, Garima Blankstein, Ron Gulati, Martha Mossialos, Elias Hyder, Adnan A. Cainzos-Achirica, Miguel Nasir, Khurram |
| author_role |
author |
| author2 |
Javed, Zulqarnain Acquah, Isaac Hagan, Kobina Khan, Madiha Valero-Elizondo, Javier Chang, Ryan Javed, Umair Taha, Mohamad B. Blaha, Michael J. Virani, Salim S. Sharma, Garima Blankstein, Ron Gulati, Martha Mossialos, Elias Hyder, Adnan A. Cainzos-Achirica, Miguel Nasir, Khurram |
| author2_role |
author author author author author author author author author author author author author author author author author |
| dc.subject.none.fl_str_mv |
All-cause mortality Cardiovascular disease Educational attainment Health disparities |
| topic |
All-cause mortality Cardiovascular disease Educational attainment Health disparities |
| description |
Introduction: Educational attainment is an important social determinant of health (SDOH) for cardiovascular disease (CVD). However, the association between educational attainment and all-cause and CVD mortality has not been longitudinally evaluated on a population-level in the US, especially in individuals with atherosclerotic cardiovascular disease (ASCVD). In this nationally representative study, we assessed the association between educational attainment and the risk of all-cause and cardiovascular (CVD) mortality in the general adult population and in adults with ASCVD in the US. Methods: We used data from the 2006-2014 National Death Index-linked National Health Interview Survey for adults ≥ 18 years. We generated age-adjusted mortality rates (AAMR) by levels of educational attainment (< high school (HS), HS/General Education Development (GED), some college, and ≥ College) in the overall population and in adults with ASCVD. Cox proportional hazards models were used to examine the multivariable-adjusted associations between educational attainment and all-cause and CVD mortality. Results: The sample comprised 210,853 participants (mean age 46.3), representing ~ 189 million adults annually, of which 8% had ASCVD. Overall, 14.7%, 27%, 20.3%, and 38% of the population had educational attainment < HS, HS/GED, Some College, and ≥ College, respectively. During a median follow-up of 4.5 years, all-cause age-adjusted mortality rates were 400.6 vs. 208.6 and 1446.7 vs. 984.0 for the total and ASCVD populations for < HS vs ≥ College education, respectively. CVD age adjusted mortality rates were 82.1 vs. 38.7 and 456.4 vs 279.5 for the total and ASCVD populations for < HS vs ≥ College education, respectively. In models adjusting for demographics and SDOH, < HS (reference = ≥ College) was associated with 40-50% increased risk of mortality in the total population and 20-40% increased risk of mortality in the ASCVD population, for both all-cause and CVD mortality. Further adjustment for traditional risk factors attenuated the associations but remained statistically significant for < HS in the overall population. Similar trends were seen across sociodemographic subgroups including age, sex, race/ethnicity, income, and insurance status. Conclusions: Lower educational attainment is independently associated with increased risk of all-cause and CVD mortality in both the total and ASCVD populations, with the highest risk observed for individuals with < HS education. Future efforts to understand persistent disparities in CVD and all-cause mortality should pay close attention to the role of education, and include educational attainment as an independent predictor in mortality risk prediction algorithms. |
| publishDate |
2023 |
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2023 2024 2024 |
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info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
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article |
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publishedVersion |
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http://hdl.handle.net/10230/59263 http://dx.doi.org/10.1186/s12889-023-15621-y |
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http://hdl.handle.net/10230/59263 http://dx.doi.org/10.1186/s12889-023-15621-y |
| dc.language.none.fl_str_mv |
Inglés |
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Inglés |
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BMC Public Health. 2023 May 16;23(1):900 |
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http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess |
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http://creativecommons.org/licenses/by/4.0/ |
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openAccess |
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application/pdf application/pdf |
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BioMed Central |
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BioMed Central |
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reponame:Recercat. Dipósit de la Recerca de Catalunya instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) |
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Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) |
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Recercat. Dipósit de la Recerca de Catalunya |
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Recercat. Dipósit de la Recerca de Catalunya |
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Low educational attainment is associated with higher all-cause and cardiovascular mortality in the United States adult populationKhan, NajahJaved, ZulqarnainAcquah, IsaacHagan, KobinaKhan, MadihaValero-Elizondo, JavierChang, RyanJaved, UmairTaha, Mohamad B.Blaha, Michael J.Virani, Salim S.Sharma, GarimaBlankstein, RonGulati, MarthaMossialos, EliasHyder, Adnan A.Cainzos-Achirica, MiguelNasir, KhurramAll-cause mortalityCardiovascular diseaseEducational attainmentHealth disparitiesIntroduction: Educational attainment is an important social determinant of health (SDOH) for cardiovascular disease (CVD). However, the association between educational attainment and all-cause and CVD mortality has not been longitudinally evaluated on a population-level in the US, especially in individuals with atherosclerotic cardiovascular disease (ASCVD). In this nationally representative study, we assessed the association between educational attainment and the risk of all-cause and cardiovascular (CVD) mortality in the general adult population and in adults with ASCVD in the US. Methods: We used data from the 2006-2014 National Death Index-linked National Health Interview Survey for adults ≥ 18 years. We generated age-adjusted mortality rates (AAMR) by levels of educational attainment (< high school (HS), HS/General Education Development (GED), some college, and ≥ College) in the overall population and in adults with ASCVD. Cox proportional hazards models were used to examine the multivariable-adjusted associations between educational attainment and all-cause and CVD mortality. Results: The sample comprised 210,853 participants (mean age 46.3), representing ~ 189 million adults annually, of which 8% had ASCVD. Overall, 14.7%, 27%, 20.3%, and 38% of the population had educational attainment < HS, HS/GED, Some College, and ≥ College, respectively. During a median follow-up of 4.5 years, all-cause age-adjusted mortality rates were 400.6 vs. 208.6 and 1446.7 vs. 984.0 for the total and ASCVD populations for < HS vs ≥ College education, respectively. CVD age adjusted mortality rates were 82.1 vs. 38.7 and 456.4 vs 279.5 for the total and ASCVD populations for < HS vs ≥ College education, respectively. In models adjusting for demographics and SDOH, < HS (reference = ≥ College) was associated with 40-50% increased risk of mortality in the total population and 20-40% increased risk of mortality in the ASCVD population, for both all-cause and CVD mortality. Further adjustment for traditional risk factors attenuated the associations but remained statistically significant for < HS in the overall population. Similar trends were seen across sociodemographic subgroups including age, sex, race/ethnicity, income, and insurance status. Conclusions: Lower educational attainment is independently associated with increased risk of all-cause and CVD mortality in both the total and ASCVD populations, with the highest risk observed for individuals with < HS education. Future efforts to understand persistent disparities in CVD and all-cause mortality should pay close attention to the role of education, and include educational attainment as an independent predictor in mortality risk prediction algorithms.BioMed Central202420242023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/59263http://dx.doi.org/10.1186/s12889-023-15621-yreponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésBMC Public Health. 2023 May 16;23(1):900© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:recercat.cat:10230/592632026-05-29T05:05:01Z |
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15,811543 |