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...
| Authors: | ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; |
|---|---|
| Format: | Article |
| Status: | Published version |
| Publication date: | 2023 |
| Country: | España |
| Institution: | Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) |
| Repository: | Recercat. Dipósit de la Recerca de Catalunya |
| OAI Identifier: | oai:recercat.cat:10230/59263 |
| Online Access: | http://hdl.handle.net/10230/59263 http://dx.doi.org/10.1186/s12889-023-15621-y |
| Access Level: | Open access |
| Keyword: | All-cause mortality Cardiovascular disease Educational attainment Health disparities |
| _version_ | 1878731456288653312 |
|---|---|
| author | Khan, Najah |
| 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 |
| author_browse | Acquah, Isaac Blaha, Michael J. Blankstein, Ron Cainzos-Achirica, Miguel Chang, Ryan Gulati, Martha Hagan, Kobina Hyder, Adnan A. Javed, Umair Javed, Zulqarnain Khan, Madiha Khan, Najah Mossialos, Elias Nasir, Khurram Sharma, Garima Taha, Mohamad B. Valero-Elizondo, Javier Virani, Salim S. |
| 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 |
| collection | Recercat. Dipósit de la Recerca de Catalunya |
| 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. |
| eu_rights_str_mv | openAccess |
| format | article |
| id | ES_2ffd05e718ea72e666f7df72eea22e3b |
| institution | Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) |
| instname_str | Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) |
| network_acronym_str | ES |
| network_name_str | España |
| oai_identifier_str | oai:recercat.cat:10230/59263 |
| publishDate | 2023 |
| publishDateSort | 2023 |
| publisher | BioMed Central |
| publisherStr | BioMed Central |
| reponame_str | Recercat. Dipósit de la Recerca de Catalunya |
| spelling | Low educational attainment is associated with higher all-cause and cardiovascular mortality in the United States adult population 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 All-cause mortality Cardiovascular disease Educational attainment Health disparities 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. BioMed Central http://hdl.handle.net/10230/59263 http://dx.doi.org/10.1186/s12889-023-15621-y |
| 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 |
| status_str | publishedVersion |
| title | 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_short | 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 |
| topic | All-cause mortality Cardiovascular disease Educational attainment Health disparities |
| topic_facet | All-cause mortality Cardiovascular disease Educational attainment Health disparities |
| url | http://hdl.handle.net/10230/59263 http://dx.doi.org/10.1186/s12889-023-15621-y |