Low educational attainment is associated with higher all-cause and cardiovascular mortality in the United States adult population

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• dc.contributor.author Khan, Najah
• dc.contributor.author Javed, Zulqarnain
• dc.contributor.author Acquah, Isaac
• dc.contributor.author Hagan, Kobina
• dc.contributor.author Khan, Madiha
• dc.contributor.author Valero-Elizondo, Javier
• dc.contributor.author Chang, Ryan
• dc.contributor.author Javed, Umair
• dc.contributor.author Taha, Mohamad B.
• dc.contributor.author Blaha, Michael J.
• dc.contributor.author Virani, Salim S.
• dc.contributor.author Sharma, Garima
• dc.contributor.author Blankstein, Ron
• dc.contributor.author Gulati, Martha
• dc.contributor.author Mossialos, Elias
• dc.contributor.author Hyder, Adnan A.
• dc.contributor.author Cainzos-Achirica, Miguel
• dc.contributor.author Nasir, Khurram
• dc.date.accessioned 2024-02-27T07:21:51Z
• dc.date.available 2024-02-27T07:21:51Z
• dc.date.issued 2023
• dc.description.abstract 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.
• dc.format.mimetype application/pdf
• dc.identifier.citation Khan N, Javed Z, Acquah I, Hagan K, Khan M, Valero-Elizondo J, Chang R, Javed U, Taha MB, Blaha MJ, Virani SS, Sharma G, Blankstein R, Gulati M, Mossialos E, Hyder AA, Achirica MC, Nasir K. Low educational attainment is associated with higher all-cause and cardiovascular mortality in the United States adult population. BMC Public Health. 2023 May 16;23(1):900. DOI: 10.1186/s12889-023-15621-y
• dc.identifier.doi http://dx.doi.org/10.1186/s12889-023-15621-y
• dc.identifier.issn 1471-2458
• dc.identifier.uri http://hdl.handle.net/10230/59263
• dc.language.iso eng
• dc.publisher BioMed Central
• dc.relation.ispartof BMC Public Health. 2023 May 16;23(1):900
• dc.rights © 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.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword All-cause mortality
• dc.subject.keyword Cardiovascular disease
• dc.subject.keyword Educational attainment
• dc.subject.keyword Health disparities
• dc.title Low educational attainment is associated with higher all-cause and cardiovascular mortality in the United States adult population
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion