J I Blomster1, S Zoungas2, M Woodward3, B Neal4, S Harrap5, N Poulter6, M Marre7, B Williams8, J Chalmers4, G S Hillis9. 1. The George Institute for Global Health, University of Sydney, Sydney, Australia; University of Turku, Turku, Finland. Electronic address: jmakinen@georgeinstitute.org.au. 2. The George Institute for Global Health, University of Sydney, Sydney, Australia; School of Public Health, Monash University, Melbourne, Australia. 3. The George Institute for Global Health, University of Sydney, Sydney, Australia; Department of Epidemiology, Johns Hopkins University, Baltimore, USA; The George Institute for Global Health, University of Oxford, UK. 4. The George Institute for Global Health, University of Sydney, Sydney, Australia. 5. Department of Physiology, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia. 6. Imperial College London and Hammersmith Hospital, London, UK. 7. Service d'Endocrinologie Diabétologie Nutrition, Groupe Hospitalier Bichat-Claude Bernard, Paris, France. 8. University College London and the National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, UK. 9. The George Institute for Global Health, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Perth Hospital, Perth, Australia.
Abstract
AIMS: The relationship between educational level and the risk of all-cause mortality is well established, whereas the association with vascular events in individuals with type 2 diabetes is not well described. Any association may reflect a link with common cardiovascular or lifestyle-based risk factors. METHODS: The relationships between the highest level of educational attainment and major cardiovascular events, microvascular complications and all-cause mortality were explored in a cohort of 11,140 individuals with type 2 diabetes. Completion of formal education before the age of 16 was categorized as a low level of education. Regional differences between Asia, East Europe and Established Market Economies were also assessed. RESULTS: During a median of 5years of follow up, 1031 (9%) patients died, 1147 (10%) experienced a major cardiovascular event and 1136 (10%) a microvascular event. After adjustment for baseline characteristics and risk factors, individuals with lower education had an increased risk of cardiovascular events (hazard ratio (HR) 1.31, 95% CI 1.16-1.48, p<0.0001), microvascular events (HR 1.23, 95% CI 1.08-1.39, p=0.0013) and all-cause mortality (HR 1.34, 95% CI 1.18-1.52, p<0.0001). In regional analyses the increased risk of studied outcomes associated with lower education was weakest in Established Market Economies and strongest in East Europe. CONCLUSIONS: A low level of education is associated with an increased risk of vascular events and death in patients with type 2 diabetes, independently of common lifestyle associated cardiovascular risk factors. The effect size varies between geographical regions.
AIMS: The relationship between educational level and the risk of all-cause mortality is well established, whereas the association with vascular events in individuals with type 2 diabetes is not well described. Any association may reflect a link with common cardiovascular or lifestyle-based risk factors. METHODS: The relationships between the highest level of educational attainment and major cardiovascular events, microvascular complications and all-cause mortality were explored in a cohort of 11,140 individuals with type 2 diabetes. Completion of formal education before the age of 16 was categorized as a low level of education. Regional differences between Asia, East Europe and Established Market Economies were also assessed. RESULTS: During a median of 5years of follow up, 1031 (9%) patients died, 1147 (10%) experienced a major cardiovascular event and 1136 (10%) a microvascular event. After adjustment for baseline characteristics and risk factors, individuals with lower education had an increased risk of cardiovascular events (hazard ratio (HR) 1.31, 95% CI 1.16-1.48, p<0.0001), microvascular events (HR 1.23, 95% CI 1.08-1.39, p=0.0013) and all-cause mortality (HR 1.34, 95% CI 1.18-1.52, p<0.0001). In regional analyses the increased risk of studied outcomes associated with lower education was weakest in Established Market Economies and strongest in East Europe. CONCLUSIONS: A low level of education is associated with an increased risk of vascular events and death in patients with type 2 diabetes, independently of common lifestyle associated cardiovascular risk factors. The effect size varies between geographical regions.
Authors: Hongjiang Wu; Eric Sh Lau; Alice Ps Kong; Ronald Cw Ma; Risa Ozaki; Kitty Kt Cheung; Elaine Chow; Chiu Chi Tsang; Kam Piu Lau; Eric Mt Hui; Wing Yee So; Danijela Gasevic; Sarah H Wild; Juliana Cn Chan; Andrea Luk Journal: Clin Epidemiol Date: 2018-10-25 Impact factor: 4.790
Authors: Kristina B Slåtsve; Tor Claudi; Knut Tore Lappegård; Anne Karen Jenum; Marthe Larsen; Kjersti Nøkleby; Katrina Tibballs; John G Cooper; Sverre Sandberg; Esben Selmer Buhl; Karianne Fjeld Løvaas; Tore Julsrud Berg Journal: BMJ Open Diabetes Res Care Date: 2022-09