Association of Educational Attainment With Lifetime Risk of Cardiovascular Disease The Atherosclerosis Risk in Communities Study
Association of Educational Attainment With Lifetime Risk of Cardiovascular Disease The Atherosclerosis Risk in Communities Study
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DOI：
10.1001/jamainternmed.2017.1877
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发表时间：
2017-08-01
影响因子：
39
通讯作者：
Folsom, Aaron R.
中科院分区：
文献类型：
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作者：
Kubota, Yasuhiko;Heiss, Gerardo;Folsom, Aaron R.
重要性估计的终身风险可能有助于提高认识的程度，教育不平等与心血管疾病（CVD）的风险相关。目的估计心血管疾病的终身风险根据类别的教育achievement.DESIGN，设置，和参与者从1987年到2013年12月31日。所有CVD事件（冠心病、心力衰竭和卒中）均经医生审查和国际疾病分类代码证实。从4个美国社区（马里兰州的华盛顿县;北卡罗来纳州的福赛斯县;密西西比的杰克逊;以及明尼苏达州明尼阿波利斯郊区）共纳入了13948名45 - 64岁且基线时无CVD的白人和非洲裔美国人。数据分析于2016年6月7日至8月31日进行。暴露受教育程度。主要结果和指标我们使用生命表方法根据受教育程度估计45岁至85岁CVD的终身风险。我们调整了竞争的死亡风险，从根本原因以外的CVD.RESULTS样本的13948名参与者是56%的女性和27%的非洲裔美国人。在269210人年的随访中，我们记录了4512例CVD事件和2401例非CVD死亡。受教育程度与心血管疾病的累积风险呈负剂量-反应关系，这在中年时期变得明显，未完成高中学业与完成高中学业之间的差距最为显著。在男性中，CVD的终生风险为59.0%，（95% CI，54.0%-64.1%）小学，52.5%（95%CI，47.7%-56.8%）高中学历未毕业者，50.9%（95% CI，47.3%-53.9%）高中毕业，47.2%（95% CI，41.5%-52.5%）职业学校，46.4%（95%CI，42.8%-49.6%）对于大学毕业或未毕业，42.2%（95% CI，36.6%-47.0%）研究生/专业学校;在妇女中，50.8%（95% CI，45.7%-55.8%），49.3%（95% CI，45.1%-53.1%）、36.3%（95% CI，33.4%-39.1%）、32.2%（95% CI，26.0%-37.3%）、32.8%（95% CI，29.1%-35.9%）和28.0%（95% CI，21.9%-33.3%）。教育程度与CVD呈负相关，即使在家庭收入，收入变化，职业，或父母的教育level.CONCLUSIONS和相关性超过1 2个人少于高中教育有一个终身CVD事件。无论其他重要的社会经济特征如何，受教育程度与心血管疾病的终生风险呈负相关。我们的研究结果强调，需要进一步努力，以减少心血管疾病的不平等有关的教育差距。
IMPORTANCE Estimates of lifetime risk may help raise awareness of the extent to which educational inequalities are associated with risk of cardiovascular disease (CVD).OBJECTIVE To estimate lifetime risks of CVD according to categories of educational attainment.DESIGN, SETTING, AND PARTICIPANTS Participants were followed from 1987 through December 31, 2013. All CVD events (coronary heart disease, heart failure, and stroke) were confirmed by physician review and International Classification of Diseases codes. A total of 13 948 whites and African Americans who were 45 to 64 years old and free of CVD at baseline were included from 4 US communities (Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and suburbs of Minneapolis, Minnesota). The data analysis was performed from June 7 to August 31, 2016.EXPOSURES Educational attainment.MAIN OUTCOMES AND MEASURES We used a life table approach to estimate lifetime risks of CVD from age 45 through 85 years according to educational attainment. We adjusted for competing risks of death from underlying causes other than CVD.RESULTS The sample of 13 948 participants was 56% female and 27% African American. During 269 210 person-years of follow-up, we documented 4512 CVD events and 2401 non-CVD deaths. Educational attainment displayed an inverse dose-response relation with cumulative risk of CVD, which became evident in middle age, with the most striking gap between those not completing vs completing high school. In men, lifetime risks of CVD were 59.0%(95% CI, 54.0%-64.1%) for grade school, 52.5%(95% CI, 47.7%-56.8%) for high school education without graduation, 50.9%(95% CI, 47.3%-53.9%) for high school graduation, 47.2%(95% CI, 41.5%-52.5%) for vocational school, 46.4%(95% CI, 42.8%-49.6%) for college with or without graduation, and 42.2%(95% CI, 36.6%-47.0%) for graduate/professional school; in women, 50.8%(95% CI, 45.7%-55.8%), 49.3%(95% CI, 45.1%-53.1%), 36.3%(95% CI, 33.4%-39.1%), 32.2%(95% CI, 26.0%-37.3%), 32.8%(95% CI, 29.1%-35.9%), and 28.0%(95% CI, 21.9%-33.3%), respectively. Educational attainment was inversely associated with CVD even within categories of family income, income change, occupation, or parental educational level.CONCLUSIONS AND RELEVANCE More than 1 in 2 individuals with less than high school education had a lifetime CVD event. Educational attainment was inversely associated with the lifetime risk of CVD, regardless of other important socioeconomic characteristics. Our findings emphasize the need for further efforts to reduce CVD inequalities related to educational disparities.