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BMJ Open. 2019 Aug 22;9(8):e026225. doi: 10.1136/bmjopen-2018-026225.

Association between educational level and total and cause-specific mortality: a pooled analysis of over 694 000 individuals in the Asia Cohort Consortium.

Author information

1
Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA.
2
Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA.
3
Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan.
4
Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
5
Healis - Sekhsaria Institute for Public Health, Navi Mumbai, India.
6
Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
7
Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
8
State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
9
Health Services and Systems Research, Duke-NUS Medical School, Singapore.
10
Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
11
Tohoku University Graduate School of Medicine, Sendai, Japan.
12
Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan.
13
Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
14
School of Medicine, Big Data Research Centre, Fu-Jen Catholic University, Taipei, Taiwan.
15
Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
16
Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea.
17
Department of Population Health, Department of Environmental Medicine, New York University School of Medicine, New York City, New York, USA.
18
Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.
19
Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, The Republic of Korea.
20
Armed Forces Capital Hospital, Seoul National University College of Medicine, Seoul, The Republic of Korea.
21
Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA.
22
Epidemiology Program, Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
23
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
24
Centre for Public Health Research, Massey University, Wellington, New Zealand.
25
Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA hnan@iu.edu.

Abstract

OBJECTIVE:

To study the association of educational level and risk of death from all causes, cardiovascular disease (CVD) and cancer among Asian populations.

DESIGN:

A pooled analysis of 15 population-based cohort studies.

SETTING AND PARTICIPANTS:

694 434 Asian individuals from 15 prospective cohorts within the Asia Cohort Consortium.

INTERVENTIONS:

None.

MAIN OUTCOME MEASURES:

HRs and 95% CIs for all-cause mortality, as well as for CVD-specific mortality and cancer-specific mortality.

RESULTS:

A total of 694 434 participants (mean age at baseline=53.2 years) were included in the analysis. During a mean follow-up period of 12.5 years, 103 023 deaths were observed, among which 33 939 were due to cancer and 34 645 were due to CVD. Higher educational levels were significantly associated with lower risk of death from all causes compared with a low educational level (≤primary education); HRs and 95% CIs for secondary education, trade/technical education and ≥university education were 0.88 (0.85 to 0.92), 0.81 (0.73 to 0.90) and 0.71 (0.63 to 0.80), respectively (ptrend=0.002). Similarly, HRs (95% CIs) were 0.93 (0.89 to 0.97), 0.86 (0.78 to 0.94) and 0.81 (0.73 to 0.89) for cancer death, and 0.88 (0.83 to 0.93), 0.77 (0.66 to 0.91) and 0.67 (0.58 to 0.77) for CVD death with increasing levels of education (both ptrend <0.01). The pattern of the association among East Asians and South Asians was similar compared with ≤primary education; HR (95% CI) for all-cause mortality associated with ≥university education was 0.72 (0.63 to 0.81) among 539 724 East Asians (Chinese, Japanese and Korean) and 0.61 (0.54 to 0.69) among 154 710 South Asians (Indians and Bangladeshis).

CONCLUSION:

Higher educational level was associated with substantially lower risk of death among Asian populations.

KEYWORDS:

Asia; cancer; cardiovascular; education; mortality

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