The impact of level of education on vascular events and mortality in patients with type 2 diabetes mellitus: Results from the ADVANCE study. (May 2017)

• Record Type: Journal Article
• Authors: Blomster, J.I.; Zoungas, S.; Woodward, M.; Neal, B.; Harrap, S.; Poulter, N.; Marre, M.; Williams, B.; Chalmers, J.; Hillis, G.S.
• Is Part Of: Diabetes research and clinical practice. Volume 127(2017)
• Page Start: 212
• Page End: 217
• Publication Date: 2017-05
• Subjects: Type 2 diabetes -- Level of education -- Cardiovascular events -- Microvascular events; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2017.03.015
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: Lower formal educational attainment is associated with cardiovascular events. Lower formal educational attainment is associated with microvascular events. Lower formal educational attainment is associated with mortality. The effects of educational level on cardiovascular risk wary in geographic regions. The effects of educational level are less prominent in high income countries. 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 5 years 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.