TY - JOUR
T1 - The impact of level of education on vascular events and mortality in patients with type 2 diabetes mellitus
T2 - Results from the ADVANCE study
AU - Blomster, J. I.
AU - Zoungas, S.
AU - Woodward, M.
AU - Neal, B.
AU - Harrap, S.
AU - Poulter, N.
AU - Marre, M.
AU - Williams, B.
AU - Chalmers, J.
AU - Hillis, G. S.
PY - 2017/5/1
Y1 - 2017/5/1
N2 - 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. (C) 2017 Published by Elsevier Ireland Ltd.
AB - 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. (C) 2017 Published by Elsevier Ireland Ltd.
KW - Type 2 diabetes
KW - Level of education
KW - Cardiovascular events
KW - Microvascular events
KW - OF-THE-LITERATURE
KW - CARDIOVASCULAR-DISEASE
KW - SOCIOECONOMIC POSITION
KW - PHYSICAL-ACTIVITY
KW - INCOME COUNTRIES
KW - RISK-FACTORS
KW - US ADULTS
KW - FOLLOW-UP
KW - LIFE
KW - HEALTH
U2 - 10.1016/j.diabres.2017.03.015
DO - 10.1016/j.diabres.2017.03.015
M3 - Article
C2 - 28395214
SN - 0168-8227
VL - 127
SP - 212
EP - 217
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
ER -
