A1 Refereed original research article in a scientific journal
The impact of level of education on vascular events and mortality in patients with type 2 diabetes mellitus: Results from the ADVANCE study
Authors: Blomster JI, Zoungas S, Woodward M, Neal B, Harrap S, Poulter N, Marre M, Williams B, Chalmers J, Hillis GS
Publisher: ELSEVIER IRELAND LTD
Publication year: 2017
Journal: Diabetes Research and Clinical Practice
Journal name in source: DIABETES RESEARCH AND CLINICAL PRACTICE
Journal acronym: DIABETES RES CLIN PR
Volume: 127
First page : 212
Last page: 217
Number of pages: 6
ISSN: 0168-8227
DOI: https://doi.org/10.1016/j.diabres.2017.03.015(external)
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. (C) 2017 Published by Elsevier Ireland Ltd.
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.
UTU Research Portal