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

Keming Yang; Ying Zhang; Eiko Saito; Md Shafiur Rahman; Prakash Chandra Gupta; Norie Sawada; Akiko Tamakoshi; Yu Tang Gao; Woon Puay Koh; Xiao Ou Shu; Ichiro Tsuji; Atsuko Sadakane; Chisato Nagata; San Lin You; Jian Min Yuan; Myung Hee Shin; Yu Chen; Wen Harn Pan; Mangesh S. Pednekar; Shoichiro Tsugane; Hui Cai; Yong Bing Xiang; Kotaro Ozasa; Yasutake Tomata; Seiki Kanemura; Yumi Sugawara; Keiko Wada; Renwei Wang; Yoon Ok Ahn; Keun Young Yoo; Habibul Ahsan; Kee Seng Chia; Paolo Boffetta; Daehee Kang; John D. Potter; Manami Inoue; Wei Zheng; Hongmei Nan

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

Keming Yang, Ying Zhang, Eiko Saito, Md Shafiur Rahman, Prakash Chandra Gupta, Norie Sawada, Akiko Tamakoshi, Yu Tang Gao, Woon Puay Koh, Xiao Ou Shu, Ichiro Tsuji, Atsuko Sadakane, Chisato Nagata, San Lin You, Jian Min Yuan, Myung Hee Shin, Yu Chen, Wen Harn Pan, Mangesh S. Pednekar, Shoichiro TsuganeHui Cai, Yong Bing Xiang, Kotaro Ozasa, Yasutake Tomata, Seiki Kanemura, Yumi Sugawara, Keiko Wada, Renwei Wang, Yoon Ok Ahn, Keun Young Yoo, Habibul Ahsan, Kee Seng Chia, Paolo Boffetta, Daehee Kang, John D. Potter, Manami Inoue, Wei Zheng, Hongmei Nan

Urban Initiative

Research output: Contribution to journal › Article › peer-review

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 (p trend=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 p trend <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.

Original language	English (US)
Article number	e026225
Journal	BMJ open
Volume	9
Issue number	8
DOIs	https://doi.org/10.1136/bmjopen-2018-026225
State	Published - Aug 1 2019

Keywords

Asia
cancer
cardiovascular
education
mortality
Cardiovascular Diseases/mortality
Prospective Studies
Correlation of Data
Humans
Middle Aged
Mortality
Risk Factors
Male
Educational Status
Cause of Death
Neoplasms/mortality
Asia/epidemiology
Female
Cohort Studies

ASJC Scopus subject areas

General Medicine

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10.1136/bmjopen-2018-026225

Cite this

Yang, K., Zhang, Y., Saito, E., Rahman, M. S., Gupta, P. C., Sawada, N., Tamakoshi, A., Gao, Y. T., Koh, W. P., Shu, X. O., Tsuji, I., Sadakane, A., Nagata, C., You, S. L., Yuan, J. M., Shin, M. H., Chen, Y., Pan, W. H., Pednekar, M. S., ... Nan, H. (2019). Association between educational level and total and cause-specific mortality: A pooled analysis of over 694 000 individuals in the Asia Cohort Consortium. BMJ open, 9(8), Article e026225. https://doi.org/10.1136/bmjopen-2018-026225

Yang, K, Zhang, Y, Saito, E, Rahman, MS, Gupta, PC, Sawada, N, Tamakoshi, A, Gao, YT, Koh, WP, Shu, XO, Tsuji, I, Sadakane, A, Nagata, C, You, SL, Yuan, JM, Shin, MH, Chen, Y, Pan, WH, Pednekar, MS, Tsugane, S, Cai, H, Xiang, YB, Ozasa, K, Tomata, Y, Kanemura, S, Sugawara, Y, Wada, K, Wang, R, Ahn, YO, Yoo, KY, Ahsan, H, Chia, KS, Boffetta, P, Kang, D, Potter, JD, Inoue, M, Zheng, W & Nan, H 2019, 'Association between educational level and total and cause-specific mortality: A pooled analysis of over 694 000 individuals in the Asia Cohort Consortium', BMJ open, vol. 9, no. 8, e026225. https://doi.org/10.1136/bmjopen-2018-026225

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title = "Association between educational level and total and cause-specific mortality: A pooled analysis of over 694 000 individuals in the Asia Cohort Consortium",

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 (p trend=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 p trend <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, Cardiovascular Diseases/mortality, Prospective Studies, Correlation of Data, Humans, Middle Aged, Mortality, Risk Factors, Male, Educational Status, Cause of Death, Neoplasms/mortality, Asia/epidemiology, Female, Cohort Studies",

author = "Keming Yang and Ying Zhang and Eiko Saito and Rahman, {Md Shafiur} and Gupta, {Prakash Chandra} and Norie Sawada and Akiko Tamakoshi and Gao, {Yu Tang} and Koh, {Woon Puay} and Shu, {Xiao Ou} and Ichiro Tsuji and Atsuko Sadakane and Chisato Nagata and You, {San Lin} and Yuan, {Jian Min} and Shin, {Myung Hee} and Yu Chen and Pan, {Wen Harn} and Pednekar, {Mangesh S.} and Shoichiro Tsugane and Hui Cai and Xiang, {Yong Bing} and Kotaro Ozasa and Yasutake Tomata and Seiki Kanemura and Yumi Sugawara and Keiko Wada and Renwei Wang and Ahn, {Yoon Ok} and Yoo, {Keun Young} and Habibul Ahsan and Chia, {Kee Seng} and Paolo Boffetta and Daehee Kang and Potter, {John D.} and Manami Inoue and Wei Zheng and Hongmei Nan",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2019",

month = aug,

day = "1",

doi = "10.1136/bmjopen-2018-026225",

language = "English (US)",

volume = "9",

journal = "BMJ open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "8",

}

TY - JOUR

T1 - Association between educational level and total and cause-specific mortality

T2 - A pooled analysis of over 694 000 individuals in the Asia Cohort Consortium

AU - Yang, Keming

AU - Zhang, Ying

AU - Saito, Eiko

AU - Rahman, Md Shafiur

AU - Gupta, Prakash Chandra

AU - Sawada, Norie

AU - Tamakoshi, Akiko

AU - Gao, Yu Tang

AU - Koh, Woon Puay

AU - Shu, Xiao Ou

AU - Tsuji, Ichiro

AU - Sadakane, Atsuko

AU - Nagata, Chisato

AU - You, San Lin

AU - Yuan, Jian Min

AU - Shin, Myung Hee

AU - Chen, Yu

AU - Pan, Wen Harn

AU - Pednekar, Mangesh S.

AU - Tsugane, Shoichiro

AU - Cai, Hui

AU - Xiang, Yong Bing

AU - Ozasa, Kotaro

AU - Tomata, Yasutake

AU - Kanemura, Seiki

AU - Sugawara, Yumi

AU - Wada, Keiko

AU - Wang, Renwei

AU - Ahn, Yoon Ok

AU - Yoo, Keun Young

AU - Ahsan, Habibul

AU - Chia, Kee Seng

AU - Boffetta, Paolo

AU - Kang, Daehee

AU - Potter, John D.

AU - Inoue, Manami

AU - Zheng, Wei

AU - Nan, Hongmei

N1 - Publisher Copyright: © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2019/8/1

Y1 - 2019/8/1

N2 - 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 (p trend=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 p trend <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.

AB - 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 (p trend=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 p trend <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.

KW - Asia

KW - cancer

KW - cardiovascular

KW - education

KW - mortality

KW - Cardiovascular Diseases/mortality

KW - Prospective Studies

KW - Correlation of Data

KW - Humans

KW - Middle Aged

KW - Mortality

KW - Risk Factors

KW - Male

KW - Educational Status

KW - Cause of Death

KW - Neoplasms/mortality

KW - Asia/epidemiology

KW - Female

KW - Cohort Studies

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UR - http://www.scopus.com/inward/citedby.url?scp=85071279754&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2018-026225

DO - 10.1136/bmjopen-2018-026225

M3 - Article

C2 - 31444178

AN - SCOPUS:85071279754

SN - 2044-6055

VL - 9

JO - BMJ open

JF - BMJ open

IS - 8

M1 - e026225

ER -

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

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