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

Research output: Contribution to journalArticlepeer-review


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.


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 languageEnglish (US)
Article numbere026225
JournalBMJ open
Issue number8
StatePublished - Aug 1 2019


  • 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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