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 journalArticle

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 languageEnglish (US)
Article numbere026225
JournalBMJ open
Volume9
Issue number8
DOIs
StatePublished - Aug 1 2019

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Education
Mortality
Cardiovascular Diseases
Cause of Death
Neoplasms
Population
Cohort Studies
Outcome Assessment (Health Care)

Keywords

  • Asia
  • cancer
  • cardiovascular
  • education
  • mortality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Association between educational level and total and cause-specific mortality : A pooled analysis of over 694 000 individuals in the Asia Cohort Consortium. / Yang, Keming; Zhang, Ying; Saito, Eiko; Rahman, Md Shafiur; Gupta, Prakash Chandra; Sawada, Norie; Tamakoshi, Akiko; Gao, Yu Tang; Koh, Woon Puay; Shu, Xiao Ou; Tsuji, Ichiro; Sadakane, Atsuko; Nagata, Chisato; You, San Lin; Yuan, Jian Min; Shin, Myung Hee; Chen, Yu; Pan, Wen Harn; Pednekar, Mangesh S.; Tsugane, Shoichiro; Cai, Hui; Xiang, Yong Bing; Ozasa, Kotaro; Tomata, Yasutake; Kanemura, Seiki; Sugawara, Yumi; Wada, Keiko; Wang, Renwei; Ahn, Yoon Ok; Yoo, Keun Young; Ahsan, Habibul; Chia, Kee Seng; Boffetta, Paolo; Kang, Daehee; Potter, John D.; Inoue, Manami; Zheng, Wei; Nan, Hongmei.

In: BMJ open, Vol. 9, No. 8, e026225, 01.08.2019.

Research output: Contribution to journalArticle

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
Yang, Keming ; Zhang, Ying ; Saito, Eiko ; Rahman, Md Shafiur ; Gupta, Prakash Chandra ; Sawada, Norie ; Tamakoshi, Akiko ; Gao, Yu Tang ; Koh, Woon Puay ; Shu, Xiao Ou ; Tsuji, Ichiro ; Sadakane, Atsuko ; Nagata, Chisato ; You, San Lin ; Yuan, Jian Min ; Shin, Myung Hee ; Chen, Yu ; Pan, Wen Harn ; Pednekar, Mangesh S. ; Tsugane, Shoichiro ; Cai, Hui ; Xiang, Yong Bing ; Ozasa, Kotaro ; Tomata, Yasutake ; Kanemura, Seiki ; Sugawara, Yumi ; Wada, Keiko ; Wang, Renwei ; Ahn, Yoon Ok ; Yoo, Keun Young ; Ahsan, Habibul ; Chia, Kee Seng ; Boffetta, Paolo ; Kang, Daehee ; Potter, John D. ; Inoue, Manami ; Zheng, Wei ; Nan, Hongmei. / Association between educational level and total and cause-specific mortality : A pooled analysis of over 694 000 individuals in the Asia Cohort Consortium. In: BMJ open. 2019 ; Vol. 9, No. 8.
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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",
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",
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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

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

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U2 - 10.1136/bmjopen-2018-026225

DO - 10.1136/bmjopen-2018-026225

M3 - Article

C2 - 31444178

AN - SCOPUS:85071279754

VL - 9

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

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