Association of educational attainment with chronic disease and mortality: the Kidney Early Evaluation Program (KEEP).

BACKGROUND

Recent reports have suggested a close relationship between education and health, including mortality, in the United States.

STUDY DESIGN

Observational cohort.

SETTING & PARTICIPANTS: We studied 61,457 participants enrolled in a national health screening initiative, the National Kidney Foundation's Kidney Early Evaluation Program (KEEP).

PREDICTOR

Self-reported educational attainment.

OUTCOMES

Chronic diseases (hypertension, diabetes, cardiovascular disease, reduced kidney function, and albuminuria) and mortality.

MEASUREMENTS

We evaluated cross-sectional associations between self-reported educational attainment with the chronic diseases listed using logistic regression models adjusted for demographics, access to care, behaviors, and comorbid conditions. The association of educational attainment with survival was determined using multivariable Cox proportional hazards regression.

RESULTS

Higher educational attainment was associated with a lower prevalence of each of the chronic conditions listed. In multivariable models, compared with persons not completing high school, college graduates had a lower risk of each chronic condition, ranging from 11% lower odds of decreased kidney function to 37% lower odds of cardiovascular disease. During a mean follow-up of 3.9 (median, 3.7) years, 2,384 (4%) deaths occurred. In the fully adjusted Cox model, those who had completed college had 24% lower mortality compared with participants who had completed at least some high school.

LIMITATIONS

Lack of income data does not allow us to disentangle the independent effects of education from income.

CONCLUSIONS

In this diverse contemporary cohort, higher educational attainment was associated independently with a lower prevalence of chronic diseases and short-term mortality in all age and race/ethnicity groups.