Morton Rachael L, Schlackow Iryna, Staplin Natalie, Gray Alastair, Cass Alan, Haynes Richard, Emberson Jonathan, Herrington William, Landray Martin J, Baigent Colin, Mihaylova Borislava
NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia; Health Economics Research Centre, University of Oxford, Oxford, United Kingdom.
Health Economics Research Centre, University of Oxford, Oxford, United Kingdom.
Am J Kidney Dis. 2016 Jan;67(1):31-9. doi: 10.1053/j.ajkd.2015.07.021. Epub 2015 Sep 16.
The inverse association between educational attainment and mortality is well established, but its relevance to vascular events and renal progression in a population with chronic kidney disease (CKD) is less clear. This study aims to determine the association between highest educational attainment and risk of vascular events, cause-specific mortality, and CKD progression.
Prospective epidemiologic analysis among participants in the Study of Heart and Renal Protection (SHARP), a randomized controlled trial.
SETTING & PARTICIPANTS: 9,270 adults with moderate to severe CKD (6,245 not receiving dialysis at baseline) and no history of myocardial infarction or coronary revascularization recruited in Europe, North America, Asia, Australia, and New Zealand.
Highest educational attainment measured at study entry using 6 levels that ranged from "no formal education" to "tertiary education."
Any vascular event (any fatal or nonfatal cardiac, cerebrovascular, or peripheral vascular event), cause-specific mortality, and CKD progression during 4.9 years' median follow-up.
There was a significant trend (P<0.001) toward increased vascular risk with decreasing levels of education. Participants with no formal education were at a 46% higher risk of vascular events (relative risk [RR], 1.46; 95% CI, 1.14-1.86) compared with participants with tertiary education. The trend for mortality across education levels was also significant (P<0.001): all-cause mortality was twice as high among those with no formal education compared with tertiary-educated individuals (RR, 2.05; 95% CI, 1.62-2.58), and significant increases were seen for both vascular (RR, 1.84; 95% CI, 1.21-2.81) and nonvascular (RR, 2.15; 95% CI, 1.60-2.89) deaths. Lifestyle factors and prior disease explain most of the excess mortality risk. Among 6,245 participants not receiving dialysis at baseline, education level was not significantly associated with progression to end-stage renal disease or doubling of creatinine level (P for trend = 0.4).
No data for employment or health insurance coverage.
Lower educational attainment is associated with increased risk of adverse health outcomes in individuals with CKD.
教育程度与死亡率之间的负相关关系已得到充分证实，但其与慢性肾脏病（CKD）患者血管事件及肾脏进展的相关性尚不清楚。本研究旨在确定最高教育程度与血管事件风险、特定病因死亡率及CKD进展之间的关联。
对心脏和肾脏保护研究（SHARP）的参与者进行前瞻性流行病学分析，该研究为一项随机对照试验。
9270名中重度CKD成人（6245名基线时未接受透析），他们在欧洲、北美、亚洲、澳大利亚和新西兰招募，且无心肌梗死或冠状动脉血运重建史。
研究入组时使用从“未接受正规教育”到“高等教育”的6个等级来衡量最高教育程度。
在4.9年的中位随访期内的任何血管事件（任何致命或非致命的心脏、脑血管或外周血管事件）、特定病因死亡率及CKD进展。
随着教育水平降低，血管风险增加存在显著趋势（P<0.001）。与接受高等教育的参与者相比，未接受正规教育的参与者发生血管事件的风险高46%（相对风险[RR]，1.46；95%置信区间[CI]，1.14 - 1.86）。不同教育水平的死亡率趋势也具有显著性（P<0.001）：未接受正规教育者的全因死亡率是接受高等教育者的两倍（RR，2.05；95%CI，1.62 - 2.58），血管性死亡（RR，1.84；95%CI，1.21 - 2.81）和非血管性死亡（RR，2.15；95%CI，1.60 - 2.89）均显著增加。生活方式因素和既往疾病解释了大部分额外的死亡风险。在6245名基线时未接受透析的参与者中，教育水平与进展至终末期肾病或肌酐水平翻倍无显著关联（趋势P值 = 0.4）。
无就业或医疗保险覆盖数据。
较低的教育程度与CKD患者不良健康结局风险增加相关。
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