Lund Jensen Nikoline, Pedersen Henrik Søndergaard, Vestergaard Mogens, Mercer Stewart W, Glümer Charlotte, Prior Anders
Research Unit for General Practice.
Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
Clin Epidemiol. 2017 May 10;9:279-289. doi: 10.2147/CLEP.S129415. eCollection 2017.
Multimorbidity (MM) is more prevalent among people of lower socioeconomic status (SES), and both MM and SES are associated with higher mortality rates. However, little is known about the relationship between SES, MM, and mortality. This study investigates the association between educational level and mortality, and to what extent MM modifies this association.
We followed 239,547 individuals invited to participate in the Danish National Health Survey 2010 (mean follow-up time: 3.8 years). MM was assessed by using information on drug prescriptions and diagnoses for 39 long-term conditions. Data on educational level were provided by Statistics Denmark. Date of death was obtained from the Civil Registration System. Information on lifestyle factors and quality of life was collected from the survey. The main outcomes were overall and premature mortality (death before the age of 75).
Of a total of 12,480 deaths, 6,607 (9.5%) were of people with low educational level (LEL) and 1,272 (2.3%) were of people with high educational level (HEL). The mortality rate was higher among people with LEL compared with HEL in groups of people with 0-1 disease (hazard ratio: 2.26, 95% confidence interval: 2.00-2.55) and ≥4 diseases (hazard ratio: 1.14, 95% confidence interval: 1.04-1.24), respectively (adjusted model). The absolute number of deaths was six times higher among people with LEL than those with HEL in those with ≥4 diseases. The 1-year cumulative mortality proportions for overall death in those with ≥4 diseases was 5.59% for people with HEL versus 7.27% for people with LEL, and 1-year cumulative mortality proportions for premature death was 2.93% for people with HEL versus 4.04% for people with LEL. Adjusting for potential mediating factors such as lifestyle and quality of life eliminated the statistical association between educational level and mortality in people with MM.
Our study suggests that LEL is associated with higher overall and premature mortality and that the association is affected by MM, lifestyle factors, and quality of life.
多重疾病（MM）在社会经济地位较低（SES）的人群中更为普遍，且MM和SES均与较高的死亡率相关。然而，关于SES、MM和死亡率之间的关系却知之甚少。本研究调查教育水平与死亡率之间的关联，以及MM在多大程度上改变这种关联。
我们对受邀参加2010年丹麦国家健康调查的239,547人进行了随访（平均随访时间：3.8年）。通过使用39种长期疾病的药物处方和诊断信息来评估MM。丹麦统计局提供了教育水平数据。死亡日期来自民事登记系统。生活方式因素和生活质量信息通过该调查收集。主要结局为全因死亡率和过早死亡率（75岁之前死亡）。
在总共12,480例死亡中，6,607例（9.5%）为低教育水平（LEL）人群，1,272例（2.3%）为高教育水平（HEL）人群。在患有0 - 1种疾病的人群中，LEL人群的死亡率高于HEL人群（风险比：2.26，95%置信区间：2.00 - 2.55）；在患有≥4种疾病的人群中，LEL人群的死亡率也高于HEL人群（风险比：1.14，95%置信区间：1.04 - 1.24）（校正模型）。在患有≥4种疾病的人群中，LEL人群的死亡绝对数比HEL人群高六倍。在患有≥4种疾病的人群中，HEL人群的全因死亡1年累积死亡率为5.59%，而LEL人群为7.27%；HEL人群的过早死亡1年累积死亡率为2.93%，而LEL人群为4.04%。对生活方式和生活质量等潜在中介因素进行校正后，消除了MM患者教育水平与死亡率之间的统计学关联。
我们的研究表明，低教育水平与较高的全因死亡率和过早死亡率相关，且这种关联受MM、生活方式因素和生活质量的影响。
