Department of Tropical and Infectious Diseases, Policlinico Umberto I, Rome, Italy.
Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
Eur J Intern Med. 2020 May;75:55-59. doi: 10.1016/j.ejim.2020.01.008. Epub 2020 Jan 22.
The potential link between educational level and chronic liver diseases (CLD) were explored using the mortality records of liver cirrhosis, which lack accuracy and are unable to identify the different etiological factors of liver cirrhosis. Information on the association of low educational level with the severity of CLD is lacking.
To evaluate the potential association linking education level to etiology and clinical stage of CLD cases.
Consecutive enrolment of 11,107 subjects with CLD aged≥18 years prospectively recruited in two national surveys in 2001 and 2014 at one of the participating Italian liver units throughout the country. Subjects were pooled in two groups: low education level (less than high school) and high education level (completed high school or beyond). The association of demographic, etiological, and clinical stage of subjects with educational level was assessed using logistic regression analysis. In the analysis low educational level was the outcome variable.
A total of 11,107 subjects born in Italy (mean age 55.5 years, sex ratio 1.5) were evaluated. Multiple logistic regression analysis shows that chronic HCV infection (O.R.1,38:95%,C.I.1.23-1.55), risky alcohol intake (O.R.1.96;95%,C.I.1.73-2.21) and liver cirrhosis (O.R.1.65;95%,C.I.1.46-1.85) all resulted independently associated with less than a completed high school education. HBV infection resulted independently associated with high education level (O.R.0.74;95%,C.I.0.64-0.86), reflecting changes in HBV modes of transmission in recent decades. No association was found with CLD related to non-alcoholic fatty liver disease (O.R.1.03;95%, C.I.0.81-1.30).
These findings show an independent association linking education level with viruses and alcohol-related CLD. Low educational level is associated with the severity of CLD.
本研究使用肝硬化死亡率记录来探索教育水平与慢性肝病（CLD）之间的潜在联系，但是这些记录的准确性较差，无法识别肝硬化的不同病因。关于低教育水平与 CLD 严重程度之间关联的信息还比较缺乏。
评估教育水平与 CLD 病因和临床分期之间的潜在关联。
2001 年和 2014 年，在意大利一家参与单位进行了两项全国性调查，连续纳入了 11107 名年龄≥18 岁的 CLD 患者。将患者分为两组：低教育水平（未完成高中学业）和高教育水平（完成高中学业及以上）。采用 logistic 回归分析评估患者的人口统计学、病因和临床分期与教育水平之间的关系。在分析中，低教育水平是因变量。
共评估了 11107 名在意大利出生的患者（平均年龄 55.5 岁，性别比 1.5）。多因素 logistic 回归分析显示，慢性 HCV 感染（O.R.1.38：95%CI1.23-1.55）、危险饮酒（O.R.1.96；95%CI1.73-2.21）和肝硬化（O.R.1.65；95%CI1.46-1.85）均与未完成高中学业独立相关。HBV 感染与高教育水平独立相关（O.R.0.74；95%CI0.64-0.86），反映了近几十年来 HBV 传播模式的变化。与非酒精性脂肪性肝病相关的 CLD 无相关性（O.R.1.03；95%CI0.81-1.30）。
这些发现表明，教育水平与病毒和酒精相关的 CLD 之间存在独立关联。低教育水平与 CLD 的严重程度相关。
