Institute of Health, Guangdong Pharmaceutical University, Guangzhou, GuangDong, People's Republic of China.
Guangdong Engineering Research Center for Light and Health, Guangzhou Higher Education Mega Center, Guangdong Pharmaceutical University, Guangzhou, GuangDong, People's Republic of China.
Sci Rep. 2020 Dec 3;10(1):21208. doi: 10.1038/s41598-020-78248-8.
We aim to characterize the association between education and incident stroke (including total stroke, ischemic stroke, and hemorrhagic stroke) and assess whether there is a causal relationship between them. The final sample size was 11,509 in this study from the Atherosclerosis Risk in Communities (ARIC) study. Cox hazard regression models were used to explore the association between education level and incident stroke. Two-sample Mendelian randomization (MR) was used to estimate the causality. During a median follow-up of 25.3 years, 915 cases (8.0%) of stroke occurred. Participants with advanced education level were associated with 25% (HR 0.75; 95% CI 0.62, 0.91) decreased the rate of incident total stroke. Hazard ratio of intermediate and advanced education level for ischemic stroke were 0.82 (0.69, 0.98) and 0.73 (0.60, 0.90) separately. In the MR analysis, we observed evidence that education was likely a negetive causal risk factor for ischemic stroke (OR 0.764, 95% CI 0.585-0.998, P = 0.048). Higher education level was associated with a decreased rate of total stroke and ischemic stroke incident, but not hemorrhagic stroke incident. There might be a protective causal association between education and ischemic stroke (but not total stroke nor hemorrhagic stroke).
我们旨在描述教育程度与卒中（包括总卒中、缺血性卒中和出血性卒中）发病之间的关联，并评估两者之间是否存在因果关系。本研究最终样本量为 11509 例，来自动脉粥样硬化风险社区（ARIC）研究。使用 Cox 风险回归模型探讨教育水平与卒中发病之间的关联。采用双样本 Mendelian 随机化（MR）来估计因果关系。在中位数为 25.3 年的随访期间，发生了 915 例（8.0%）卒中。具有较高教育程度的参与者卒中总发病风险降低了 25%（HR 0.75；95%CI 0.62, 0.91）。中高等教育程度与缺血性卒中的风险比分别为 0.82（0.69, 0.98）和 0.73（0.60, 0.90）。在 MR 分析中，我们观察到证据表明，教育程度可能是缺血性卒中的负向因果风险因素（OR 0.764，95%CI 0.585-0.998，P=0.048）。较高的教育程度与总卒中及缺血性卒中发病风险降低相关，但与出血性卒中发病风险无关。教育程度与缺血性卒中（而非总卒中或出血性卒中）之间可能存在保护因果关联。
