Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Public Health. 2021 Jun;195:98-104. doi: 10.1016/j.puhe.2021.04.006. Epub 2021 May 30.
To examine the association between educational level and chronic kidney disease (CKD) among the Iranian population.
This is a prospective cohort study conducted in the framework of the Tehran Lipid and Glucose Study.
A total of 8173 Iranians (men = 3659) aged ≥20 years were included in the study. CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m. The association between educational status and CKD was explored using multivariate Cox proportional regression analyses, adjusted for age, gender, current smoking, marital status, body mass index, waist circumference, baseline eGFR, diabetes, hypertension, physical activity, history of cardiovascular diseases and dyslipidaemia.
During a median follow-up of 13.14 years, 2609 cases of incident CKD were identified; the corresponding incidence rate was 26.35 (range 25.39-27.34) per 1000 person-years. Compared to low educational level, middle and high educational levels showed lower risks for incident CKD in the crude model [hazard ratio (HR) 0.37 (95% confidence interval {CI} 0.34-0.40) and HR 0.40 (95% CI 0.35-0.45), respectively]; however, these HRs changed direction after further adjustment for age and gender [HR 1.26 (95% CI 1.14-1.39) and HR 1.40 (95% CI 1.22-1.61), respectively]. The increased risk of incident CKD for those at higher educational levels remained significant in the fully adjusted model. In addition, results from the gender stratified analyses were in the same direction as those found among the whole study population (P-value for interaction of gender and education >0.8).
Higher educational levels were associated with incident CKD during more than a decade of follow-up; this finding may be attributed to unhealthy lifestyle behaviours among this population group.
探讨伊朗人群中教育水平与慢性肾脏病（CKD）之间的关系。
这是在德黑兰血脂和血糖研究框架内进行的一项前瞻性队列研究。
共纳入 8173 名年龄≥20 岁的伊朗人（男性 3659 人）。CKD 的定义为估计肾小球滤过率（eGFR）<60 mL/min/1.73 m。使用多变量 Cox 比例风险回归分析探讨教育状况与 CKD 的关系，调整因素包括年龄、性别、当前吸烟状况、婚姻状况、体重指数、腰围、基线 eGFR、糖尿病、高血压、身体活动、心血管疾病和血脂异常史。
在中位随访 13.14 年期间，共确定了 2609 例新发 CKD 病例，相应的发病率为 26.35（范围 25.39-27.34）/1000 人年。与低教育水平相比，中、高教育水平在粗模型中显示出新发 CKD 的风险较低[风险比（HR）0.37（95%置信区间 {CI} 0.34-0.40）和 HR 0.40（95% CI 0.35-0.45）]；然而，在校正年龄和性别后，这些 HR 发生了变化[HR 1.26（95% CI 1.14-1.39）和 HR 1.40（95% CI 1.22-1.61）]。在完全调整模型中，较高教育水平的人新发 CKD 的风险仍然显著增加。此外，性别分层分析的结果与整个研究人群的结果一致（性别与教育之间交互作用的 P 值>0.8）。
在超过 10 年的随访期间，较高的教育水平与新发 CKD 相关；这一发现可能归因于该人群群体不健康的生活方式行为。
