Bai Xue, Chen Lantao, Ren Fenghai, Zhao Ying, Zheng Yue, Wang Yanbo, Pang Sainan, Zhang Jian, Guo Erliang, Li Huiyan
Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, Heilongjiang, 150081, China.
BMC Pulm Med. 2025 Apr 30;25(1):209. doi: 10.1186/s12890-025-03658-1.
Clinical observational studies have shown an association between educational attainment and a lower incidence of Chronic Obstructive Pulmonary Disease (COPD). However, strong evidence for a causal relationship remains lacking.
Genome-wide association data for years of schooling, cognitive performance, intelligence, COPD, and COPD-related risk factors such as smoking and asthma were obtained from public databases. We conducted two-sample Mendelian randomization (MR) analyses to assess the causal relationships between years of schooling, cognitive performance, intelligence, and the risk of developing COPD. Sensitivity analyses using MR-Egger and MR-PRESSO were performed to detect and correct for pleiotropy. Multivariable Mendelian randomization analysis was used to identify potential mediators.
Longer years of schooling (OR = 0.537, 95% CI: 0.474-0.608, P = 9.63E-23), higher cognitive performance (OR = 0.793, 95% CI: 0.702-0.895, P = 1.78E-04), and intelligence (OR = 0.813, 95% CI: 0.720-0.919, P = 8.81E-04) were causally associated with a reduced risk of COPD. Longer years of schooling were identified as an independent protective factor for COPD risk (OR = 0.600, 95% CI: 0.472 - 0.762, P = 2.85E-05). Smoking initiation and asthma were identified as mediating factors in the causal relationship between years of schooling and COPD risk. In the reduction of the COPD risk by years of schooling, the mediating effects of smoking initiation and asthma accounted for 32.8% and 6.9% respectively.
These findings provide support for the causal impact of educational attainment on the occurrence of COPD, with a significant portion of this causal effect being mediated through modifiable risk factors. On the premise of controlling socioeconomic - status - related confounders, an increase in educational attainment may provide multi-level intervention targets for COPD prevention through intervenable pathways such as improving health behaviors and environmental exposure.
临床观察性研究表明，受教育程度与慢性阻塞性肺疾病（COPD）发病率较低之间存在关联。然而，因果关系的有力证据仍然缺乏。
从公共数据库中获取了关于受教育年限、认知能力、智力、COPD以及吸烟和哮喘等COPD相关危险因素的全基因组关联数据。我们进行了两样本孟德尔随机化（MR）分析，以评估受教育年限、认知能力、智力与患COPD风险之间的因果关系。使用MR-Egger和MR-PRESSO进行敏感性分析，以检测和校正多效性。多变量孟德尔随机化分析用于确定潜在的中介因素。
受教育年限较长（OR = 0.537，95% CI：0.474 - 0.608，P = 9.63E - 23）、认知能力较高（OR = 0.793，95% CI：0.702 - 0.895，P = 1.78E - 04）和智力较高（OR = 0.813，95% CI：0.720 - 0.919，P = 8.81E - 04）与COPD风险降低存在因果关联。受教育年限较长被确定为COPD风险的独立保护因素（OR = 0.600，95% CI：0.472 - 0.762，P = 2.85E - 05）。开始吸烟和哮喘被确定为受教育年限与COPD风险之间因果关系的中介因素。在受教育年限降低COPD风险方面，开始吸烟和哮喘的中介作用分别占32.8%和6.9%。
这些发现为受教育程度对COPD发生的因果影响提供了支持，这种因果效应的很大一部分是通过可改变的危险因素介导的。在控制与社会经济地位相关的混杂因素的前提下，提高受教育程度可能通过改善健康行为和环境暴露等可干预途径，为COPD预防提供多层次的干预靶点。
