Association between educational level and cardiovascular disease and all-cause mortality in patients with type 2 diabetes: a prospective study in the Joint Asia Diabetes Evaluation Program
Received 16 June 2018
Accepted for publication 22 August 2018
Published 25 October 2018 Volume 2018:10 Pages 1561—1571
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 3
Editor who approved publication: Professor Irene Petersen
Hongjiang Wu,1,2 Eric SH Lau,3 Alice PS Kong,2,4 Ronald CW Ma,2,4 Risa Ozaki,4 Kitty KT Cheung,4 Elaine Chow,4 Chiu Chi Tsang,5 Kam Piu Lau,6 Eric MT Hui,7 Wing Yee So,8 Danijela Gasevic,1,9 Sarah H Wild,1 Juliana CN Chan,2–4 Andrea Luk2–4
1Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK; 2Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China; 3Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China; 4Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China; 5Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China; 6Northern District Hospital, Fanling, Hong Kong SAR, China; 7Department of Family Medicine, Prince of Wales Hospital, Hong Kong SAR, China; 8Hospital Authority Head Office, Hong Kong SAR, China; 9School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Purpose: The aim of this study was to describe the association between educational level and incident cardiovascular disease (CVD) and all-cause mortality in Hong Kong Chinese patients with type 2 diabetes.
Patients and methods: We included 12,634 patients with type 2 diabetes who were enrolled into the Joint Asia Diabetes Evaluation Program between June 1, 2007, and June 30, 2017. We classified patients’ educational level into the following three groups: ≤6 years, 6–13 years, and >13 years. Incident CVD events were identified using hospital discharge diagnoses. Death was identified from Hong Kong Death Register. We estimated HRs for incident CVD and all-cause mortality using Cox regression models.
Results: Patients with the highest educational level were younger and had shorter diabetes duration and better glycemic control at enrollment than those with the lowest educational level. During the median follow-up of 6.2 years for CVD and 6.4 years for all-cause mortality, 954 CVD events and 833 deaths were recorded. HRs for CVD and all-cause mortality were 0.73 (95% CI: 0.57, 0.94) and 0.71 (95% CI: 0.54, 0.94) for the highest educational level compared to the lowest educational level, after adjustment for age, sex, diabetes duration, and family history of diabetes.
Conclusion: Educational level is inversely associated with the risk of CVD and all-cause mortality among Hong Kong Chinese patients with type 2 diabetes. Hong Kong Chinese patients with type 2 diabetes and low educational level should be given special attention for the prevention of key complications of diabetes.
Keywords: socioeconomic status, educational level, diabetes, cardiovascular disease, all-cause mortality
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