Blomster, JI;
Zoungas, S;
Woodward, M;
Neal, B;
Harrap, S;
Poulter, N;
Marre, M;
... Hillis, GS; + view all
(2017)
The impact of level of education on vascular events and mortality in patients with type 2 diabetes mellitus: Results from the ADVANCE study.
Diabetes Research and Clinical Practice
, 127
pp. 212-217.
10.1016/j.diabres.2017.03.015.
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Abstract
Aims The relationship between educational level and the risk of all-cause mortality is well established, whereas the association with vascular events in individuals with type 2 diabetes is not well described. Any association may reflect a link with common cardiovascular or lifestyle-based risk factors. Methods The relationships between the highest level of educational attainment and major cardiovascular events, microvascular complications and all-cause mortality were explored in a cohort of 11,140 individuals with type 2 diabetes. Completion of formal education before the age of 16 was categorized as a low level of education. Regional differences between Asia, East Europe and Established Market Economies were also assessed. Results During a median of 5 years of follow up, 1031 (9%) patients died, 1147 (10%) experienced a major cardiovascular event and 1136 (10%) a microvascular event. After adjustment for baseline characteristics and risk factors, individuals with lower education had an increased risk of cardiovascular events (hazard ratio (HR) 1.31, 95% CI 1.16–1.48, p < 0.0001), microvascular events (HR 1.23, 95% CI 1.08–1.39, p = 0.0013) and all-cause mortality (HR 1.34, 95% CI 1.18–1.52, p < 0.0001). In regional analyses the increased risk of studied outcomes associated with lower education was weakest in Established Market Economies and strongest in East Europe. Conclusions A low level of education is associated with an increased risk of vascular events and death in patients with type 2 diabetes, independently of common lifestyle associated cardiovascular risk factors. The effect size varies between geographical regions.
| Type: | Article |
|---|---|
| Title: | The impact of level of education on vascular events and mortality in patients with type 2 diabetes mellitus: Results from the ADVANCE study |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.diabres.2017.03.015 |
| Publisher version: | https://doi.org/10.1016/j.diabres.2017.03.015 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Science & Technology, Life Sciences & Biomedicine, Endocrinology & Metabolism, Type 2 diabetes, Level of education, Cardiovascular events, Microvascular events, OF-THE-LITERATURE, CARDIOVASCULAR-DISEASE, SOCIOECONOMIC POSITION, PHYSICAL-ACTIVITY, INCOME COUNTRIES, RISK-FACTORS, US ADULTS, FOLLOW-UP, LIFE, HEALTH |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10069263 |
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