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

Hongjiang Wu, Eric S.H. Lau, Alice P.S. Kong, Ronald C.W. Ma, Risa Ozaki, Kitty K.T. Cheung, Elaine Chow, Chiu Chi Tsang, Kam Piu Lau, Eric M.T. Hui, Wing Yee So, Danijela Gasevic, Sarah H. Wild, Juliana C.N. Chan, Andrea Luk

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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.

Original languageEnglish
Pages (from-to)1561-1571
Number of pages11
JournalClinical Epidemiology
Publication statusPublished - 25 Oct 2018


  • All-cause mortality
  • Cardiovascular disease
  • Diabetes
  • Educational level
  • Socioeconomic status

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