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

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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
Volume10
DOIs
Publication statusPublished - 25 Oct 2018

Keywords

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

Cite this

Wu, Hongjiang ; Lau, Eric S.H. ; Kong, Alice P.S. ; Ma, Ronald C.W. ; Ozaki, Risa ; Cheung, Kitty K.T. ; Chow, Elaine ; Tsang, Chiu Chi ; Lau, Kam Piu ; Hui, Eric M.T. ; So, Wing Yee ; Gasevic, Danijela ; Wild, Sarah H. ; Chan, Juliana C.N. ; Luk, Andrea. / 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. In: Clinical Epidemiology. 2018 ; Vol. 10. pp. 1561-1571.
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title = "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",
abstract = "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 = "All-cause mortality, Cardiovascular disease, Diabetes, Educational level, Socioeconomic status",
author = "Hongjiang Wu and Lau, {Eric S.H.} and Kong, {Alice P.S.} and Ma, {Ronald C.W.} and Risa Ozaki and Cheung, {Kitty K.T.} and Elaine Chow and Tsang, {Chiu Chi} and Lau, {Kam Piu} and Hui, {Eric M.T.} and So, {Wing Yee} and Danijela Gasevic and Wild, {Sarah H.} and Chan, {Juliana C.N.} and Andrea Luk",
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language = "English",
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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. / Wu, Hongjiang; Lau, Eric S.H.; Kong, Alice P.S.; Ma, Ronald C.W.; Ozaki, Risa; Cheung, Kitty K.T.; Chow, Elaine; Tsang, Chiu Chi; Lau, Kam Piu; Hui, Eric M.T.; So, Wing Yee; Gasevic, Danijela; Wild, Sarah H.; Chan, Juliana C.N.; Luk, Andrea.

In: Clinical Epidemiology, Vol. 10, 25.10.2018, p. 1561-1571.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Association between educational level and cardiovascular disease and all-cause mortality in patients with type 2 diabetes

T2 - A prospective study in the joint asia diabetes evaluation program

AU - Wu, Hongjiang

AU - Lau, Eric S.H.

AU - Kong, Alice P.S.

AU - Ma, Ronald C.W.

AU - Ozaki, Risa

AU - Cheung, Kitty K.T.

AU - Chow, Elaine

AU - Tsang, Chiu Chi

AU - Lau, Kam Piu

AU - Hui, Eric M.T.

AU - So, Wing Yee

AU - Gasevic, Danijela

AU - Wild, Sarah H.

AU - Chan, Juliana C.N.

AU - Luk, Andrea

PY - 2018/10/25

Y1 - 2018/10/25

N2 - 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.

AB - 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.

KW - All-cause mortality

KW - Cardiovascular disease

KW - Diabetes

KW - Educational level

KW - Socioeconomic status

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