Impact of Educational Attainment on Health Outcomes in Moderate to Severe CKD

Rachael Morton, Iryna Schlackow, Natalie D Staplin, Alastair Gray, Alan Cass, Richard Haynes, Joanthan Emberson, William Herrington, Martin Landray, Colin Baigent, Borislava Mihaylova

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: The inverse association between educational attainment and mortality is well established, but its relevance to vascular events and renal progression in a population with chronic kidney disease (CKD) is less clear. This study aims to determine the association between highest educational attainment and risk of vascular events, cause-specific mortality, and CKD progression.

    Study Design: Prospective epidemiologic analysis among participants in the Study of Heart and Renal Protection (SHARP), a randomized controlled trial.

    Setting & Participants: 9,270 adults with moderate to severe CKD (6,245 not receiving dialysis at baseline) and no history of myocardial infarction or coronary revascularization recruited in Europe, North America, Asia, Australia, and New Zealand.
     
    Predictor: Highest educational attainment measured at study entry using 6 levels that ranged from "no formal education" to "tertiary education."

    Outcomes: Any vascular event (any fatal or nonfatal cardiac, cerebrovascular, or peripheral vascular event), cause-specific mortality, and CKD progression during 4.9 years' median follow-up.

    Results: There was a significant trend (P < 0.001) toward increased vascular risk with decreasing levels of education. Participants with no formal education were at a 46% higher risk of vascular events (relative risk [RR], 1.46; 95% CI, 1.14-1.86) compared with participants with tertiary education. The trend for mortality across education levels was also significant (P < 0.001): all-cause mortality was twice as high among those with no formal education compared with tertiary-educated individuals (RR, 2.05; 95% CI, 1.62-2.58), and significant increases were seen for both vascular (RR, 1.84; 95% CI, 1.21-2.81) and nonvascular (RR, 2.15; 95% CI, 1.60-2.89) deaths. Lifestyle factors and prior disease explain most of the excess mortality risk. Among 6,245 participants not receiving dialysis at baseline, education level was not significantly associated with progression to end-stage renal disease or doubling of creatinine level (P for trend = 0.4).

    Limitations: No data for employment or health insurance coverage.

    Conclusions: Lower educational attainment is associated with increased risk of adverse health outcomes in individuals with CKD.
    Original languageEnglish
    Pages (from-to)31-39
    Number of pages9
    JournalAmerican Journal of Kidney Diseases
    Volume67
    Issue number1
    DOIs
    Publication statusPublished - Jan 2016

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    Chronic Renal Insufficiency
    Blood Vessels
    Education
    Health
    Mortality
    Disease Progression
    Dialysis
    Northern Asia
    Kidney
    Insurance Coverage
    Health Insurance
    North America
    New Zealand
    Chronic Kidney Failure
    Life Style
    Creatinine
    Randomized Controlled Trials
    Myocardial Infarction
    Prospective Studies
    Population

    Cite this

    Morton, Rachael ; Schlackow, Iryna ; Staplin, Natalie D ; Gray, Alastair ; Cass, Alan ; Haynes, Richard ; Emberson, Joanthan ; Herrington, William ; Landray, Martin ; Baigent, Colin ; Mihaylova, Borislava. / Impact of Educational Attainment on Health Outcomes in Moderate to Severe CKD. In: American Journal of Kidney Diseases. 2016 ; Vol. 67, No. 1. pp. 31-39.
    @article{057be97c58c64390acca6a2da4d7d1e9,
    title = "Impact of Educational Attainment on Health Outcomes in Moderate to Severe CKD",
    abstract = "Background: The inverse association between educational attainment and mortality is well established, but its relevance to vascular events and renal progression in a population with chronic kidney disease (CKD) is less clear. This study aims to determine the association between highest educational attainment and risk of vascular events, cause-specific mortality, and CKD progression. Study Design: Prospective epidemiologic analysis among participants in the Study of Heart and Renal Protection (SHARP), a randomized controlled trial. Setting & Participants: 9,270 adults with moderate to severe CKD (6,245 not receiving dialysis at baseline) and no history of myocardial infarction or coronary revascularization recruited in Europe, North America, Asia, Australia, and New Zealand. Predictor: Highest educational attainment measured at study entry using 6 levels that ranged from {"}no formal education{"} to {"}tertiary education.{"} Outcomes: Any vascular event (any fatal or nonfatal cardiac, cerebrovascular, or peripheral vascular event), cause-specific mortality, and CKD progression during 4.9 years' median follow-up. Results: There was a significant trend (P < 0.001) toward increased vascular risk with decreasing levels of education. Participants with no formal education were at a 46{\%} higher risk of vascular events (relative risk [RR], 1.46; 95{\%} CI, 1.14-1.86) compared with participants with tertiary education. The trend for mortality across education levels was also significant (P < 0.001): all-cause mortality was twice as high among those with no formal education compared with tertiary-educated individuals (RR, 2.05; 95{\%} CI, 1.62-2.58), and significant increases were seen for both vascular (RR, 1.84; 95{\%} CI, 1.21-2.81) and nonvascular (RR, 2.15; 95{\%} CI, 1.60-2.89) deaths. Lifestyle factors and prior disease explain most of the excess mortality risk. Among 6,245 participants not receiving dialysis at baseline, education level was not significantly associated with progression to end-stage renal disease or doubling of creatinine level (P for trend = 0.4). Limitations: No data for employment or health insurance coverage. Conclusions: Lower educational attainment is associated with increased risk of adverse health outcomes in individuals with CKD.",
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    author = "Rachael Morton and Iryna Schlackow and Staplin, {Natalie D} and Alastair Gray and Alan Cass and Richard Haynes and Joanthan Emberson and William Herrington and Martin Landray and Colin Baigent and Borislava Mihaylova",
    year = "2016",
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    language = "English",
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    Morton, R, Schlackow, I, Staplin, ND, Gray, A, Cass, A, Haynes, R, Emberson, J, Herrington, W, Landray, M, Baigent, C & Mihaylova, B 2016, 'Impact of Educational Attainment on Health Outcomes in Moderate to Severe CKD', American Journal of Kidney Diseases, vol. 67, no. 1, pp. 31-39. https://doi.org/10.1053/j.ajkd.2015.07.021

    Impact of Educational Attainment on Health Outcomes in Moderate to Severe CKD. / Morton, Rachael; Schlackow, Iryna; Staplin, Natalie D; Gray, Alastair; Cass, Alan; Haynes, Richard; Emberson, Joanthan; Herrington, William; Landray, Martin; Baigent, Colin; Mihaylova, Borislava.

    In: American Journal of Kidney Diseases, Vol. 67, No. 1, 01.2016, p. 31-39.

    Research output: Contribution to journalArticleResearchpeer-review

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    T1 - Impact of Educational Attainment on Health Outcomes in Moderate to Severe CKD

    AU - Morton, Rachael

    AU - Schlackow, Iryna

    AU - Staplin, Natalie D

    AU - Gray, Alastair

    AU - Cass, Alan

    AU - Haynes, Richard

    AU - Emberson, Joanthan

    AU - Herrington, William

    AU - Landray, Martin

    AU - Baigent, Colin

    AU - Mihaylova, Borislava

    PY - 2016/1

    Y1 - 2016/1

    N2 - Background: The inverse association between educational attainment and mortality is well established, but its relevance to vascular events and renal progression in a population with chronic kidney disease (CKD) is less clear. This study aims to determine the association between highest educational attainment and risk of vascular events, cause-specific mortality, and CKD progression. Study Design: Prospective epidemiologic analysis among participants in the Study of Heart and Renal Protection (SHARP), a randomized controlled trial. Setting & Participants: 9,270 adults with moderate to severe CKD (6,245 not receiving dialysis at baseline) and no history of myocardial infarction or coronary revascularization recruited in Europe, North America, Asia, Australia, and New Zealand. Predictor: Highest educational attainment measured at study entry using 6 levels that ranged from "no formal education" to "tertiary education." Outcomes: Any vascular event (any fatal or nonfatal cardiac, cerebrovascular, or peripheral vascular event), cause-specific mortality, and CKD progression during 4.9 years' median follow-up. Results: There was a significant trend (P < 0.001) toward increased vascular risk with decreasing levels of education. Participants with no formal education were at a 46% higher risk of vascular events (relative risk [RR], 1.46; 95% CI, 1.14-1.86) compared with participants with tertiary education. The trend for mortality across education levels was also significant (P < 0.001): all-cause mortality was twice as high among those with no formal education compared with tertiary-educated individuals (RR, 2.05; 95% CI, 1.62-2.58), and significant increases were seen for both vascular (RR, 1.84; 95% CI, 1.21-2.81) and nonvascular (RR, 2.15; 95% CI, 1.60-2.89) deaths. Lifestyle factors and prior disease explain most of the excess mortality risk. Among 6,245 participants not receiving dialysis at baseline, education level was not significantly associated with progression to end-stage renal disease or doubling of creatinine level (P for trend = 0.4). Limitations: No data for employment or health insurance coverage. Conclusions: Lower educational attainment is associated with increased risk of adverse health outcomes in individuals with CKD.

    AB - Background: The inverse association between educational attainment and mortality is well established, but its relevance to vascular events and renal progression in a population with chronic kidney disease (CKD) is less clear. This study aims to determine the association between highest educational attainment and risk of vascular events, cause-specific mortality, and CKD progression. Study Design: Prospective epidemiologic analysis among participants in the Study of Heart and Renal Protection (SHARP), a randomized controlled trial. Setting & Participants: 9,270 adults with moderate to severe CKD (6,245 not receiving dialysis at baseline) and no history of myocardial infarction or coronary revascularization recruited in Europe, North America, Asia, Australia, and New Zealand. Predictor: Highest educational attainment measured at study entry using 6 levels that ranged from "no formal education" to "tertiary education." Outcomes: Any vascular event (any fatal or nonfatal cardiac, cerebrovascular, or peripheral vascular event), cause-specific mortality, and CKD progression during 4.9 years' median follow-up. Results: There was a significant trend (P < 0.001) toward increased vascular risk with decreasing levels of education. Participants with no formal education were at a 46% higher risk of vascular events (relative risk [RR], 1.46; 95% CI, 1.14-1.86) compared with participants with tertiary education. The trend for mortality across education levels was also significant (P < 0.001): all-cause mortality was twice as high among those with no formal education compared with tertiary-educated individuals (RR, 2.05; 95% CI, 1.62-2.58), and significant increases were seen for both vascular (RR, 1.84; 95% CI, 1.21-2.81) and nonvascular (RR, 2.15; 95% CI, 1.60-2.89) deaths. Lifestyle factors and prior disease explain most of the excess mortality risk. Among 6,245 participants not receiving dialysis at baseline, education level was not significantly associated with progression to end-stage renal disease or doubling of creatinine level (P for trend = 0.4). Limitations: No data for employment or health insurance coverage. Conclusions: Lower educational attainment is associated with increased risk of adverse health outcomes in individuals with CKD.

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