Association of Educational Attainment With Chronic Disease and Mortality: The Kidney Early Evaluation Program (KEEP)

• Published in: American journal of kidney diseases Vol. 58; no. 2; pp. 228 - 234
• Main Authors: Choi, Andy I., MD, Weekley, Cristin C., BA, Chen, Shu-Cheng, MS, Li, Suying, PhD, Kurella Tamura, Manjula, MD, Norris, Keith C., MD, Shlipak, Michael G., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2011; Elsevier
• Subjects: Biological and medical sciences; Chronic Disease; chronic kidney disease; Education; Educational Status; Female; Humans; Kidney Diseases - mortality; Kidneys; Male; Medical sciences; Middle Aged; mortality; Nephrology; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Renal failure; Urinary system involvement in other diseases. Miscellaneous; mortality; Education; chronic kidney disease; Kidney disease; Evaluation; Nephrology; Urinary system disease; Program; Mortality; Chronic kidney disease; Epidemiology; Urology; Association; Renal failure; Early
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2011.02.388

Background Recent reports have suggested a close relationship between education and health, including mortality, in the United States. Study Design Observational cohort. Setting & Participants We studied 61,457 participants enrolled in a national health screening initiative, the National Kidney Foundation's Kidney Early Evaluation Program (KEEP). Predictor Self-reported educational attainment. Outcomes Chronic diseases (hypertension, diabetes, cardiovascular disease, reduced kidney function, and albuminuria) and mortality. Measurements We evaluated cross-sectional associations between self-reported educational attainment with the chronic diseases listed using logistic regression models adjusted for demographics, access to care, behaviors, and comorbid conditions. The association of educational attainment with survival was determined using multivariable Cox proportional hazards regression. Results Higher educational attainment was associated with a lower prevalence of each of the chronic conditions listed. In multivariable models, compared with persons not completing high school, college graduates had a lower risk of each chronic condition, ranging from 11% lower odds of decreased kidney function to 37% lower odds of cardiovascular disease. During a mean follow-up of 3.9 (median, 3.7) years, 2,384 (4%) deaths occurred. In the fully adjusted Cox model, those who had completed college had 24% lower mortality compared with participants who had completed at least some high school. Limitations Lack of income data does not allow us to disentangle the independent effects of education from income. Conclusions In this diverse contemporary cohort, higher educational attainment was associated independently with a lower prevalence of chronic diseases and short-term mortality in all age and race/ethnicity groups.