RT Journal Article
SR Electronic
T1 Socioeconomic status in relation to cardiovascular disease and cause-specific mortality: a comparison of Asian and Australasian populations in a pooled analysis
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e006408
DO 10.1136/bmjopen-2014-006408
VO 5
IS 3
A1 Mark Woodward
A1 Sanne A E Peters
A1 G David Batty
A1 Hirotsugu Ueshima
A1 Jean Woo
A1 Graham G Giles
A1 Federica Barzi
A1 Suzanne C Ho
A1 Rachel R Huxley
A1 Hisatomi Arima
A1 Xianghua Fang
A1 Annette Dobson
A1 Tai Hing Lam
A1 Prin Vathesatogkit
A1 on behalf of the Asia Pacific Cohort Studies Collaboration
YR 2015
UL http://bmjopen.bmj.com/content/5/3/e006408.abstract
AB Objectives In Western countries, lower socioeconomic status is associated with a higher risk of cardiovascular disease (CVD) and premature mortality. These associations may plausibly differ in Asian populations, but data are scarce and direct comparisons between the two regions are lacking. We, thus, aimed to compare such associations between Asian and Western populations in a large collaborative study, using the highest level of education attained as our measure of social status. Setting Cohort studies in general populations conducted in Asia or Australasia. Participants 303 036 people (71% from Asia) from 24 studies in the Asia Pacific Cohort Studies Collaboration. Studies had to have a prospective cohort study design, have accumulated at least 5000 person-years of follow-up, recorded date of birth (or age), sex and blood pressure at baseline and date of, or age at, death during follow-up. Outcome measures We used Cox regression models to estimate relationships between educational attainment and CVD (fatal or non-fatal), as well as all-cause, cardiovascular and cancer mortality. Results During more than two million person-years of follow-up, 11 065 deaths (3655 from CVD and 4313 from cancer) and 1809 CVD non-fatal events were recorded. Adjusting for classical CVD risk factors and alcohol drinking, hazard ratios (95% CIs) for primary relative to tertiary education in Asia (Australasia) were 1.81 (1.38, 2.36) (1.10 (0.99, 1.22)) for all-cause mortality, 2.47(1.47, 4.17) (1.24 (1.02, 1.51)) for CVD mortality, 1.66 (1.00, 2.78) (1.01 (0.87, 1.17)) for cancer mortality and 2.09 (1.34, 3.26) (1.23 (1.04, 1.46)) for all CVD. Conclusions Lower educational attainment is associated with a higher risk of CVD or premature mortality in Asia, to a degree exceeding that in the Western populations of Australasia.