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Education level impacts health outcomes for patients with CKD
Lower educational attainment was associated with increased risk for adverse health outcomes in patients with moderate to severe chronic kidney disease, according to a study published in the American Journal of Kidney Diseases.
“The inverse association between education and health outcomes is well established in the general population, with a gradient in health across levels of educational attainment,” Rachael L. Morton, PhD, of the National Health Medical Research Council Clinical Trials Centre at the University of Sydney, Australia, and colleagues wrote. “Two general mechanisms, lifestyle factors (or behaviors) and access to effective health care, are believed to contribute to this gradient. However, studies of the relevance of educational attainment to health outcomes in CKD are sparse.”
Researchers conducted a prospective epidemiological analysis of 9,270 adults with moderate to severe CKD (6,245 not receiving dialysis at baseline) and no history of myocardial infarction or coronary revascularization who had participated in the Study of Heart and Renal Protection (SHARP) trial.
Highest education level completed for each participant was recorded at study entry. Levels included postgraduate tertiary education, undergraduate tertiary education, high school, vocational studies, lower high school, primary school or no formal education.
The considered outcomes of the study were the occurrence of any vascular event (fatal or nonfatal cardiac, cerebrovascular or peripheral vascular event), cause-specific mortality and CKD progression.
Participants were followed for a median of 4.9 years. During this time, 2,317 participants experienced at least one vascular event and 2,257 participants died.
Researchers found that there was a significant trend toward increasing vascular event risk with lower levels of educational attainment and that participants with no formal education had a 46% higher risk for vascular events (RR = 1.46; 95% CI, 1.14-1.86) than participants with tertiary education.
Further, the trend for mortality across education levels was significant with all-cause mortality twice as high among those with no formal education (RR = 2.05; 95% CI, 1.62-2.58) vs. tertiary-educated individuals. Significant increases for both vascular (RR = 1.84; 95% CI, 1.21-2.81) and non-vascular (RR = 2.15; 95% CI, 1.60-2.89) deaths were also observed. Researchers noted that lifestyle factors and prior disease explained most of the excess mortality risk.
“These findings suggest that educational attainment should be taken into account when implementing interventions to reduce risk of adverse health outcomes in CKD,” the researchers wrote. – by Melissa J. Webb
Disclosures: Morton reports receiving support from the Australian National Health Medical Research Council. Please see the study for all other authors’ relevant financial disclosures.