Low educational attainment is associated with higher all-cause and cardiovascular mortality in the United States adult population. 

 -  2023 
<br/><br/>Available online from MWHC library: 2001 - present 
<br/><br/> CONCLUSIONS: Lower educational attainment is independently associated with increased risk of all-cause and CVD mortality in both the total and ASCVD populations, with the highest risk observed for individuals with < HS education. Future efforts to understand persistent disparities in CVD and all-cause mortality should pay close attention to the role of education, and include educational attainment as an independent predictor in mortality risk prediction algorithms. Copyright © 2023. The Author(s).  INTRODUCTION: Educational attainment is an important social determinant of health (SDOH) for cardiovascular disease (CVD). However, the association between educational attainment and all-cause and CVD mortality has not been longitudinally evaluated on a population-level in the US, especially in individuals with atherosclerotic cardiovascular disease (ASCVD). In this nationally representative study, we assessed the association between educational attainment and the risk of all-cause and cardiovascular (CVD) mortality in the general adult population and in adults with ASCVD in the US.  METHODS: We used data from the 2006-2014 National Death Index-linked National Health Interview Survey for adults >= 18 years. We generated age-adjusted mortality rates (AAMR) by levels of educational attainment (< high school (HS), HS/General Education Development (GED), some college, and >= College) in the overall population and in adults with ASCVD. Cox proportional hazards models were used to examine the multivariable-adjusted associations between educational attainment and all-cause and CVD mortality.  RESULTS: The sample comprised 210,853 participants (mean age 46.3), representing ~ 189 million adults annually, of which 8% had ASCVD. Overall, 14.7%, 27%, 20.3%, and 38% of the population had educational attainment < HS, HS/GED, Some College, and >= College, respectively. During a median follow-up of 4.5 years, all-cause age-adjusted mortality rates were 400.6 vs. 208.6 and 1446.7 vs. 984.0 for the total and ASCVD populations for < HS vs >= College education, respectively. CVD age adjusted mortality rates were 82.1 vs. 38.7 and 456.4 vs 279.5 for the total and ASCVD populations for < HS vs >= College education, respectively. In models adjusting for demographics and SDOH, < HS (reference = >= College) was associated with 40-50% increased risk of mortality in the total population and 20-40% increased risk of mortality in the ASCVD population, for both all-cause and CVD mortality. Further adjustment for traditional risk factors attenuated the associations but remained statistically significant for < HS in the overall population. Similar trends were seen across sociodemographic subgroups including age, sex, race/ethnicity, income, and insurance status. 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>1471-2458 
<br/><br/><label>Standard No.: </label>10.1186/s12889-023-15621-y [doi] 10.1186/s12889-023-15621-y [pii] 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Cardiovascular Diseases<br/>Adult<br/>Cardiovascular Diseases/ep [Epidemiology]<br/>Educational Status<br/>Ethnicity<br/>Humans<br/>Middle Aged<br/>Proportional Hazards Models<br/>Risk Factors<br/>United States/ep [Epidemiology]--Automated
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Union Memorial Hospital
<br/><br/><label>Index Terms--Occupation: </label><br/>Internal Medicine Residency
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article