Khan, Najah, Javed, Zulqarnain, Acquah, Isaac, Hagan, Kobina, Khan, Madiha, Valero-Elizondo, Javier, Chang, Ryan, Javed, Umair, Taha, Mohamad B., Blaha, Michael J., Virani, Salim S., Sharma, Garima, Blankstein, Ron, Gulati, Martha, Mossialos, Elias, Hyder, Adnan A., Achirica, Miguel Cainzos, Nasir, Khurram, Khan, Najah, Javed, Zulqarnain, Acquah, Isaac, Hagan, Kobina, Khan, Madiha, Valero-Elizondo, Javier, Chang, Ryan, Javed, Umair, Taha, Mohamad B., Blaha, Michael J., Virani, Salim S., Sharma, Garima, Blankstein, Ron, Gulati, Martha, Mossialos, Elias, Hyder, Adnan A., Achirica, Miguel Cainzos, and Nasir, Khurram
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 adju