Relationship of education to major risk factors and death from coronary heart disease, cardiovascular diseases and all causes, Findings of three Chicago epidemiologic studies.

Abstract

The relationship of education to risk factors at baseline and to long-term mortality from coronary heart disease (CHD), cardiovascular diseases (CVD) and all causes was analyzed for 3 cohorts of middle-aged employed white men in Chicago: 8047 from the Chicago Heart Association Detection Project in Industry (CHA) (entry 1967-1973), 1250 from the Peoples Gas Company Study (PG) (entry 1958-1959) and 1730 from the Western Electric Study (WE) (entry 1957-1958). Each man was classified into 1 of 4 groups: not a high school graduate, high school graduate, some college but not a graduate, or college graduate. For all 3 cohorts, a graded, inverse association was observed at baseline between education and blood pressure, which was statistically significant for CHA and WE men and independent of age and relative weight. For all 3 cohorts, a significant, graded, inverse association was also recorded between education and cigarette use at entry. For serum cholesterol, no clear pattern was observed for the education groups in any of the 3 cohorts. CHA men showed a graded, inverse relationship between education and relative weight. This cohort was the only 1 of 3 showing a significant, graded inverse association between education and prevalence of ECG abnormalities at entry. For this CHA cohort, 5-yr follow-up data showed a statistically significant, graded, inverse relationship between education and age-adjusted mortality rates from CHD, CVD and all causes. With adjustment for entry age, diastolic pressure, cigarettes, serum cholesterol, relative weight and ECG abnormalities, this inverse relationship remained, reduced in degree but still statistically significant for CVD mortality. Similarly, for the pooled PG-WE cohort of 2980 with 20-21 yr of follow-up, education and the 3 mortality endpoints were inversely related but not graded, with statistical significance for all 3 endpoints in the univariate analyses. The results of these studies indicate inverse relationships between education and lifestyle-related risk factors at baseline and between education and long-term risk of CHD, CVD and all-causes mortality. The inverse relationship between education and mortality is accounted for in part by the established major biomedical risk factors.