The impact of education level on all-cause mortality in patients with atrial fibrillation

Abstract The association between socioeconomic status and cardiovascular morbidity and mortality is well known, but data on the influence of education level on mortality in individuals with atrial fibrillation (AF) are scarce. We investigated education level as a predictor of all-cause mortality in patients diagnosed with AF. This retrospective cohort study used a database created from several Swedish nationwide registries to identify all patients hospitalized with a diagnosis of AF from 1995 through 2008. Education level was categorized as primary, secondary, and academic. All-cause mortality risk was estimated in subpopulations defined by Charlson´s Comorbidity Index and several comorbidities. A total of 272,182 patients (56% male; mean age 72 ± 10 years) were followed over a five-year period. Cox regression models showed a reduction in all–cause mortality risk with increased education level. Hazard ratios (HR) relative to primary education remained significant after stratification and adjustment for several confounders: secondary education HR = 0.88; 95% CI: 0.86–0.89; p < 0.001; academic education HR = 0.70; 95% CI: 0.67–0.72; p < 0.001. Subpopulation analyses further confirmed that the relative risk reduction associated with a higher education level was statistically significant, regardless of comorbidity.