Abstract 14405: Impact of Educational Attainment on All-Cause and Cardiovascular Mortality: Findings From a National Study of US Adults

Introduction: Education is an important determinant of cardiovascular disease (CVD). However, the extent to which educational attainment impacts the risk of all-cause and cardiovascular (CV) mortality on a population level is relatively understudied. Methods: We used data from 2006-2014 National Death Index-linked National Health Interview Survey for adults ≥ 18 years. We generated age-adjusted mortality rates (AAMR) by levels of education (< High School (HS), HS/General Education Development (GED), Some College, and > College) in adults with and without CVD. Cox proportional hazards models were used to examine the association between educational attainment and all-cause and CV mortality. Results: Final sample comprised of 256,991 participants (mean age=46.3), representing ~230 million adults annually, of which 8% had ASCVD. Overall, 14.8% of participants had College education, respectively. During a median follow-up of 4.5 (IQR: 2.5-6.8) years (1179 million person-years), all-cause and CV AAMRs were approximately 1.5 and 2 fold higher, respectively, for College education in the CVD population and 2 fold higher in the non-CVD population ( Figure 1 ). In fully adjusted models, < HS (reference= >College) was associated with 20% increased risk of all-cause (HR 1.20, 95% CI: 1.07-1.35) and 40% increased risk of CV mortality (HR 1.41, 95% CI: 1.10-1.81) in the CVD population, compared to 40-45% increased risk of mortality in the non-CVD population (all-cause mortality HR 1.39, 95% CI: 1.29-1.49; CV mortality HR 1.45, 95% CI: 1.20-1.75). Similar trends were seen by race/ethnicity (data not shown). Conclusions: Lower education is an independent predictor of all-cause and CV mortality in both CVD and non-CVD populations. Efforts for integration of educational attainment into existing CV risk prediction algorithms are needed to mitigate observed socioeconomic disparities in mortality.