Gender Disparities in the Association Between EducationalAttainment and Cardiovascular-Kidney-Metabolic Syndrome:Cross-Sectional Study

被引：4

作者：

Ding, Yi ^{[1
]}

Wu, Xianglin ^{[1
]}

Cao, Qiuyu ^{[1
]}

Huang, Jiaojiao ^{[1
]}

Xu, Xiaoli ^{[1
]}

Jiang, Youjin ^{[1
]}

Huo, Yanan ^{[2
]}

Wan, Qin ^{[3
]}

Qin, Yingfen ^{[4
]}

Hu, Ruying ^{[5
]}

Shi, Lixin ^{[6
]}

Su, Qing ^{[7
]}

Yu, Xuefeng ^{[8
]}

Yan, Li ^{[9
]}

Qin, Guijun ^{[10
]}

Tang, Xulei ^{[11
]}

Chen, Gang ^{[12
]}

Xu, Min ^{[1
]}

Wang, Tiange ^{[1
]}

Zhao, Zhiyun ^{[1
]}

Gao, Zhengnan ^{[13
]}

Wang, Guixia ^{[14
]}

Shen, Feixia ^{[15
]}

Luo, Zuojie ^{[4
]}

Chen, Li ^{[16
]}

Li, Qiang ^{[17
]}

Ye, Zhen ^{[5
]}

Zhang, Yinfei ^{[18
]}

Liu, Chao ^{[19
]}

Wang, Youmin ^{[20
]}

Yang, Tao ^{[21
]}

Deng, Huacong ^{[22
]}

Chen, Lulu ^{[23
]}

Zeng, Tianshu ^{[23
]}

Zhao, Jiajun ^{[24
]}

Mu, Yiming ^{[25
]}

Wu, Shengli ^{[26
]}

Chen, Yuhong ^{[1
]}

Lu, Jieli ^{[1
]}

Wang, Weiqing ^{[1
]}

Ning, Guang ^{[1
]}

Xu, Yu ^{[1
]}

Bi, Yufang ^{[1
]}

Li, Mian ^{[1
]}

机构：

[1] Shanghai Jiao Tong Univ, Sch Med, Ruijin Hosp, Dept Endocrine & Metab Dis,Shanghai Inst Endocrine, 197 RuiJin 2nd Rd, Shanghai 200025, Peoples R China

[2] Nanchang Univ, Jiangxi Prov Peoples Hosp, Nanchang, Peoples R China

[3] Southwest Med Univ, Affiliated Hosp, Luzhou, Peoples R China

[4] Guangxi Med Univ, Affiliated Hosp 1, Nanning, Peoples R China

[5] Zhejiang Prov Ctr Dis Control & Prevent, Hangzhou, Peoples R China

[6] Guiyang Med Coll, Affiliated Hosp, Guiyang, Peoples R China

[7] Shanghai Jiao Tong Univ, Sch Med, Xinhua Hosp, Shanghai, Peoples R China

[8] Huazhong Univ Sci & Technol, Tongji Hosp, Tongji Med Coll, Wuhan, Peoples R China

[9] Sun Yat Sen Univ, Sun Yat Sen Mem Hosp, Guangzhou, Peoples R China

[10] Zhengzhou Univ, Affiliated Hosp 1, Zhengzhou, Peoples R China

[11] Lanzhou Univ, Hosp 1, Lanzhou, Peoples R China

[12] Fujian Med Univ, Fujian Prov Hosp, Fuzhou, Peoples R China

[13] Dalian Municipal Cent Hosp, Dalian, Peoples R China

[14] First Hosp Jilin Univ, Changchun, Peoples R China

[15] Wenzhou Med Univ, Affiliated Hosp 1, Wenzhou, Peoples R China

[16] Shandong Univ, Qilu Hosp, Jinan, Peoples R China

[17] Harbin Med Univ, Affiliated Hosp 2, Harbin, Peoples R China

[18] Cent Hosp Shanghai Jiading Dist, Shanghai, Peoples R China

[19] Jiangsu Prov Hosp Integrat Chinese & Western Med, Nanjing, Peoples R China

[20] Anhui Med Univ, Affiliated Hosp 1, Hefei, Peoples R China

[21] Nanjing Med Univ, Affiliated Hosp 1, Nanjing, Peoples R China

[22] Chongqing Med Univ, Affiliated Hosp 1, Chongqing, Peoples R China

[23] Huazhong Univ Sci & Technol, Union Hosp, Tongji Med Coll, Wuhan, Peoples R China

[24] Shandong Univ, Shandong Prov Hosp, Jinan, Peoples R China

[25] Chinese Peoples Liberat Army Gen Hosp, Beijing, Peoples R China

[26] Karamay Municipal Peoples Hosp, Karamay, Peoples R China

来源：

JMIR PUBLIC HEALTH AND SURVEILLANCE | 2024年 / 10卷

基金：

中国国家自然科学基金;

关键词：

cardiovascular-kidney-metabolic syndrome; education; health behavior; sex difference; cross-sectional study; gender; GLP-1 RECEPTOR AGONISTS; SOCIOECONOMIC-STATUS; SEX-DIFFERENCES; RISK-FACTORS; HEALTH; INHIBITORS; BENEFITS; DISEASE;

D O I：

10.2196/57920

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

Background: Cardiovascular-kidney-metabolic (CKM) health is affected by social determinants of health, especially education. CKM syndrome has not been evaluated in Chinese population, and the association of education with CKM syndrome in different sexes and its intertwined relation with lifestyles have not been explored. Objective: We aimed to explore the association between educational attainment and the prevalence of CKM syndrome stages in middle-aged and older Chinese men and women as well as the potential role of health behavior based on Life's Essential 8 construct. Methods: This study used data from the nationwide, community-based REACTION (Risk Evaluation of Cancers in Chinese diabetic individuals: a longitudinal study). A total of 132,085 participants with complete information to determine CKM syndrome stage and education level were included. Educational attainment was assessed by the self-reported highest educational level achieved by the participants and recategorized as low (elementary school or no formal education) or high (middle school, high school, technical school/college, or above). CKM syndrome was ascertained and classified into 5 stages according to the American Heart Association presidential advisory released in 2023. Results: Among 132,085 participants (mean age 56.95, SD 9.19 years; n=86,675, 65.62% women) included, most had moderate-risk CKM syndrome (stages 1 and 2), and a lower proportion were at higher risk of CKM (stages 3 and 4). Along the CKM continuum, low education was associated with 34% increased odds of moderate-risk CKM syndrome for women (odds ratio 1.36, 95% CI 1.23-1.49) with a significant sex disparity, but was positively correlated with high-risk CKM for both sexes. The association between low education and high-risk CKM was more evident in women with poor health behavior but not in men, which was also interactive with and partly mediated by behavior. Conclusions: Low education was associated with adverse CKM health for both sexes but was especially detrimental to women. Such sex-specific educational disparity was closely correlated with health behavior but could not be completely attenuated by behavior modification. These findings highlight the disadvantage faced by women in CKM health ascribed to low education, underscoring the need for public health support to address this inequality.

引用

页数：12

共 38 条

[1] Sex differences in the relationship between socioeconomic status and cardiovascular disease: a systematic review and meta-analysis [J].

Backholer, Kathryn ;

Peters, Sanne A. E. ;

Bots, Sophie H. ;

Peeters, Anna ;

Huxley, Rachel R. ;

Woodward, Mark .

JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, 2017, 71 (06) :550-557

[2] Cohort profile: Risk evaluation of cancers in Chinese diabetic individuals: A longitudinal (REACTION) study [J].

Bi, Yufang ;

Lu, Jieli ;

Wang, Weiqing ;

Mu, Yiming ;

Zhao, Jiajun ;

Liu, Chao ;

Chen, Lulu ;

Shi, Lixin ;

Li, Qiang ;

Wan, Qin ;

Wu, Shengli ;

Yang, Tao ;

Yan, Li ;

Liu, Yan ;

Wang, Guixia ;

Luo, Zuojie ;

Tang, Xulei ;

Chen, Gang ;

Huo, Yanan ;

Gao, Zhengnan ;

Su, Qing ;

Ye, Zhen ;

Wang, Youming ;

Qin, Guijun ;

Deng, Huacong ;

Yu, Xuefeng ;

Shen, Feixia ;

Chen, Li ;

Zhao, Liebin ;

Zhang, Jie ;

Sun, Jichao ;

Dai, Meng ;

Xu, Min ;

Xu, Yu ;

Chen, Yuhong ;

Lai, Shenghan ;

Bloomgarden, Zachary T. ;

Li, Donghui ;

Ning, Guang .

JOURNAL OF DIABETES, 2014, 6 (02) :147-157

[3] Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017 [J].

Bikbov, Boris ;

Purcell, Carrie ;

Levey, Andrew S. ;

Smith, Mari ;

Abdoli, Amir ;

Abebe, Molla ;

Adebayo, Oladimeji M. ;

Afarideh, Mohsen ;

Agarwal, Sanjay Kumar ;

Agudelo-Botero, Marcela ;

Ahmadian, Elham ;

Al-Aly, Ziyad ;

Alipour, Vahid ;

Almasi-Hashiani, Amir ;

Al-Raddadi, Rajaa M. ;

Alvis-Guzman, Nelson ;

Amini, Saeed ;

Andrei, Tudorel ;

Andrei, Catalina Liliana ;

Andualem, Zewudu ;

Anjomshoa, Mina ;

Arabloo, Jalal ;

Ashagre, Alebachew Fasil ;

Asmelash, Daniel ;

Ataro, Zerihun ;

Atout, Maha Moh'd Wahbi ;

Ayanore, Martin Amogre ;

Badawi, Alaa ;

Bakhtiari, Ahad ;

Ballew, Shoshana H. ;

Balouchi, Abbas ;

Banach, Maciej ;

Barquera, Simon ;

Basu, Sanjay ;

Bayih, Mulat Tirfie ;

Bedi, Neeraj ;

Bello, Aminu K. ;

Bensenor, Isabela M. ;

Bijani, Ali ;

Boloor, Archith ;

Borzi, Antonio M. ;

Camera, Luis Alberto ;

Carrero, Juan J. ;

Carvalho, Felix ;

Castro, Franz ;

Catala-Lopez, Ferran ;

Chang, Alex R. ;

Chin, Ken Lee ;

Chung, Sheng-Chia ;

Cirillo, Massimo .

LANCET, 2020, 395 (10225) :709-733

[4] Association of education level with diabetes prevalence in Latin American cities and its modification by city social environment [J].

Braverman-Bronstein, Ariela ;

Hessel, Philipp ;

Gonzalez-Uribe, Catalina ;

Kroker, Maria F. ;

Diez-Canseco, Francisco ;

Langellier, Brent ;

Lucumi, Diego I. ;

Osiac, Lorena Rodriguez ;

Trotta, Andres ;

Roux, Ana V. Diez .

JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, 2021, 75 (09) :874-880

[5]

Collaborators GBDD, 2023, Lancet, V402, P203, DOI DOI 10.1016/S0140-6736(23)01301-6

[6] Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment [J].

Danaei, Goodarz ;

Lu, Yuan ;

Singh, Gitanjali M. ;

Carnahan, Emily ;

Stevens, Gretchen A. ;

Cowan, Melanie J. ;

Farzadfar, Farshad ;

Lin, John K. ;

Finucane, Mariel M. ;

Rao, Mayuree ;

Khang, Young-Ho ;

Riley, Leanne M. ;

Mozaff, Dariush ;

Lim, Stephen S. ;

Ezzati, Majid ;

Aamodt, Geir ;

Abdeen, Ziad ;

Abdella, Nabila A. ;

Abdul Rahim, Hanan F. ;

Addo, Juliet ;

Aekplakorn, Wichai ;

Afifi, Mustafa M. ;

Agabiti-Rosei, Enrico ;

Salinas, Carlos A. Aguilar ;

Agyemang, Charles ;

Ali, Mohammed K. ;

Ali, Mohamed M. ;

Al-Nsour, Mohannad ;

Al-Nuaim, Abdul R. ;

Ambady, Ramachandran ;

Di Angelantonio, Emanuele ;

Aro, Pertti ;

Azizi, Fereidoun ;

Babu, Bontha V. ;

Bahalim, Adil N. ;

Barbagallo, Carlo M. ;

Barbieri, Marco A. ;

Barcelo, Alberto ;

Barreto, Sandhi M. ;

Barros, Henrique ;

Bautista, Leonelo E. ;

Benetos, Athanase ;

Bjerregaard, Peter ;

Bjoerkelund, Cecilia ;

Bo, Simona ;

Bobak, Martin ;

Bonora, Enzo ;

Botana, Manuel A. ;

Bovet, Pascal ;

Breckenkamp, Juergen .

LANCET DIABETES & ENDOCRINOLOGY, 2014, 2 (08) :634-647

[7] Development and Validation of the American Heart Association's PREVENT Equations [J].

Khan, Sadiya S. ;

Matsushita, Kunihiro ;

Sang, Yingying ;

Ballew, Shoshana H. ;

Grams, Morgan E. ;

Surapaneni, Aditya ;

Blaha, Michael J. ;

Carson, April P. ;

Chang, Alexander R. ;

Ciemins, Elizabeth ;

Go, Alan S. ;

Gutierrez, Orlando M. ;

Hwang, Shih-Jen ;

Jassal, Simerjot K. ;

Kovesdy, Csaba P. ;

Lloyd-Jones, Donald M. ;

Shlipak, Michael G. ;

Palaniappan, Latha P. ;

Sperling, Laurence ;

Virani, Salim S. ;

Tuttle, Katherine ;

Neeland, Ian J. ;

Chow, Sheryl L. ;

Rangaswami, Janani ;

Pencina, Michael J. ;

Ndumele, Chiadi E. ;

Coresh, Josef .

CIRCULATION, 2024, 149 (06) :430-449

[8] Novel Prediction Equations for Absolute Risk Assessment of Total Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health: A Scientific Statement From the American Heart Association [J].

Khan, Sadiya S. ;

Coresh, Josef ;

Pencina, Michael J. ;

Ndumele, Chiadi E. ;

Rangaswami, Janani ;

Chow, Sheryl L. ;

Palaniappan, Latha P. ;

Sperling, Laurence S. ;

Virani, Salim S. ;

Ho, Jennifer E. ;

Neeland, Ian J. ;

Tuttle, Katherine R. ;

Singh, Radhika Rajgopal ;

Elkind, Mitchell S. V. ;

Lloyd-Jones, Donald M. .

CIRCULATION, 2023, 148 (24) :1982-2004

[9] Association between socioeconomic status and the development of mental and physical health conditions in adulthood: a multi-cohort study [J].

Kivimaki, Mika ;

Batty, G. David ;

Pentti, Jaana ;

Shipley, Martin J. ;

Sipila, Pyry N. ;

Nyberg, Solja T. ;

Suominen, Sakari B. ;

Oksanen, Tuula ;

Stenholm, Sari ;

Virtanen, Marianna ;

Marmot, Michael G. ;

Singh-Manoux, Archana ;

Brunner, Eric J. ;

Lindbohm, Joni, V ;

Ferrie, Jane E. ;

Vahtera, Jussi .

LANCET PUBLIC HEALTH, 2020, 5 (03) :E140-E149

[10] Sex differences in the association between socio-economic status and type 2 diabetes: data from the 2005 Korean National Health and Nutritional Examination Survey (KNHANES) [J].

Lee, D. S. ;

Kim, Y. J. ;

Han, H. R. .

PUBLIC HEALTH, 2013, 127 (06) :554-560

← 1 2 3 4 →