| Title: | Impact of education level on complications and mortalities in type 2 diabetes: A UK biobank prospective cohort study |
| Journal: | BMC Public Health |
| Published: | 9 Oct 2025 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/41068666/ |
| DOI: | https://doi.org/10.1186/s12889-025-24491-5 |
| URL: | https://bmcpublichealth.biomedcentral.com/counter/pdf/10.1186/s12889-025-24491-5 |
Publication 19241
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Abstract
BackgroundEducational attainment is a critical determinant of health outcomes. Lower education levels have been associated with higher mortality and increased risk of chronic diseases in the general population, but its specific impacts on both traditional and non-traditional complications of type 2 diabetes remain unclear. We aimed to investigate the associations between educational attainment and risks of all-cause mortality, traditional complications, and non-traditional complications in a large prospective cohort of patients with type 2 diabetes.MethodsWe analyzed data from the UK Biobank, collected from March 13, 2006, to June 30, 2023. Educational attainment was categorized as college, high school, or less than high school. Primary outcomes included all-cause mortality, traditional complications (e.g., cardiovascular disease, chronic kidney disease, diabetic retinopathy), and non-traditional complications (e.g., cancer, cognitive impairment, liver disease, infections, and affective disorders). Hazard ratios (HRs) were estimated using Cox proportional hazard models adjusted for sociodemographic, clinical, and diabetes-specific covariates. Sensitivity and interaction analyses were performed to assess robustness and effect modifiers.ResultsA total of 23,246 participants with type 2 diabetes (median age 61.0 years [IQR 55.0-65.0], 38.3% women) were included in the final analyses. During a median follow-up of 13.98 years (IQR 13.11-14.86), 5,196 deaths were recorded. Compared with college-educated participants, those with less than high school education had a 27% higher risk of all-cause mortality (HR 1.27, 95% CI 1.18-1.38). Traditional complications were more common in lower-educated groups, including cardiovascular disease (HR 1.30, 95% CI 1.18-1.43) and chronic kidney disease (HR 1.40, 95% CI 1.28-1.54), but not diabetic retinopathy. Non-traditional complications were also more prevalent, including cognitive impairment (HR 1.40, 95% CI 1.16-1.68), liver disease (HR 1.26, 95% CI 1.10-1.45), infections (HR 1.26, 95% CI 1.17-1.37), and affective disorders (HR 1.43, 95% CI 1.22-1.67). Findings were consistent across sensitivity analyses, and interactions were observed for age, sex, and diabetes duration.ConclusionsLower educational attainment is associated with increased risks of all-cause mortality, and traditional and non-traditional diabetes-related complications. These findings underscore the need for targeted interventions to address educational disparities in diabetes management and improve health literacy among vulnerable populations.</p>
13 Keywords
- Aged
- Biological Specimen Banks
- Diabetes Complications
- Diabetes Mellitus, Type 2
- Educational Status
- Female
- Humans
- Male
- Middle Aged
- Prospective Studies
- Risk Factors
- UK Biobank
- United Kingdom
20 Authors
- Yunpeng Luo
- Xinlong Li
- Tianyi Yang
- Kehua Zhou
- Tong Wang
- Ye Zhang
- Jukai Huang
- Chaoyue Hu
- Jiaoyue Li
- Qiyao Zhao
- Jinlin Dai
- Ping Li
- Zifan Huang
- Gang Wang
- Xin He
- Xinying Wang
- Chunshu Li
- Haojie Yang
- Yan Liu
- Xiaohui Yang
1 Application
| Application ID | Title |
|---|---|
| 95356 | Association of education level with all cause and cause-specific mortality among individuals with T2DM:a prospective study in UK Biobank |
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