title: Unusually strong association between education and mortality in young adults in a community with a high rate of injection-drug users.
abstract: BACKGROUND
  To examine the association between education and mortality for various causes of death in young adults in a community with a high rate of injection-drug users.
  
  
  METHODS
  Linked mortality study based on mortality records for 1996 and 1997 and on 1996 population census data from the Region of Madrid (Spain). The association between educational level and mortality was estimated by the mortality rate ratio.
  
  
  RESULTS
  After adjustment for age and other socioeconomic variables the mortality rate in men and women aged 25-44 years with no education was, respectively, 4.7 and 3.7 times higher than in men and women with the highest educational level. The causes of death with the strongest association were chronic liver disease and cirrhosis, AIDS and diseases of the heart in both sexes and suicide in men. For these causes of death the mortality rate ratio between persons with the lowest and highest educational level ranged from 6.8 to 21.8 in men and from 4.1 to 16.9 in women.
  
  
  CONCLUSIONS
  These causes of death are the leading specific causes of death in persons aged 25-44 years. Given that probably a substantial part of deaths from diseases of the heart in this age category are drug-related, the common denominator of the excess mortality related poor education seems to be drug injection.
authors.affiliation: Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Complutense de Madrid, Spain. enriqueregidor@hotmail.com
authors.forename: Enrique
authors.initials: E
authors.lastname: Regidor
authors.forename: Luis
authors.initials: L
authors.lastname: de la Fuente
authors.forename: M Elisa
authors.initials: ME
authors.lastname: Calle
authors.forename: Pedro
authors.initials: P
authors.lastname: Navarro
authors.forename: Vicente
authors.initials: V
authors.lastname: Domínguez
mesh_terms: D000328:Adult; D002423:Cause of Death; D019352:Censuses; D004522:Educational Status; D005260:Female; D006556:Heroin Dependence / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D012042:Registries; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000401:mortality