title: Illiteracy, low educational status, and cardiovascular mortality in India.
abstract: BACKGROUND
  Influence of education, a marker of SES, on cardiovascular disease (CVD) mortality has not been evaluated in low-income countries. To determine influence of education on CVD mortality a cohort study was performed in India.
  
  
  METHODS
  148,173 individuals aged ≥ 35 years were recruited in Mumbai during 1991-1997 and followed to ascertain vital status during 1997-2003. Subjects were divided according to educational status into one of the five groups: illiterate, primary school (≦ 5 years of formal education), middle school (6-8 years), secondary school (9-10 years) and college (> 10 years). Multivariate analyses using Cox proportional hazard model was performed and hazard ratios (HRs) and 95% confidence intervals (CIs) determined.
  
  
  RESULTS
  At average follow-up of 5.5 years (774,129 person-years) 13,261 deaths were observed. CVD was the major cause of death in all the five educational groups. Age adjusted all-cause mortality per 100,000 in illiterate to college going men respectively was 2154, 2149, 1793, 1543 and 1187 and CVD mortality was 471, 654, 618, 518 and 450; and in women all-cause mortality was 1444, 949, 896, 981 and 962 and CVD mortality was 429, 301, 267, 426 and 317 (ptrend < 0.01). Compared with illiterate, age-adjusted HRs for CVD mortality in primary school to college going men were 1.36, 1.27, 1.01 and 0.88 (ptrend < 0.05) and in women 0.69, 0.55, 1.04 and 0.74, respectively (ptrend > 0.05).
  
  
  CONCLUSIONS
  Inverse association of literacy status with all-cause mortality was observed in Indian men and women, while, for CVD mortality it was observed only in men.
authors.affiliation: Healis Sekhsaria Institute for Public Health, CBD Belapur, Navi Mumbai, Maharashtra 400614, India. pednekarmangesh@healis.org
authors.forename: Mangesh S
authors.initials: MS
authors.lastname: Pednekar
authors.forename: Rajeev
authors.initials: R
authors.lastname: Gupta
authors.forename: Prakash C
authors.initials: PC
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D004522:Educational Status; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011795:Surveys and Questionnaires; D016019:Survival Analysis