title: Socioeconomic status in relation to cardiovascular disease and cause-specific mortality: a comparison of Asian and Australasian populations in a pooled analysis.
abstract: OBJECTIVE
  In Western countries, lower socioeconomic status is associated with a higher risk of cardiovascular disease (CVD) and premature mortality. These associations may plausibly differ in Asian populations, but data are scarce and direct comparisons between the two regions are lacking. We, thus, aimed to compare such associations between Asian and Western populations in a large collaborative study, using the highest level of education attained as our measure of social status.
  
  
  METHODS
  Cohort studies in general populations conducted in Asia or Australasia.
  
  
  METHODS
  303,036 people (71% from Asia) from 24 studies in the Asia Pacific Cohort Studies Collaboration. Studies had to have a prospective cohort study design, have accumulated at least 5000 person-years of follow-up, recorded date of birth (or age), sex and blood pressure at baseline and date of, or age at, death during follow-up.
  
  
  METHODS
  We used Cox regression models to estimate relationships between educational attainment and CVD (fatal or non-fatal), as well as all-cause, cardiovascular and cancer mortality.
  
  
  RESULTS
  During more than two million person-years of follow-up, 11,065 deaths (3655 from CVD and 4313 from cancer) and 1809 CVD non-fatal events were recorded. Adjusting for classical CVD risk factors and alcohol drinking, hazard ratios (95% CIs) for primary relative to tertiary education in Asia (Australasia) were 1.81 (1.38, 2.36) (1.10 (0.99, 1.22)) for all-cause mortality, 2.47(1.47, 4.17) (1.24 (1.02, 1.51)) for CVD mortality, 1.66 (1.00, 2.78) (1.01 (0.87, 1.17)) for cancer mortality and 2.09 (1.34, 3.26) (1.23 (1.04, 1.46)) for all CVD.
  
  
  CONCLUSIONS
  Lower educational attainment is associated with a higher risk of CVD or premature mortality in Asia, to a degree exceeding that in the Western populations of Australasia.
authors.affiliation: Nuffield Department of Population Health, The George Institute for Global Health, University of Oxford, Oxford, UK The George Institute for Global Health, University of Sydney, Sydney, Australia Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.affiliation: Nuffield Department of Population Health, The George Institute for Global Health, University of Oxford, Oxford, UK Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Sanne A E
authors.initials: SA
authors.lastname: Peters
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.
authors.forename: G David
authors.initials: GD
authors.lastname: Batty
authors.affiliation: Department of Health Science, Shiga University of Medical Science, Shiga, Japan.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Ueshima
authors.affiliation: Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Jean
authors.initials: J
authors.lastname: Woo
authors.affiliation: Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia.
authors.forename: Graham G
authors.initials: GG
authors.lastname: Giles
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Federica
authors.initials: F
authors.lastname: Barzi
authors.affiliation: Division of Epidemiology, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Ho
authors.affiliation: Faculty of Medicine and Biomedical Sciences, School of Population Health, University of Queensland, Australia.
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Huxley
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia Department of Health Science, Shiga University of Medical Science, Shiga, Japan.
authors.forename: Hisatomi
authors.initials: H
authors.lastname: Arima
authors.affiliation: Xuanwu Hospital, Capital Medical University, Bejing, China.
authors.forename: Xianghua
authors.initials: X
authors.lastname: Fang
authors.affiliation: Faculty of Medicine and Biomedical Sciences, School of Population Health, University of Queensland, Australia.
authors.forename: Annette
authors.initials: A
authors.lastname: Dobson
authors.affiliation: School of Public Health, The University of Hong Kong, Hong Kong, China.
authors.forename: Tai Hing
authors.initials: TH
authors.lastname: Lam
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand.
authors.forename: Prin
authors.initials: P
authors.lastname: Vathesatogkit
mesh_terms: D001208:Asia / Q000453:epidemiology; D044362:Australasia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000401:mortality*; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012923:Social Class
keywords: CARDIOLOGY; EPIDEMIOLOGY; PUBLIC HEALTH