title: The Relationship of Educational Attainment with Pulmonary Emphysema and Airway Wall Thickness.
abstract: BACKGROUND
  Low educational attainment is a risk factor of chronic obstructive pulmonary disease (COPD). There is limited knowledge on the relationship between educational level and computed tomography measures of emphysema and airway wall thickness (AWT).
  
  
  OBJECTIVE
  We hypothesized that low educational attainment is associated with increased emphysema and AWT in ever-smokers with and without COPD.
  
  
  METHODS
  We included 462 and 485 ever-smokers with and without COPD in a cross-sectional study, aged 40-86 years. The sample was divided into groups reflecting educational attainment: primary, secondary, and university. We performed linear regression to examine associations between educational attainment and both emphysema and AWT separately for those with and without COPD. We adjusted for sex, age, smoking status, age of onset of smoking, pack-years, height, and body mass index.
  
  
  RESULTS
  Compared with university education, in subjects with COPD, primary education was associated with a 68.1% (95% confidence interval = 14.2-147.6%; P = 0.01) relative increase in emphysema and secondary education was associated with a 50.6% (95% confidence interval = 5.7-114.6%; P = 0.02) relative increase. There was a nonsignificant trend toward an association between lower educational attainment and increased emphysema among those without COPD (P = 0.18), yet greater age appeared to modify this association (P = 0.01). We did not detect significant linear relationships between educational attainment and AWT in subjects with or without COPD.
  
  
  CONCLUSIONS
  Lower educational attainment was associated with increased emphysema among adults with COPD. Among those without COPD, this association was more pronounced with increasing age. No significant linear relationship between educational attainment and AWT was found. Clinicians treating adults with emphysema should keep in mind that factors related to low education beyond that of smoking and occupational dust exposure might be of importance to the disease.
authors.affiliation: 1 Norwegian Registry of Long-Term Mechanical Ventilation.|2 Norwegian Registry of Chronic Obstructive Pulmonary Disease.
authors.forename: Miriam
authors.initials: M
authors.lastname: Gjerdevik
authors.affiliation: 3 Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.|4 Department of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Grydeland
authors.affiliation: 5 Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: George R
authors.initials: GR
authors.lastname: Washko
authors.affiliation: 6 Department of Radiology and Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada; and.
authors.forename: Harvey O
authors.initials: HO
authors.lastname: Coxson
authors.affiliation: 7 The Channing Division of Network Medicine and Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Edwin K
authors.initials: EK
authors.lastname: Silverman
authors.affiliation: 4 Department of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Amund
authors.initials: A
authors.lastname: Gulsvik
authors.affiliation: 4 Department of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Per S
authors.initials: PS
authors.lastname: Bakke
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006306:Health Surveys; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D011656:Pulmonary Emphysema / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013147:Spirometry / Q000379:methods; D013223:Statistics as Topic; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: chronic obstructive pulmonary disease; educational level; quantitative computed tomography imaging