Association Of Educational Level Research Articles

Impact of Educational Background on Preoperative Disease Severity and Postoperative Outcomes Among Patients With Cervical Spondylotic Myelopathy.

Retrospective review of a prospectively maintained database. Assess differences in preoperative status and postoperative outcomes among patients of different educational backgrounds undergoing surgical management of cervical spondylotic myelopathy (CSM). Patient education level (EL) has been suggested to correlate with health literacy, disease perception, socioeconomic status (SES), and access to health care. The CSM data set of the Quality Outcomes Database (QOD) was queried for patients undergoing surgical management of CSM. EL was grouped as high school or below, graduate-level, and postgraduate level. The association of EL with baseline disease severity (per patient-reported outcome measures), symptoms >3 or ≤3 months, and 24-month patient-reported outcome measures were evaluated. Among 1141 patients with CSM, 509 (44.6%) had an EL of high school or below, 471 (41.3%) had a graduate degree, and 161 (14.1%) had obtained postgraduate education. Lower EL was statistically significantly associated with symptom duration of >3 months (odds ratio=1.68), higher arm pain numeric rating scale (NRS) (coefficient=0.5), and higher neck pain NRS (coefficient=0.79). Patients with postgraduate education had statistically significantly lower Neck Disability Index (NDI) scores (coefficient=-7.17), lower arm pain scores (coefficient=-1), and higher quality-adjusted life-years (QALY) scores (coefficient=0.06). Twenty-four months after surgery, patients of lower EL had higher NDI scores, higher pain NRS scores, and lower QALY scores ( P <0.05 in all analyses). Among patients undergoing surgical management for CSM, those reporting a lower educational level tended to present with longer symptom duration, more disease-inflicted disability and pain, and lower QALY scores. As such, patients of a lower EL are a potentially vulnerable subpopulation, and their health literacy and access to care should be prioritized.

Education and Intended Number of Children in Germany, Moldova and Norway: An International Comparison Using FReDA and GGS-II-data

In this study, we compare the intended number of children in Germany, Moldova and Norway in 2020 and 2021, during the COVID-19 pandemic. In a first step, we compare the intended number of children (including children born) in the newly available Generations and Gender Survey round 2 (GGS-II) and the German FReDA-GGS data. In a second step, we estimate the number of further intended children with multinomial logistic regression models. The results reveal considerable differences across the three countries. Respondents in Moldova plan to have rather large families (on average 3.3 children, including children born), whereas individuals in Norway and Germany intend to have 2.0 and 1.8 children, respectively. In the multinomial logistic regression analyses, we find differences in the association of educational level and fertility plans by gender and country. In Germany, education is positively related to the intention to have further children. This pattern is more pronounced for women than for men. Furthermore, this association is also found among Norwegian men. In Moldova, we find only weak evidence for this association. For Norwegian women, education and the intention to have further children also seem to be unrelated. While most data about the intended number of children refer to the 2000s or earlier, we contribute to the literature by providing recent insights on the intended number of children in three European countries, including Moldova, a country that is understudied in demographic research.&#x0D; * This article belongs to a special issue on “Family Research and Demographic Analysis – New Insights from the German Family Demography Panel Study (FReDA)”.

Association of education level with the risk of female breast cancer: a prospective cohort study

BackgroundBreast cancer is a serious threat to female health, and its incidence varies with education level (EL). In the present study, the association between EL and the risk of developing female breast cancer was investigated.MethodsFrom May 2006 to December 2007, 20,400 observation subjects in Kailuan Cohort received questionnaires and were subjected to clinical examinations for data collection on baseline population characteristics, height, weight, lifestyle and past disease history. Then, these participants were followed up with from the date of recruitment to December 31, 2019. Cox proportional risk regression models were used to analyse the association between EL and the risk of developing female breast cancer.ResultsThe cumulative follow-up period of 20,129 observation subjects that meet the inclusion criteria of this study was 254,386.72 person-years, and the median follow-up time was 12.96 years. During the follow-up period, 279 cases of breast cancer were diagnosed. In comparison with the low EL group, the risk of developing breast cancer was significantly higher in the medium (hazard ratio [HR] (95% confidence interval [CI]) = 2.23 (1.12–4.64)] and high [HRs (95% CI) = 2.52 (1.12–5.70)] EL group.ConclusionAn increased risk of breast cancer was associated with a higher EL, and some certain factors, such as alcohol use and hormone therapy, may play a mediating role.

Associations of Education Level With Survival Outcomes and Treatment Receipt in Patients With Gastric Adenocarcinoma.

BackgroundIt remains largely unclear how education level, an important socioeconomic factor, affects prognoses for patients with gastric adenocarcinoma (GAC). We aimed to demonstrate the associations between education level and clinical outcomes in patients with GAC.MethodsWe included a total of 30,409 patients diagnosed with GAC from the Surveillance, Epidemiology, and End Results 18 registry database. Education level, household income, unemployment rate, poverty rate, insurance status, and marital status were selected as sociodemographic variables for the comprehensive analysis. Cox and logistic regression models, Kaplan–Meier curves, and subgroup analyses were the primary statistical methods employed.ResultsA low level of education was correlated with less income, higher unemployment rates, and higher poverty rates (all p < 0.001). The multivariate Cox analysis indicated that a high education level was significantly associated with superior overall survival rates and cancer-specific survival rates in patients with GAC (both p < 0.001). We also corroborated favorable survival outcomes by high education level within almost every clinical and demographic subgroup. Furthermore, chemotherapy combined with surgery could markedly prolong the survival for all patients, including patients of stage IV cancer (both p < 0.001). By using multivariable logistic models, patients in counties with high education levels had a higher probability of chemotherapy receipt (p < 0.001). Contrarily, those in the counties with low levels of education were less likely to receive chemotherapy or undergo surgery (p < 0.001).ConclusionsEducation level was identified and confirmed as an independent predictor of treatment and survival for GAC patients. Efforts are needed to provide effective interventions for those whose educational status is adverse.

Disposal of plastic waste in Ghana: the knowledge, attitude and practices of households in the Tamale metropolis

ABSTRACT The authors report a cross-sectional study in Tamale, Ghana, using a stratified simple random sample of 270 households to assess the knowledge, attitudes, and practices of households, in relation to the disposal of plastic waste. Data gathered using a structured questionnaire and in-depth interviews revealed that 48% of respondents had moderate-to-high levels of knowledge, 87% of respondents showed a negative attitude, and 46% performed poor practices in plastic waste disposal. There was a statistically significant association of education level and employment status of residents with plastic waste disposal. The knowledge, attitude, and practices of households were unsatisfactory though not significantly associated with plastic waste disposal. There is a need to use formal and informal education on waste management and improve access to affordable waste disposal services.

Education level and misuse of antibiotics in the general population: a systematic review and dose\u2013response meta-analysis

BackgroundNumerous studies evaluated the association of education level with misuse of antibiotics by the general population, yet divergent findings were reported. Therefore, a meta-analysis was conducted to summarize this association.MethodsA categorical and continuous dose–response meta-analysis of the association of education level with antibiotic misuse was undertaken. Summary odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated using random-effect model.ResultsThe meta-analysis included 85 studies from 42 countries of different socioeconomic status. Compared to low education (≤ 9 years), medium education (> 9–12 years) is associated with 20% lower odds of antibiotic misuse in high-income countries (OR = 0.80; 95% CI 0.66, 0.97), while high education (> 12 years) is associated with 14% lower odds of any aspect of antibiotic misuse (OR = 0.86; 95% CI 0.72, 1.03). The association is more pronounced in Middle East (OR = 0.64; 95% CI 0.42, 1.00) and countries of lower-middle economies (OR = 0.67, 95% CI 0.41, 1.11). Inversely, in Europe, high education is associated with 25% higher odds of antibiotic misuse (OR = 1.25, 95% CI 1.00, 1.58). Each additional year of education was associated with 4% lower odds of any aspect of antibiotic misuse in lower-middle economies (OR = 0.96; 95% CI 0.92, 1.00) and in Middle East (OR = 0.96; 95% CI 0.93, 1.00). Conversely, it was associated with 3% higher odds of antibiotic storage, a specific type of misuse (OR = 1.03, 95% CI 1.01, 1.06).ConclusionIndividuals misuse antibiotics irrespective of their education level. Intervention programs to enhance the proper use of antibiotics should target all communities independent of their education level.

The association of education level with autonomy support, self-efficacy and health behaviour in patients with cardiovascular risk factors.

The study aimed to investigate whether the patients' education level affected the mediation effect of self-efficacy on the relationship between the autonomy-supportive healthcare climate and health behaviour among patients with cardiovascular risk factors. Autonomy and self-efficacy are identified as influential factors related to the behaviours of individuals with health problems. However, it is unclear whether autonomy support from healthcare providers affects health behaviour through self-efficacy and if patients' education level affects the association. A cross-sectional study. A convenience sample of 207 individuals with one or more cardiovascular diseases completed self-administered surveys including the healthcare climate questionnaire, self-efficacy scale and the engagement in health behaviour scale. Data were analysed using descriptive statistics, t test, Pearson's correlation coefficients and hierarchical regression analysis. All procedures of the study adhered to the STROBE guidelines. The influence of autonomy support from healthcare providers on self-efficacy differed by individuals' education level. Self-efficacy in less educated, but not highly educated individuals, tended to depend on the autonomy-supportive climate. Additionally, the autonomy-supportive healthcare climate affected health behaviour through self-efficacy only in less educated individuals. The relationship between autonomy support from healthcare providers and self-efficacy was more evident in the relatively less educated individuals. The associations among autonomy support, self-efficacy and health behaviour differed by patient education level, and the mediating role of self-efficacy on the relationship between autonomy-supportive climate and health behaviour was found only in those less educated. Healthcare providers should recognise the importance of supporting patients' need for autonomy to improve self-efficacy and healthy behaviour, particularly in less educated patients. Additionally, healthcare providers' support tailored to patients' needs and educational status should be highlighted.

Association of education level with diabetes prevalence in Latin American cities and its modification by city social environment

BackgroundDiabetes prevalence continues to increase in urban areas of low-income and middle-income countries (LMIC). Evidence from high-income countries suggests an inverse association between educational attainment and diabetes, but research in...

Education Level and Long-term Mortality, Recurrent Stroke, and Cardiovascular Events in Patients With Ischemic Stroke.

BackgroundEpidemiological studies have reported discrepant findings on the relationship between education level and outcomes after stroke. We aimed to prospectively investigate the relationship between education level and mortality, recurrent stroke, and cardiovascular events in Chinese patients with ischemic stroke.Methods and ResultsWe included 3861 participants from the China Antihypertensive Trial in Acute Ischemic Stroke. Education level was categorized as illiteracy, primary school, middle school, and college. Study outcomes were all‐cause mortality, stroke‐specific mortality, recurrent stroke, and cardiovascular events within 2 years after ischemic stroke. A meta‐analysis was conducted to incorporate the results of the current study and previous other studies on the association of education level with outcomes after stroke. Within 2 years after ischemic stroke, there were 327 (8.5%) all‐cause deaths, 264 (6.8%) stroke‐specific deaths, 303 (7.9%) recurrent strokes, and 364 (9.4%) cardiovascular events, respectively. The Kaplan–Meier curves showed that patients with the lowest education level had the highest cumulative incidence rates of all‐cause mortality, stroke‐specific mortality, and cardiovascular events (log‐rank P≤0.01). After adjusted for covariates, hazard ratios and 95% CIs of illiteracy versus college education were 2.79 (1.32–5.87) for all‐cause mortality, 3.68 (1.51–8.98) for stroke‐specific mortality, 2.82 (1.20–6.60) for recurrent stroke, and 3.46 (1.50–7.95) for cardiovascular events. The meta‐analysis confirmed the significant association between education status and mortality after stroke (pooled relative risk for lowest versus highest education level, 1.24 [95% CI, 1.05–1.46]).ConclusionsLow education level was significantly associated with increased risk of mortality, recurrent stroke, and cardiovascular events after ischemic stroke, independently of established risk factors.RegistrationURL: https://www.clini​caltr​ials.gov; Unique identifier: NCT01840072.

Factors associated with attendance and attendance patterns in a population-based mammographic screening program.

To explore the factors associated with attendance and attendance pattern in BreastScreen Norway. We evaluated the number of invitations (n = 1,253,995) and attendances, 2015-2019, stratified by age, invitation method, screening unit and time of appointment. Attendance pattern was analysed for women invited 10 times (n = 47,979), 1996-2019. The association of education level, body mass index, physical activity and smoking status with attendance was analysed for a sub-sample of women (n = 37,930). Descriptive statistics were used to analyse attendance, and negative binomial regression was used to analyse the association between the total number of attendances and education level and lifestyle factors. The attendance rate was 76.0%, 2015-2019. The rate was 78.0% for women aged >64 and 73.9% for those <55 . We found a rate of 82.0% for women who received a digital invitation, while it was 73.7% for those invited by post. The rate was 78.1% for invitations in the late afternoon, 3-6 p.m., while later appointments reached a rate of 73.7%. Half of the women invited 10 times attended all times. The predicted total number of attendances was 9 out of 10 for the factors investigated. The highest attendance rates were shown for women aged >64, those who received digital invitations and those having appointments in late afternoon. The differences in predicted number of attendances between the investigated factors were minor. Overall, BreastScreen Norway has a high attendance rate. However, efforts aimed at increasing the attendance in specific groups should be considered.

Are there educational disparities in health and functioning among the oldest old? Evidence from the Nordic countries

With the ageing of the population and recent pressures on important welfare state arrangements, updated knowledge on the linkage between socioeconomic status and health in old age is pertinent for shedding light on emerging patterns of health inequalities in the Nordic countries. This study examined self-rated health (SRH), mobility and activities of daily living (ADL) according to level of education in the three oldest old age groups 75–84, 85–94, and 95+, in four Nordic countries. Altogether, 6132 individuals from Danish Longitudinal Study of Ageing, Norwegian Life Course, Ageing and Generation study, Swedish Panel Study of Living Conditions of the Oldest Old, the 5-Country Oldest Old (Sweden) and Vitality 90 + Study were analysed. First, associations of education level with SRH, mobility, and ADL were estimated for each individual study by means of age- and gender-adjusted logistic regression. Second, results from individual studies were synthesized in a meta-analysis. Older adults with higher education level were more likely to report good SRH, and they were more often independent in mobility and ADL than those with basic education when all age groups were combined. In mobility and ADL, differences between education groups remained stable across the age groups but for SRH, differences seemed to be weaker in older ages. With only a few exceptions, in all age groups, individuals with higher education had more favourable health and functioning than those with basic education. This study shows remarkable persistence of health and functioning inequalities in the Nordic countries throughout later life.

Abstract P005: Association Between County Elementary and Secondary Educational Policy With Cardiovascular Health

BACKGROUND: Recent research recognizing the socioeconomic influence of educational attainment on population health, including cardiovascular health (CVH), suggests that modifying educational policy to improve educational outcomes could be an effective approach to improving health outcomes. Although the positive association of educational level with health status is well documented, the effect of education policy on health outcomes is not as thoroughly studied. Identifying relationships amongst educational policy and CVH could provide a target for public policy initiatives designed to positively impact population health. OBJECTIVE: The objective was to examine the potential effect of varying county educational policy on county and individual CVH outcomes. METHODS: Variables of county educational policy were expenditures per pupil, percent of total revenue from each state and local sources, and pupil teacher ratios. School district data from 1997-2005 sourced from the National Center for Education Statistics were adjusted for inflation using the U.S. Dept. of Labor Consumer Price Index as well as regional cost differences using the NCES Comparable Wage Index by school district, and grouped by county. County and individual CVH for 2011 was scored using the AHA’s CVH metric and data from the Behavioral Risk Factor Surveillance System. Linear regression models were used to compare the county means for each education policy variable with both county and individual CVH scores. RESULTS: Mean percent revenue from local sources and mean pupil teacher ratio were both shown to be positively associated with county level CVH (p=0.007 and p=0.023). Individual CVH was inversely associated with mean expenditures per pupil (p=0.023), and positively associated with mean percent revenue from local (p&lt;0.01), mean percent revenue from state (p&lt;0.01), and mean pupil teacher ratio (p&lt;0.001). There was an interactive effect between mean expenditure per pupil and county urbanicity on county CVH (p&lt;0.05), which differed in rural counties compared to the most urban. There was also an interactive effect between mean percent revenue from local and county urbanicity on county CVH (p&lt;0.001). Although no significant effect was observed for mean expenditures per pupil on county CVH, mean expenditures per pupil was inversely related to county CVH in the most urban counties (b=-3.58e-06), and positively related to county CVH in most rural counties (b=4.62e-06). Evidence of relationships between county educational policies and resources with CVH suggests the need for continued research more thoroughly examining variables of education policy as indicators for CVH. CONCLUSION: Further clarification of these relationships will help determine if educational policy adjustments driven by health improvement initiatives would be a useful addition to current strategies aimed at improving population health.

Educational Differences in Adolescents' Sexual Health: A Pervasive Phenomenon in a National Dutch Sample

Educational level is strongly associated with age of first intercourse and risk of unintended pregnancies. This study examined these associations in a large representative sample of Dutch adolescents and also included associations of educational level with other sexual health aspects. Adolescents aged 12 to 25 (3,926 boys and 3,915 girls) completed an online questionnaire that included measures of romantic and sexual experience; the evaluation of their sexual debut; the risk of sexually transmitted infections (STIs) and pregnancy; and sexual attitudes, satisfaction, self-efficacy, knowledge, victimization, and functioning. The results showed that adolescents on a vocational track or who completed fewer years of education were more at risk of several adverse sexual health outcomes than adolescents on an academic track. They had their first sexual experiences at an earlier age; evaluated these experiences less favorably; had less sexual health knowledge and fewer refusal skills; and had a higher risk of unintended pregnancy, STIs, and victimization. Possible explanations for these consistent differences are discussed. Sex education and services should pay specific and targeted attention to less educated young people and tailor their efforts specifically to the needs, characteristics, and realities of this group.

Assessment of the Self-Perception of Dental Appearance, Its Comparison with Orthodontist's Assessment and Demand for Treatment in Eastern Nepalese Patients.

Aims. The aim of this study was to assess the self-perception of dental appearance among Eastern Nepalese patients using aesthetic component (AC) of the index of orthodontic treatment need (IOTN) and to compare it with that of an orthodontist's assessment using the same scale and determine whether gender, area of residence, and level of education influence subject's self-perception and orthodontist's ratings. Methods. A total of 252 subjects (equal number of male and female) were conveniently selected. The average ages of subjects were 22.33 ± 2.114 years. The level of subject's perception and orthodontist's assessment was analyzed by nonparametric Chi square test. Kappa coefficient was done to verify its agreement. The Spearman's correlation test was used to check the association of educational level and age. Mann-Whitney test was used to check the associations of sex and areas of residence. Results. The demand for treatment was significantly associated with the perception of the subject and orthodontist's assessment. However, age, gender, and educational level were statistically insignificant in influencing subject perception and orthodontist's assessment. Conclusion. Patient's self-perception should be given equal importance while planning orthodontic treatment.

The Association of Education Level on Outcome after Distal Radius Fracture

Socioeconomic factors have been found to be predictors of outcome for other ailments. The purpose of this study was to evaluate the association of patient education level on pain and disability after distal radius fracture. A series of patients with distal radius fractures (n = 335) were enrolled into a prospective research registry. Standard demographic information was obtained from patients, including a five-value categorical education variable. After treatment with closed reduction, external fixation, or internal fixation patients were evaluated for pain, function (Disability of the Arm, Shoulder, and Hand score [DASH]), range of motion (ROM), and grip strength at standard intervals until 12months post-injury. A series of linear mixed effects models were developed to evaluate the relationship between time from injury and education level with each of the outcomes measured. Complete demographic and 12-month follow-up data were available on 227 patients (75%). There were neither group differences in mode of injury, severity, nor treatment modality after stratification by education level. Mixed effects model analyses revealed a significant linear association between level of education and measured outcomes at each follow-up point. Overall, each increase in education level demonstrated a doubling of improvement in pain, ROM, grip strength, and DASH score. Outcome of distal radius fracture depends on acute care and follow-up rehabilitation; however, patient-related factors indicative of socioeconomic status are becoming increasingly relevant as predictors of outcome and should be considered by the orthopaedist.

Obesity Explains Gender Differences in the Association Between Education Level and Metabolic Syndrome in South Korea

This study aimed to examine the association of educational level with metabolic syndrome (MS) and its risk factors by gender in South Korea. A total of 6178 participants aged 20 years or older from The Fifth Korean National Health and Nutrition Examination Survey were included in this study. A generalized linear model and adjusted proportion were used to identify educational disparities in MS, its components, and its risk factors (smoking, high-risk alcohol consumption, obesity, and stress). In women, a clearly inverse association between education level and MS were observed with significant trend, and the decreasing trends of all risk factors across education quartiles were in line with the inverse association. However, the association between education level and MS was not observed with a significant trend among men. An opposite trend of risk factors across education levels was shown in men, with an increasing trend for obesity and decreasing trends for smoking and high-risk alcohol consumption. These findings demonstrate that obesity can explain gender differences in the association between education level and MS in South Korea.

Associations of Education Level and Bone Density Tests among Cognitively Intact Elderly White Women in Managed Medicare

Objectives. To examine associations between having bone density tests and level of education among white elderly women in managed Medicare. Method. Data from the ninth through twelfth cohort (2006–2009) of the Medicare Health Outcome Survey (HOS) of managed Medicare plans were analyzed; 239331 white elderly women were included. Respondents were grouped by education level and the percentages of respondents who had lifetime bone density testing done among each group were analyzed. Results. 62.7% of respondents with less than a high school education reported previously taking a bone density test. This was lower than the 73.8% for respondents who completed high school and the 81.0% for respondents with more than a high school education. When potential confounding factors such as age, body mass index, marital status, smoking history, year of HOS survey, and region were factored in, the odds ratios of having a bone density test when compared to respondents with less than a high school education were 1.61 and 2.39, respectively, for those with just a high school education and more than a high school education (P < 0.001). Conclusion. Higher education was independently associated with greater use of bone density test in these elderly white women.

Selection bias and patterns of confounding in cohort studies: the case of the NINFEA web-based birth cohort

BackgroundSeveral studies have examined the effects of sample selection on the exposure–outcome association estimates in cohort studies, but the reasons why this selection may induce bias have not been fully...

Gender differences in cholesterol-lowering medication prescribing in peripheral artery disease

Among 320 patients with lower extremity peripheral artery disease (PAD) and low-density lipoprotein-cholesterol (LDL-C) levels > 70 mg/dl, we determined whether male sex, higher education, and greater self-efficacy for willingness to request therapy from one's physician were associated with increases in LDL-C-lowering medication and achievement of an LDL-C level < 70 mg/dl at 1-year follow-up. Participants were enrolled in a randomized controlled clinical trial to determine whether a telephone counseling intervention can help PAD patients achieve an LDL-C level < 70 mg/dl, compared to usual care and attention control conditions, respectively. Adjusting for age, race, comorbidities, PAD severity, and other covariates, male sex (odds ratio = 3.33, 95% confidence interval = 1.64 to 6.77, p = 0.001) was associated with a higher likelihood of adding cholesterol-lowering medication during follow-up, but was not associated with achieving an LDL-C < 70 mg/dl (odds ratio = 1.09, 95% confidence interval = 0.55 to 2.18). No associations of education level or self-efficacy with study outcomes were identified. In conclusion, male PAD patients with baseline LDL-C levels ≥ 70 mg/dl were more likely to intensify LDL-C-lowering medication during 1-year follow-up than female PAD patients. Despite greater increases in LDL-C-lowering medication among female PAD patients, there was no difference in the degree of LDL-C lowering during the study between men and women with PAD.

Association of education level with dialysis outcome

The impact of education on health care outcome has been studied in the past, but its role in the dialysis population is unclear. In this report, we evaluated this association. We used the United States Renal Data System data of end-stage renal disease patients aged 18 years. Education level at the time of end-stage renal disease onset was the primary variable of interest. The outcome of the study was patient mortality. We used four categories of education level: 0 = less than 12 years of education; 1 = high school graduate; 2 = some college; 3 = college graduate. Subgroups based on age, race, sex, donor type, and diabetic status were also analyzed. After adjustments for covariates in the Cox model, using individuals with less than 12 years of education as a reference, patients with college education showed decreased mortality with hazard ratio of 0.81 (95% confidence interval 0.69–0.95), P = 0.010. In conclusion, we showed that higher education level is associated with improved survival of patients on dialysis.