TY  - JOUR
AU  - Ding, Yi
AU  - Wu, Xianglin
AU  - Cao, Qiuyu
AU  - Huang, Jiaojiao
AU  - Xu, Xiaoli
AU  - Jiang, Youjin
AU  - Huo, Yanan
AU  - Wan, Qin
AU  - Qin, Yingfen
AU  - Hu, Ruying
AU  - Shi, Lixin
AU  - Su, Qing
AU  - Yu, Xuefeng
AU  - Yan, Li
AU  - Qin, Guijun
AU  - Tang, Xulei
AU  - Chen, Gang
AU  - Xu, Min
AU  - Wang, Tiange
AU  - Zhao, Zhiyun
AU  - Gao, Zhengnan
AU  - Wang, Guixia
AU  - Shen, Feixia
AU  - Luo, Zuojie
AU  - Chen, Li
AU  - Li, Qiang
AU  - Ye, Zhen
AU  - Zhang, Yinfei
AU  - Liu, Chao
AU  - Wang, Youmin
AU  - Yang, Tao
AU  - Deng, Huacong
AU  - Chen, Lulu
AU  - Zeng, Tianshu
AU  - Zhao, Jiajun
AU  - Mu, Yiming
AU  - Wu, Shengli
AU  - Chen, Yuhong
AU  - Lu, Jieli
AU  - Wang, Weiqing
AU  - Ning, Guang
AU  - Xu, Yu
AU  - Bi, Yufang
AU  - Li, Mian
PY  - 2024
DA  - 2024/8/23
TI  - Gender Disparities in the Association Between Educational Attainment and Cardiovascular-Kidney-Metabolic Syndrome: Cross-Sectional Study
JO  - JMIR Public Health Surveill
SP  - e57920
VL  - 10
KW  - cardiovascular-kidney-metabolic syndrome
KW  - education
KW  - health behavior
KW  - sex difference
KW  - cross-sectional study
KW  - gender
AB  - Background: Cardiovascular-kidney-metabolic (CKM) health is affected by social determinants of health, especially education. CKM syndrome has not been evaluated in Chinese population, and the association of education with CKM syndrome in different sexes and its intertwined relation with lifestyles have not been explored. Objective: We aimed to explore the association between educational attainment and the prevalence of CKM syndrome stages in middle-aged and older Chinese men and women as well as the potential role of health behavior based on Life’s Essential 8 construct. Methods: This study used data from the nationwide, community-based REACTION (Risk Evaluation of Cancers in Chinese diabetic individuals: a longitudinal study). A total of 132,085 participants with complete information to determine CKM syndrome stage and education level were included. Educational attainment was assessed by the self-reported highest educational level achieved by the participants and recategorized as low (elementary school or no formal education) or high (middle school, high school, technical school/college, or above). CKM syndrome was ascertained and classified into 5 stages according to the American Heart Association presidential advisory released in 2023. Results: Among 132,085 participants (mean age 56.95, SD 9.19 years; n=86,675, 65.62% women) included, most had moderate-risk CKM syndrome (stages 1 and 2), and a lower proportion were at higher risk of CKM (stages 3 and 4). Along the CKM continuum, low education was associated with 34% increased odds of moderate-risk CKM syndrome for women (odds ratio 1.36, 95% CI 1.23-1.49) with a significant sex disparity, but was positively correlated with high-risk CKM for both sexes. The association between low education and high-risk CKM was more evident in women with poor health behavior but not in men, which was also interactive with and partly mediated by behavior. Conclusions: Low education was associated with adverse CKM health for both sexes but was especially detrimental to women. Such sex-specific educational disparity was closely correlated with health behavior but could not be completely attenuated by behavior modification. These findings highlight the disadvantage faced by women in CKM health ascribed to low education, underscoring the need for public health support to address this inequality. 
SN  - 2369-2960
UR  - https://publichealth.jmir.org/2024/1/e57920
UR  - https://doi.org/10.2196/57920
DO  - 10.2196/57920
ID  - info:doi/10.2196/57920
ER  -