[The relationship of education and mortality with special concern to coronary heart disease mortality. The Reykjavik...

Coronary heart disease is a leading cause of death in the Western world and coronary heart disease mortality has been connected with socio-economic status. Formerly, coronary heart disease mortality was higher xamong those with higher educational achievement, but recent research has shown this relationship to have been reversed. To assess this in Iceland, a prospective study of the relationship between education and coronary heart disease mortality as well as mortality due to all causes was performed.

This study was a part of the Reykjavik Study. The participants (18,912) were divided into four groups according to education. The relationship between education and mortality was assessed with the Cox proportional hazards model, using the group of lowest educational status as a reference. Corrections were made for age and year of examination along with risk factors (cholesterol, triglycerides, systolic blood pressure, glucose tolerance and smoking).

A statistically significant negative relationship between education and coronary heart disease mortality was found for men and women (p<0.02 and p<0.01 respectively). Mortality risk of the highest educational group was 66% of the lowest group for men and 23% for women. The relationship was present after adjustment for risk factors, but significant for men only (p<0.03 and p<0.10 respectively).

Education has a significant independent protective effect against coronary heart disease mortality in men. The same relationship is probably present among women, but fewer deaths had occurred. Educational status was a strong predictor of mortality and known risk factors only explained a small part of the mortality difference between various educational groups. Higher education was also associated with lowered mortality due to all causes.