UB Study Shows Those With Less Than 12 Years Education Face Twice the Risk of Dying from Stroke

BUFFALO, N.Y. -- If policymakers need one more reason to press for a good education for all Americans, here it is: Education is a boon to public health.

University at Buffalo researchers have found that as education level goes up, risk of death from stroke and brain hemorrhage goes down. The relationship likely exists for other chronic diseases, as well.

Adnan I. Qureshi, M.D., UB assistant professor of neurosurgery and lead author of the study, presented the results at the recent 27th International Stroke Conference in San Antonio. The research was conducted at UB's Toshiba Stroke Research Center in the School of Medicine and Biomedicine Sciences. The study assessed data from a representative sample of the U.S. population totaling more than 21,000 persons.

After adjusting for several conditions that could influence a participant's risk of death from stroke or brain hemorrhage -- age, race, gender, hypertension, cigarette smoking, serum cholesterol, socioeconomic status and diabetes -- the findings showed that persons with less than a high school education had a 40 percent increase in risk of from dying from stroke compared to those with more than 12 years of schooling.

The risk was of dying from intracerebral hemorrhage was twice as high for people with less than 12 years of education.

The underlying reason for the association between education level and risk of fatal stroke and intracerebral hemorrhage is not clear, Qureshi said, but he noted some possible explanations.

"Education probably contributes to one's awareness of risk factors and the importance of preventive efforts," he said. "There may be sociopsychological factors involved that we are unable to identify at this point. Or there may be issues related to differences in lifestyle that may explain, in part, the observed association.

"It is definitely possible that diet and physical activity may be different based on your educational status," Qureshi added. "Sedentary lifestyle may contribute to the risk of cerebrovascular diseases, although persons in higher education strata tend to have a less physically vigorous lifestyle. These are issues that require further evaluation."

While it would be reasonable to assume that education affects socioeconomic status, and that the relationship between education and stroke could be due to the inability to afford good medical care, Qureshi adjusted for socioeconomic status and the relationship was independent of this measure.

The study findings were based on an analysis of data from a national cohort of 21,443 adults who took part in one of two National Health and Nutrition Examination Surveys (NHANES) and their 15-year follow-up surveys.

Participants in the initial surveys, conducted in representative samples of the U.S. population, provided extensive information on health status and lifestyle habits, including education level. The follow-up study assessed changes in health or vital status since the initial survey.

"Lower education leads to a higher risk of cerebrovascular diseases, which brings with it a substantial financial burden on the nation," Qureshi said. "The results support a higher level of commitment from policy makers and individuals to improve the level of education among our population."

Other faculty from the UB Department of Neurosurgery and UB's Toshiba Stroke Research Center involved in the study were M. Fareed K. Suri, M.D, Mustafa Saad, M.D., Lee R. Guterman, M.D., Ph.D., and L. Nelson Hopkins, M.D., department chair.

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