JMIR Publications

ABSTRACT

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 of educational attainment and the prevalence of CKM syndrome stages in middle-aged and older Chinese men and women, and the potential role of health behavior based on Life’s Essential 8 construct.

Methods:

This study used the data from the nationwide, community-based REACTION (Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal study). A total of 132085 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 132085 participants (mean age 56.95 years, 65.62% women) included, most were in moderate-risk CKM syndrome (stage 1 and 2), and a lower proportion were in high-risk CKM (stage 3 and 4). Along the CKM continuum, low education was associated with 34% increased odds of moderate-risk CKM syndrome for women (OR: 1.34, 95% CI:1.21 to 1.47) 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 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 highlighted the female disadvantage in CKM health ascribed to low education and called for public health support to address this inequality.