The Relationship of Educational Attainment with Pulmonary Emphysema and Airway Wall Thickness.
RATIONALE
Low educational attainment is a risk factor of chronic obstructive pulmonary disease (COPD). There is limited knowledge on the relationship between educational level and computed tomography measures of emphysema and airway wall thickness (AWT).


OBJECTIVES
We hypothesized that low educational attainment is associated with increased emphysema and AWT in ever-smokers with and without COPD.


METHODS
We included 462 and 485 ever-smokers with and without COPD in a cross-sectional study, aged 40-86 years. The sample was divided into groups reflecting educational attainment: primary, secondary, and university. We performed linear regression to examine associations between educational attainment and both emphysema and AWT separately for those with and without COPD. We adjusted for sex, age, smoking status, age of onset of smoking, pack-years, height, and body mass index.


MEASUREMENTS AND MAIN RESULTS
Compared with university education, in subjects with COPD, primary education was associated with a 68.1% (95% confidence interval = 14.2-147.6%; P = 0.01) relative increase in emphysema and secondary education was associated with a 50.6% (95% confidence interval = 5.7-114.6%; P = 0.02) relative increase. There was a nonsignificant trend toward an association between lower educational attainment and increased emphysema among those without COPD (P = 0.18), yet greater age appeared to modify this association (P = 0.01). We did not detect significant linear relationships between educational attainment and AWT in subjects with or without COPD.


CONCLUSIONS
Lower educational attainment was associated with increased emphysema among adults with COPD. Among those without COPD, this association was more pronounced with increasing age. No significant linear relationship between educational attainment and AWT was found. Clinicians treating adults with emphysema should keep in mind that factors related to low education beyond that of smoking and occupational dust exposure might be of importance to the disease.
['Gjerdevik|Miriam|M|', 'Grydeland|Thomas B|TB|', 'Washko|George R|GR|', 'Coxson|Harvey O|HO|', 'Silverman|Edwin K|EK|', 'Gulsvik|Amund|A|', 'Bakke|Per S|PS|']
D000328:Adult D017668:Age of Onset D000368:Aged D003430:Cross-Sectional Studies D004522:Educational Status D005260:Female D006306:Health Surveys D006801:Humans D008168:Lung D008297:Male D008875:Middle Aged D009664:Norway D029424:Pulmonary Disease, Chronic Obstructive D011656:Pulmonary Emphysema D012307:Risk Factors D012907:Smoking D013147:Spirometry D013223:Statistics as Topic D014057:Tomography, X-Ray Computed
chronic obstructive pulmonary disease educational level quantitative computed tomography imaging