Education in relation to incidence of and mortality from cancer and cardiovascular disease in Japan

Background: Although lower education has been associated with poorer health, few studies have examined whether lower education affects mortality, incidence, both or neither of cancer and cardiovascular disease. Methods: The authors conducted a population-based prospective cohort study among 39 228 men and women who were aged 4059 years and lived in four areas in Japan. Information on education and lifestyle variables were obtained by a self-administered questionnaire in 1990. Follow-up until the end of 2002 (for incidence) or 2003 (for mortality) ascertained 2573 and 1251 incident cases of cancer and cardiovascular disease, respectively, and 2430 deaths (1064 from cancer, 548 from cardiovascular disease and 818 from other causes). Results: After adjustment for demographic and lifestyle variables, < 10 years of education, as compared with > 12 years of education, was associated with significantly higher mortality from all causes [hazard ratio (HR) 1.22, 95 confidence interval (CI): 1.051.42] and cardiovascular disease (HR 1.44, 95 CI: 1.012.06), but was not associated with higher incidence of cardiovascular disease (HR 0.96, 95 CI: 0.781.18) or higher mortality or incidence of cancer. Conclusion: The findings suggest that lower education is associated with higher mortality from all causes and cardiovascular disease among the Japanese population that is not totally attributable to lifestyle differences or higher cardiovascular disease incidence.