Highlights
- •We studied the link of education with the etiology and stage of chronic hepatitis.
- •11,107 subjects with chronic hepatitis were prospectively recruited.
- •A low educational level was associated with alcohol etiology and HCV etiology.
- •A low educational level was associated with the presence of cirrhosis.
Abstract
Background
The potential link between educational level and chronic liver diseases (CLD) were
explored using the mortality records of liver cirrhosis, which lack accuracy and are
unable to identify the different etiological factors of liver cirrhosis. Information
on the association of low educational level with the severity of CLD is lacking.
Aim
To evaluate the potential association linking education level to etiology and clinical
stage of CLD cases.
Methods
Consecutive enrolment of 11,107 subjects with CLD aged≥18 years prospectively recruited
in two national surveys in 2001 and 2014 at one of the participating Italian liver
units throughout the country. Subjects were pooled in two groups: low education level
(less than high school) and high education level (completed high school or beyond).
The association of demographic, etiological, and clinical stage of subjects with educational
level was assessed using logistic regression analysis. In the analysis low educational
level was the outcome variable.
Results
A total of 11,107 subjects born in Italy (mean age 55.5 years, sex ratio 1.5) were
evaluated. Multiple logistic regression analysis shows that chronic HCV infection
(O.R.1,38:95%,C.I.1.23-1.55), risky alcohol intake (O.R.1.96;95%,C.I.1.73-2.21) and
liver cirrhosis (O.R.1.65;95%,C.I.1.46-1.85) all resulted independently associated
with less than a completed high school education. HBV infection resulted independently
associated with high education level (O.R.0.74;95%,C.I.0.64-0.86), reflecting changes
in HBV modes of transmission in recent decades. No association was found with CLD
related to non-alcoholic fatty liver disease (O.R.1.03;95%, C.I.0.81-1.30).
Conclusions
These findings show an independent association linking education level with viruses
and alcohol-related CLD. Low educational level is associated with the severity of
CLD.
Keywords
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Article info
Publication history
Published online: January 22, 2020
Accepted:
January 14,
2020
Received in revised form:
June 24,
2019
Received:
December 22,
2018
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
