Does level of education influence mortality of SARS-CoV-2 in a developing country?

Concepción-Zavaleta, Marcio José; Arroyo, Julia; Zavaleta-Gutiérrez, Francisca Elena; Concepción-Urteaga, Luis Alberto

doi:10.1093/ije/dyaa193

Cited by 20 publications

(28 citation statements)

References 10 publications

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“…In the GWAS meta-analysis of COVID-19 severity, individuals were considered as cases if their deaths were due to COVID-19-associated causes. Thus, our study finding implied that genetic predisposition to higher education attainment may causally lower the risk of COVID-19-associated deaths, which is partially in line with most of the published observational studies in the United States [ 8 ], Sweden [ 10 ] and Peru [ 9 ]. In the National Health and Nutrition Examination Survey (NHANES), individuals with education lower than high school level (11.2% of the 2017–2018 NHANES sample) were overrepresented and accounted for approximately 25% of the COVID-19 deaths [ 11 ].…”

Section: Discussionsupporting

confidence: 88%

“…Lower education level was reported to be associated with a stronger agreement with COVID-19 misinformation [ 4 ], poorer knowledge and practices regarding COVID-19 protection [ 5 , 6 ], which may, in turn, lead to increased risk of SARS-CoV-2 infection or worse COVID-19 outcomes. Although studies have reported that lower education attainment was associated with increased risk of SARS-CoV-2 infection, COVID-19 hospitalization or mortality [ 7 , 8 , 9 , 10 , 11 , 12 , 13 ], whether the relationship is causal remains unclear. Notably, education attainment is phenotypically and genetically correlated with intelligence, and bidirectional causation exists between the two traits [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Education Attainment, Intelligence and COVID-19: A Mendelian Randomization Study

Lam

Wong

et al. 2021

JCM

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Background: Evidence of socioeconomic inequality in COVID-19-related outcomes is emerging, with a higher risk of infection and mortality observed among individuals with lower education attainment. We aimed to evaluate the potential interventions against COVID-19 from the socioeconomic perspective, including improvement in education and intelligence. Methods: With a two-sample Mendelian randomization approach using summary statistics from the largest genome-wide association meta-analysis, univariable analysis was adopted to evaluate the total causal effects of genetically determined education attainment and intelligence on COVID-19 outcomes. Multivariable analysis was performed to dissect the potential mechanisms. Results: Genetic predisposition to higher education attainment by 1 SD (4.2 years) was independently associated with reduced risk of COVID-19 severity (OR = 0.508 [95% CI: 0.417–0.617]; p < 0.001). Genetically higher education attainment also lowered the risk of COVID-19 hospitalization (0.685 [0.593–0.791]; p < 0.001), but the association was attenuated after adjustment for beta estimates of intelligence in multivariable analysis. Genetically higher intelligence was associated with reduced risk of COVID-19 hospitalization (0.780 [0.655–0.930]; p = 0.006), with attenuation of association after adjustment for education attainment. Null association was observed for genetically determined education attainment and intelligence with SARS-CoV-2 infection. Conclusion: Education may act independently and jointly with intelligence in improving the COVID-19 outcomes. Improving education may potentially alleviate the COVID-19-related health inequality.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Education Attainment, Intelligence and COVID-19: A Mendelian Randomization Study

Lam

Wong

et al. 2021

JCM

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“…Previous studies have shown differences in risk perception, knowledge, attitude, and protective behavior for COVID-19 according to education level, with lesser scores among those with low education level [ 39 , 40 ]. Further, a recent study from Peru highlighted an association between low educational level and COVID-19 mortality, which was present across all age groups (<50, 50-70, and >70 years) [ 41 ]. Social and economic inequality, and presence of adverse health behaviors were cited as the major reasons for this association.…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 Seroprevalence in Individuals With Type 1 and Type 2 Diabetes Compared With Controls

et al. 2022

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Objective Data for association between diabetes and SARS-CoV-2 susceptibility are conflicting. We aimed to evaluate this association using an analytical cross-sectional study design. Methods Study participants were recruited from endocrine clinics of our hospital and belonged to three groups: group 1 (T1DM), group 2 (T2DM), and group 3 (controls). All participants submitted blood samples for SARS-CoV-2 S1/S2 IgG antibody test (Diasorin Liaison), and were interviewed for history of documented infection. Results We evaluated total of 643 participants [T1DM: 149, T2DM: 160, Control: 334; mean age: 37.9±11.5 years]. A total of 324 (50.4%) participants were seropositive. Seropositivity rate was significantly higher in T1DM (55.7% vs. 44.9%, p=0.028) and T2DM (56.9% vs. 44.9%, p=0.013) groups, then control group. Antibody levels in seropositive T1DM and T2DM participants were not significantly different from seropositive controls. On multivariable analysis, low education status [OR: 1.41 (95% CI, 1.03, 1.94), p=0.035], diabetes [OR: 1.68 (95% CI, 1.20, 2.34), p=0.002], and overweight/obesity [OR: 1.52 (95% CI, 1.10, 2.10), p=0.012] showed significant association with SARS-CoV-2 seropositivity. The association between diabetes and SARS-CoV-2 seropositivity was found to further increase in participants with co-existing overweight/obesity [adjusted OR, 2.63 (95% CI, 1.54, 4.47, p<0.001]. Conclusions SARS-CoV-2 seropositivity, assessed before the onset of national vaccination program, was significantly higher in participants with T1DM and T2DM, compared to controls. The antibody response did not differ between seropositive participants with and without diabetes. These findings point towards an increased SARS-CoV-2 susceptibility for patients with diabetes, in general, without any differential effect of the diabetes type.

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“…Low levels of education are related to high prevalence and incidence of cerebrovascular and cardiovascular diseases, cancer, diabetes, hypertension, and chronic respiratory diseases [105]. Generally, a bad socioeconomic status may be linked to low educational level, thus increasing the risk of previously mentioned diseases [106], and of COVID-19 because of low levels of immune cells and high levels of Cytokines in body fluids [107]. It should be remembered that the access to education is not the same elsewhere; when examining urban versus rural outcomes in COVID-19, the disparities are markedly evident when considering county-level data [108].…”

Section: Introductionmentioning

confidence: 99%

Beyond vaccination: A Cross-Sectional Study of the importance of Behavioral and Native Factors on COVID-19 Infection and Severity

Aouissi

Ababsa

Leveau

et al. 2022

Preprint

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The COVID-19 pandemic has a major impact on a global scale. Understanding the innate and lifestyle-related factors influencing the rate and severity of COVID-19 is important for making evidence-based recommendations. This cross-sectional study aimed at establishing a potential relationship between human characteristics and vulnerability/resistance to SARS-CoV-2. We hypothesize that the impact of virus is not the same due to cultural and ethnic differences. A cross-sectional study was performed using an online questionnaire. The methodology included a development of a multi-language survey, expert evaluation and data analysis. Data was collected using a 13-item pre-tested questionnaire based on a literature review. Data was statistically analyzed using the logistic regression. For a total of 1125 respondents, 332 (29.5%) were COVID-19 positive, among them 130 (11.5%) required home-based treatment, and 14 (1.2%) intensive care. The significant factors included age, physical activity and health status all found to have a significant influence on the infection (p < 0.05). The severity of infection was associated with preventive measures and tobacco (p < 0.05). This suggests the importance of behavioral factors compared to innate ones. Apparently, the individual behavior is mainly responsible for the spread of the virus. Adopting a healthy lifestyle and scrupulously observing preventive measures including vaccination would greatly limit the probability of infection and prevent the development of severe COVID-19.

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Does level of education influence mortality of SARS-CoV-2 in a developing country?

Cited by 20 publications

References 10 publications

Education Attainment, Intelligence and COVID-19: A Mendelian Randomization Study

Education Attainment, Intelligence and COVID-19: A Mendelian Randomization Study

SARS-CoV-2 Seroprevalence in Individuals With Type 1 and Type 2 Diabetes Compared With Controls

Beyond vaccination: A Cross-Sectional Study of the importance of Behavioral and Native Factors on COVID-19 Infection and Severity

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