Exploring Inequalities in Population Health: A Phenome-Wide Study Examining the Association between Education and 833 diseases in Denmark

Abstract

AbstractObjectiveThe social processes that shape people’s environment and ways of living tend to create inequalities in health. Better education is often, but not always, associated with lower disease incidence and better prognosis through a multitude of different mechanisms. Most often, research in this area examine few diseases of interest, thereby creating an array of disjoint analyses that lack comparability. The objective of this study is to create a novel atlas covering 833 diseases illustrating the associated educational gradients across a wide spectrum of health outcomes.MethodLongitudinal, register-based study conducted on all Danish residents aged 30 years and over (N=4,258,789) between 2012 and 2021. We applied a phenome-wide approach to assess associations between three ISCED-based educational levels (low, medium, high) and the incidence of 833 diseases defined by ICD-10 diagnostic codes. Age-standardized incidence rates were estimated using Poisson regression adjusted for sex and birth cohort.ResultsEducational inequalities were observed in virtually all diseases studied and were, thus, not limited to particular disease areas. We found incidence rates of the vast majority of diseases increased with higher educational level (N=569). For 77 diagnoses, we observed an inverse educational gradient. Lower educated individuals had, with few exceptions, the highest incidence rates for non-communicable and communicable diseases.ConclusionsOur atlas provides a full and detailed representation of the association between education and disease incidence. It brings attention to all diseases – not only the most prevalent – and makes it possible to examine the role of education across the universe of diseases.