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已发表论文
关于教育程度与慢性阻塞性肺疾病关系及中介作用的孟德尔随机化证据
Authors Yang X , Luo X , Wang Y, Tang M , Gong J, Lian S, Zhou Y , Li X , Deng J, Cao G, Li L
Received 13 March 2025
Accepted for publication 26 August 2025
Published 18 September 2025 Volume 2025:20 Pages 3229—3240
DOI https://doi.org/10.2147/COPD.S523785
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Richard Russell
Xinyu Yang,1,* Xiaomei Luo,1,* Yan Wang,1,* Meng Tang,2 Junhui Gong,1 Shaopan Lian,1 Ying Zhou,1 Xin Li,1 Jia Deng,1 Guoqiang Cao,1 Li Li1
1Department of Respiratory Medicine, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China; 2National Engineering Research Center of Immunological Products, Department of Microbiology and Biochemical Pharmacy, College of Pharmacy, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Li Li, Department of Respiratory Medicine, Daping Hospital, Army Medical University, (Third Military Medical University), Chongqing, 400042, People’s Republic of China, Tel/Fax +86-23-68729190, Email dpyyhxlili@tmmu.edu.cn
Background: Previous epidemiological studies revealed a potential correlation between educational imbalance and chronic obstructive pulmonary disease (COPD) incidence and hospitalization. However, such studies were susceptible to confounding factors and lacked strong causal evidence. The purpose of this study was to utilize Mendelian randomization (MR) to explore the causal relationship between educational attainment (EA) and the onset and hospitalization of COPD, as well as the mediating mechanism of EA on COPD through multivariable MR (MVMR) and two-step MR.
Methods: Based on data from genome-wide association studies (GWASs), this study used single nucleotide polymorphisms (SNPs) as instrumental variables (IVs) for EA and COPD. Two-sample MR, MVMR and two-step MR analysis were conducted. The impact of each variable on the outcome was analysed, and the overall mediating effects of smoking, body mass index (BMI) and generalized allergic reactions were assessed.
Results: MR analysis suggested that greater EA significantly reduced the incidence (OR = 0.22, 95% CI = 0.12– 0.41) and hospitalization (OR = 0.28, 95% CI = 0.18– 0.44) of COPD. The MVMR findings suggested that the impact of EA (OR = 0.53, 95% CI = 0.29– 0.99) on COPD still existed after adjusting mediators. Combined MVMR and two-step MR analysis revealed that smoking, BMI and allergies mediate 47.9% of the relationship between EA and COPD.
Conclusion: High levels of education may have potentially causal protective effect on the onset and hospitalization of COPD. Reducing smoking, obesity and preventing allergic reactions are candidate approaches to prevent COPD, especially in individuals with lower levels of education.
Keywords: chronic obstructive pulmonary disease, educational attainment, Mendelian randomization
1Department of Respiratory Medicine, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China; 2National Engineering Research Center of Immunological Products, Department of Microbiology and Biochemical Pharmacy, College of Pharmacy, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Li Li, Department of Respiratory Medicine, Daping Hospital, Army Medical University, (Third Military Medical University), Chongqing, 400042, People’s Republic of China, Tel/Fax +86-23-68729190, Email dpyyhxlili@tmmu.edu.cn
Background: Previous epidemiological studies revealed a potential correlation between educational imbalance and chronic obstructive pulmonary disease (COPD) incidence and hospitalization. However, such studies were susceptible to confounding factors and lacked strong causal evidence. The purpose of this study was to utilize Mendelian randomization (MR) to explore the causal relationship between educational attainment (EA) and the onset and hospitalization of COPD, as well as the mediating mechanism of EA on COPD through multivariable MR (MVMR) and two-step MR.
Methods: Based on data from genome-wide association studies (GWASs), this study used single nucleotide polymorphisms (SNPs) as instrumental variables (IVs) for EA and COPD. Two-sample MR, MVMR and two-step MR analysis were conducted. The impact of each variable on the outcome was analysed, and the overall mediating effects of smoking, body mass index (BMI) and generalized allergic reactions were assessed.
Results: MR analysis suggested that greater EA significantly reduced the incidence (OR = 0.22, 95% CI = 0.12– 0.41) and hospitalization (OR = 0.28, 95% CI = 0.18– 0.44) of COPD. The MVMR findings suggested that the impact of EA (OR = 0.53, 95% CI = 0.29– 0.99) on COPD still existed after adjusting mediators. Combined MVMR and two-step MR analysis revealed that smoking, BMI and allergies mediate 47.9% of the relationship between EA and COPD.
Conclusion: High levels of education may have potentially causal protective effect on the onset and hospitalization of COPD. Reducing smoking, obesity and preventing allergic reactions are candidate approaches to prevent COPD, especially in individuals with lower levels of education.
Keywords: chronic obstructive pulmonary disease, educational attainment, Mendelian randomization