Higher Educational Attainment Reduces the Risk of Acute Pancreatitis by Decreasing Triglycerides and the Occurrence of Cholelithiasis

Abstract

Abstract Background: Acute pancreatitis (AP) is a significant public health concern. Although a higher level of education attainment (EA) has been observed to be associated with a lower incidence of AP, the causal relationship and potential mediators remain unclear. Method: In this study, we investigated the years of schooling as the primary indicator of EA, as well as cognitive performance and intelligence as secondary indicators. We used a large-scale database to obtain genome-wide association data on factors related to Years of schooling, cognitive performance, intelligence, cholelithiasis, triglycerides, alcohol consumption, and AP. Through two-sample Mendelian randomization (MR) analysis, including inverse variance weighted, weighted median, and MR-Egger methods, we explored the causal relationship between years of schooling, cognitive performance, intelligence, and AP. MR-Egger and MR-PRESSO were used for sensitivity analysis to address pleiotropy issues. Additionally, multivariable MR analysis helped identify independent protective factors and potential mediators. Results: Longer years of schooling (OR=0.556, 95% CI: 0.456-0.677, P=6.01E-09), better cognitive performance (OR=0.796, 95% CI: 0.653-0.970, P=0.024), and higher intelligence (OR=0.789, 95% CI: 0.637-0.977, P=0.030) had a causal effect on reducing the incidence of AP. Furthermore, cholelithiasis and triglycerides mediated the causal relationship between years of schooling and AP risk. In this causal relationship, cholelithiasis and triglycerides together accounted for 19.6% of the mediation effect. Conclusion:These research findings support the causal impact of education attainment on the occurrence of AP, with a substantial portion of the causal effect being mediated by modifiable risk factors. This suggests that strategies aimed at improving education levels are feasible for preventing AP, and interventions targeting cholelithiasis and triglyceride levels can reduce AP cases caused by imbalances in education attainment.