心血管-肾脏-代谢（CKM）健康受到健康社会决定因素的影响，尤其是教育。尚未对中国人群中的 CKM 综合征进行评估，也未探讨不同性别中教育程度与 CKM 综合征的关联及其与生活方式的交织关系。我们的目的是探讨教育程度与中年 CKM 综合征分期患病率之间的关系。 -中国老年男性和女性以及基于生命要素 8 构建的健康行为的潜在作用。本研究使用的数据来自全国性社区 REACTION（中国糖尿病患者癌症风险评估：一项纵向研究） 。共有 132,085 名参与者拥有确定 CKM 综合征阶段和教育水平的完整信息。教育程度根据参与者自我报告的最高教育水平进行评估，并重新分类为低（小学或未受过正规教育）或高（初中、高中、技术学校/学院或以上）。根据美国心脏协会 2023 年发布的主席建议，CKM 综合征被确定并分为 5 个阶段。在 132,085 名参与者（平均年龄 56.95，标准差 9.19 岁；n=86,675，65.62% 女性）中，大多数患有中危 CKM 综合征（第 1 和第 2 阶段），并且较低比例的 CKM 风险较高（第 3 和第 4 阶段）。沿着 CKM 连续体，低教育程度与女性中度风险 CKM 综合征的几率增加 34% 相关（比值比 1.36，95% CI 1.23-1.49），性别差异显着，但与高风险 CKM 呈正相关。男女皆宜。低教育程度与高风险 CKM 之间的关联在健康行为不佳的女性中更为明显，但在男性中则不然，这也与行为相互作用并部分由行为调节。低教育程度与两性的不良 CKM 健康相关，但尤其有害对女性。这种性别教育差异与健康行为密切相关，但不能通过行为矫正完全减弱。这些发现突显了女性因受教育程度低而在 CKM 健康方面面临的劣势，并强调需要公共卫生支持来解决这种不平等问题。© Yi Ding、Xianglin Wu、Qiuyu Cao、Jiaojiao Huang、Xiaoli Xu、Youjin Jiang、Yanan Huo，秦万、秦英芬、胡如英、施立新、苏青、于雪峰、李岩、秦贵军、唐旭雷、陈刚、徐敏、王天歌、赵志云、高正楠、王桂霞、沉飞霞、罗作杰, 陈力, 李强, 叶振, 张印飞, 刘超, 王友民, 杨涛, 邓华聪, 陈露露, 曾天舒, 赵家军, 穆一鸣, 吴胜利, 陈宇红, 陆洁丽, 王伟庆, 光宁，余旭，毕玉芳，李勉。最初发表于 JMIR 公共卫生和监测 (https://publichealth.jmir.org)。

Cardiovascular-kidney-metabolic (CKM) health is affected by social determinants of health, especially education. CKM syndrome has not been evaluated in Chinese population, and the association of education with CKM syndrome in different sexes and its intertwined relation with lifestyles have not been explored.We aimed to explore the association between educational attainment and the prevalence of CKM syndrome stages in middle-aged and older Chinese men and women as well as the potential role of health behavior based on Life's Essential 8 construct.This study used data from the nationwide, community-based REACTION (Risk Evaluation of Cancers in Chinese diabetic individuals: a longitudinal study). A total of 132,085 participants with complete information to determine CKM syndrome stage and education level were included. Educational attainment was assessed by the self-reported highest educational level achieved by the participants and recategorized as low (elementary school or no formal education) or high (middle school, high school, technical school/college, or above). CKM syndrome was ascertained and classified into 5 stages according to the American Heart Association presidential advisory released in 2023.Among 132,085 participants (mean age 56.95, SD 9.19 years; n=86,675, 65.62% women) included, most had moderate-risk CKM syndrome (stages 1 and 2), and a lower proportion were at higher risk of CKM (stages 3 and 4). Along the CKM continuum, low education was associated with 34% increased odds of moderate-risk CKM syndrome for women (odds ratio 1.36, 95% CI 1.23-1.49) with a significant sex disparity, but was positively correlated with high-risk CKM for both sexes. The association between low education and high-risk CKM was more evident in women with poor health behavior but not in men, which was also interactive with and partly mediated by behavior.Low education was associated with adverse CKM health for both sexes but was especially detrimental to women. Such sex-specific educational disparity was closely correlated with health behavior but could not be completely attenuated by behavior modification. These findings highlight the disadvantage faced by women in CKM health ascribed to low education, underscoring the need for public health support to address this inequality.© Yi Ding, Xianglin Wu, Qiuyu Cao, Jiaojiao Huang, Xiaoli Xu, Youjin Jiang, Yanan Huo, Qin Wan, Yingfen Qin, Ruying Hu, Lixin Shi, Qing Su, Xuefeng Yu, Li Yan, Guijun Qin, Xulei Tang, Gang Chen, Min Xu, Tiange Wang, Zhiyun Zhao, Zhengnan Gao, Guixia Wang, Feixia Shen, Zuojie Luo, Li Chen, Qiang Li, Zhen Ye, Yinfei Zhang, Chao Liu, Youmin Wang, Tao Yang, Huacong Deng, Lulu Chen, Tianshu Zeng, Jiajun Zhao, Yiming Mu, Shengli Wu, Yuhong Chen, Jieli Lu, Weiqing Wang, Guang Ning, Yu Xu, Yufang Bi, Mian Li. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org).