Investigating causality in associations between education and smoking: A two-sample Mendelian randomization study
Background: Lower educational attainment is associated with increased rates of smoking, but ascertaining causality is challenging. We used two-sample Mendelian randomization (MR) analyses of summary statistics to examine whether educational attainment is causally related to smoking. Methods and Findings: We used summary statistics from genome-wide association studies of educational attainment and a range of smoking phenotypes (smoking initiation, cigarettes per day, cotinine levels and smoking cessation). Various complementary MR techniques (inverse-variance weighted regression, MR Egger, weighted-median regression) were used to test the robustness of our results. We found broadly consistent evidence across these techniques that higher educational attainment leads to reduced likelihood of smoking initiation, reduced heaviness of smoking among smokers (as measured via self-report and cotinine levels), and greater likelihood of smoking cessation among smokers. Conclusions: Our findings indicate a causal association between low educational attainment and increased risk of smoking, and may explain the observational associations between educational attainment and adverse health outcomes such as risk of coronary heart disease.
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