Establishing an education risk factor group within the GBD study

Abstract

Social determinants such as education are central to health inequalities, yet they are not currently represented as attributable risk factors in the Global Burden of Disease (GBD) Study. A major barrier is the absence of a coordinated global research infrastructure capable of producing harmonised, cause-specific evidence linking education to mortality. To address this gap, the international Education Risk Factor Group, aligned with the GBD Study, aims to develop the empirical and methodological foundation required to include low educational attainment as a risk factor in the Comparative Risk Assessment framework. The initiative will identify and mobilise countries with high-quality population-based registry data linking education and cause-specific mortality, expanding both scale and geographic coverage. For each contributing country, relative risks will be estimated across approximately 50 leading causes of death using harmonised analytical protocols. In parallel, systematic reviews and meta-analyses will synthesise existing evidence for major causes of death where registry data are limited, ensuring robust exposure–response functions. Education will be standardised using ISCED classifications, and causes mapped to the GBD hierarchy, combining national depth with global breadth. The project will generate a comprehensive and coordinated global evidence base on educational inequalities in cause-specific mortality. By integrating country-level analyses with systematic synthesis, it will provide consistent and comparable estimates across populations. This evidence is essential to evaluate feasibility and support the inclusion of education as a GBD risk factor. Beyond supporting GBD inclusion, the initiative will foster a unique European and global research collaboration, creating new opportunities for comparative analyses, policy-relevant insights, and long-term advancement in health inequality research.