Abstract
OBJECTIVES: To assess the potential impact of years of education, which serves as a measure of socioeconomic inequality, on the occurrence of endometriosis, and to quantify the potential influence of modifiable factors as mediators. METHODS: The study used SNPs as genetic tools for genetic association. Analysis using 2-sample univariate and multivariate Mendelian randomization methods. Primary analyses were performed using an inverse variance weighted MR method. Data were obtained from publicly available genome-wide association studies (GWAS) from European populations. Data for ending endometriosis were obtained from the Neale lab. RESULTS: Each SD increase in years of education (4.2 years) has a protective effect on endometriosis (OR 0.9975; 95% CI 0.9958-0.9951). For individuals, the most significant contribution is the depression factor (mediation effect 53%, 95% CI: 3-102%). After combining, the mediator variable explains 64% (95% CI: 55%-290%) of the education-endometriosis association. SUMMARY: Higher education attainment potentially has a causal protective effect on endometriosis, while lower education levels may increase the risk of endometriosis through modifiable factors such as depression, insomnia, and anxiety.