Differential associations between state-level educational quality and cardiovascular health by race: Early-life exposures and late-life health

Vable, Anusha M.; Nguyen, Thu T.; Rehkopf, David H.; Glymour, M. Maria; Hamad, Rita

doi:10.1016/j.ssmph.2019.100418

Cited by 12 publications

(12 citation statements)

References 39 publications

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“…The relationship between marital status and self-care maintenance also did not differ by race. Consistent with the findings of Vable et al (2019), there was an association between race and education. We found that a larger proportion of Whites had a college education compared to both Black and Asian or mixed participants.…”

Section: Discussionsupporting

confidence: 85%

“…Prior studies found an interaction between race and marital status (Assari & Bazargan, 2019) and race and education (Vable et al, 2019). Among Blacks and Latinos, better educational quality was associated with lower obesity, higher rates of stroke, heart disease, and smoking (a poor self-care maintenance behavior) (Vable et al, 2019). Additionally, Blacks mostly lived in states with lower statelevel educational quality than Whites and Latinos.…”

Section: Discussionmentioning

confidence: 99%

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Sociodemographic Indicators of Social Position and Self-care Maintenance in Adults with Heart Failure

Baah¹,

Chittams

Carlson

et al. 2021

Clin Nurs Res

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Social determinants of health (SDH) are known to influence health. Adequate self-care maintenance improves heart failure (HF) outcomes. However, the relationship between self-care maintenance and SDH remains unclear. Explore the relationship between sociodemographic indicators of social position and self-care maintenance in adults with HF. This was a secondary analysis of data from a cross-sectional descriptive study of 543 adults with HF. Participants completed the Self-Care of HF Index and a sociodemographic survey. We used multiple regression with backward elimination to determine which SDH variables were determinants of self-care maintenance. Marital status ( p = .02) and race ( p = .02) were significant determinants of self-care maintenance. Education ( p = .06) was highest in Whites (35.6%). These variables explained only 3.8% of the variance in self-care maintenance. Race, education, and marital status were associated with HF self-care maintenance. SDH is complex and cannot be explained with simple sociodemographic characteristics.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Sociodemographic Indicators of Social Position and Self-care Maintenance in Adults with Heart Failure

Baah¹,

Chittams

Carlson

et al. 2021

Clin Nurs Res

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“…This matters for CVD, since educational attainment is associated with reduced risk of obesity and smoking-strong CVD risk factors-as well as mortality [9]. Furthermore, existing studies generally quantify education as years or credentials completed [9][10][11]; few measure differences in quality or other aspects of schooling [12,13].…”

Section: Introductionmentioning

confidence: 99%

School racial segregation and long-term cardiovascular health among Black adults in the US: A quasi-experimental study

et al. 2022

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Background Cardiovascular disease (CVD) disproportionately affects United States black adults. This is increasingly acknowledged to be due to inequitable distribution of health-promoting resources. One potential contributor is inequities in educational opportunities, although it is unclear what aspects of education are most salient. School racial segregation may affect cardiovascular health by increasing stress, constraining socioeconomic opportunities, and altering health behaviors. We investigated the association between school segregation and black adults’ CVD risk. Methods and findings We leveraged a natural experiment created by quasi-random (i.e., arbitrary) timing of local court decisions since 1991 that released school districts from court-ordered desegregation. We used the Panel Study of Income Dynamics (PSID) (1991 to 2017), linked with district-level school segregation measures and desegregation court order status. The sample included 1,053 black participants who ever resided in school districts that were under a court desegregation order in 1991. The exposure was mean school segregation during observed schooling years. Outcomes included several adult CVD risk factors and outcomes. We fitted standard ordinary least squares (OLS) multivariable linear regression models, then conducted instrumental variables (IV) analysis, using the proportion of schooling years spent in districts that had been released from court-ordered desegregation as an instrument. We adjusted for individual- and district-level preexposure confounders, birth year, and state fixed effects. In standard linear models, school segregation was associated with a lower probability of good self-rated health (−0.05 percentage points per SD of the segregation index; 95% CI: −0.08, −0.03; p < 0.001) and a higher probability of binge drinking (0.04 percentage points; 95% CI: 0.002, 0.07; p = 0.04) and heart disease (0.01 percentage points; 95% CI: 0.002, 0.15; p = 0.007). IV analyses also found that school segregation was associated with a lower probability of good self-rated health (−0.09 percentage points; 95% CI: −0.17, −0.02, p = 0.02) and a higher probability of binge drinking (0.17 percentage points; 95% CI: 0.04, 0.30, p = 0.008). For IV estimates, only binge drinking was robust to adjustments for multiple hypothesis testing. Limitations included self-reported outcomes and potential residual confounding and exposure misclassification. Conclusions School segregation exposure in childhood may have longstanding impacts on black adults’ cardiovascular health. Future research should replicate these analyses in larger samples and explore potential mechanisms. Given the recent rise in school segregation, this study has implications for policies and programs to address racial inequities in CVD.

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“…There are numerous hypothesized pathways linking education with CVD (Fig 1). Increased educational duration, quality, and credentials are thought to increase employment [7]; augment psychosocial resources such as literacy, social capital, and decision-making [8–11]; and improve health behaviors like smoking [12,13]. Psychosocial resources and employment, in turn, may increase income and decrease stress.…”

Section: Introductionmentioning

confidence: 99%

Educational attainment and cardiovascular disease in the United States: A quasi-experimental instrumental variables analysis

et al. 2019

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Background There is ongoing debate about whether education or socioeconomic status (SES) should be inputs into cardiovascular disease (CVD) prediction algorithms and clinical risk adjustment models. It is also unclear whether intervening on education will affect CVD, in part because there is controversy regarding whether education is a determinant of CVD or merely correlated due to confounding or reverse causation. We took advantage of a natural experiment to estimate the population-level effects of educational attainment on CVD and related risk factors. Methods and findings We took advantage of variation in United States state-level compulsory schooling laws (CSLs), a natural experiment that was associated with geographic and temporal differences in the minimum number of years that children were required to attend school. We linked census data on educational attainment ( N = approximately 5.4 million) during childhood with outcomes in adulthood, using cohort data from the 1992–2012 waves of the Health and Retirement Study (HRS; N = 30,853) and serial cross-sectional data from 1971–2012 waves of the National Health and Nutrition Examination Survey (NHANES; N = 44,732). We examined self-reported CVD outcomes and related risk factors, as well as relevant serum biomarkers. Using instrumental variables (IV) analysis, we found that increased educational attainment was associated with reduced smoking (HRS β −0.036, 95%CI: −0.06, −0.02, p < 0.01; NHANES β −0.032, 95%CI: −0.05, −0.02, p < 0.01), depression (HRS β −0.049, 95%CI: −0.07, −0.03, p < 0.01), triglycerides (NHANES β −0.039, 95%CI: −0.06, −0.01, p < 0.01), and heart disease (HRS β −0.025, 95%CI: −0.04, −0.002, p = 0.01), and improvements in high-density lipoprotein (HDL) cholesterol (HRS β 1.50, 95%CI: 0.34, 2.49, p < 0.01; NHANES β 0.86, 95%CI: 0.32, 1.48, p < 0.01), but increased BMI (HRS β 0.20, 95%CI: 0.002, 0.40, p = 0.05; NHANES β 0.13, 95%CI: 0.01, 0.32, p = 0.05) and total cholesterol (HRS β 2.73, 95%CI: 0.09, 4.97, p = 0.03). While most findings were cross-validated across both data sets, they were not robust to the inclusion of state fixed effects. Limitations included residual confounding, use of self-reported outcomes for some analyses, and possibly limited generalizability to more recent cohorts. Conclusions This study provides rigorous population-level estimates of the association of educational attainment with CVD. These findings may guide future implementation of interventions to address the social determinants of CVD and strengthen the argument for including educational attainment in prediction algorithms and primary preventi...

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Differential associations between state-level educational quality and cardiovascular health by race: Early-life exposures and late-life health

Cited by 12 publications

References 39 publications

Sociodemographic Indicators of Social Position and Self-care Maintenance in Adults with Heart Failure

Sociodemographic Indicators of Social Position and Self-care Maintenance in Adults with Heart Failure

School racial segregation and long-term cardiovascular health among Black adults in the US: A quasi-experimental study

Educational attainment and cardiovascular disease in the United States: A quasi-experimental instrumental variables analysis

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