High Education Level Protects European Americans But Not African Americans Against Chronic Obstructive Pulmonary Disease: National Health Interview Survey

Abstract

Background: Education level reduces the risk of chronic diseases (CDs), including Chronic Obstructive Pulmonary Disease (COPD). Minorities' Diminished Returns, however, refer to smaller health benefits of socioeconomic position (SEP) improvement for racial and ethnic minorities compared to majority groups. It is not known if MDRs exist for the effects of education level on COPD for African Americans (AAs), relative to European Americans (EAs). Aims: Using a nationally representative sample, the current study explored racial and ethnic variation in the association between education level and COPD among American adults. Methods: Data came from the National Health Interview Survey (NHIS 2015), a national survey. A total of 25,488 adults (18+ years old) were included in the study. From this number, 4,533 (17.8%) were AAs and 20,955 (82.2%) were EAs. Education level was the independent variable. COPD was the outcome. Age, gender, and income were the covariates. Race/ethnicity was the moderator. Results: Overall, education level was inversely associated with the odds of COPD. A statistically significant interaction was found between race/ethnicity and education level on odds of COPD, indicating smaller effect of education for AAs compared to EAs. Conclusions: In line with the Minorities' Diminished Returns (MDRs), highly educated AAs remained at high risk for COPD, a pattern which is not observed for EAs. Policies that exclusively address racial/ethnic inequalities in SEP may not be enough for eliminating racial/ethnic inequalities in COPD in the US. Public policies must go beyond equalizing SEP and address structural and environmental barriers that disproportionately increase risk of COPD in AAs across SEP levels. Future research should test if residential segregation and exposure to air pollutants contributes to high prevalence of COPD in highly educated AAs. Research is needed on multi-level interventions that may minimize MDR-related health disparities.

Race, Ethnicity, Socioeconomic Status, and Chronic Lung Disease in the U.S.

“…While research has well-documented the effects of race/ethnicity (Assari & Moghani Lankarani, 2018;Kamil, Pinzon, & Foreman, 2013) and in line with previous relevant studies (Assari & Moghani Lankarani, 2018;Assari, Caldwell, & Bazargan, 2019), we hypothesized smaller effects of SES (i.e., educational attainment and income) on CLDs for Blacks and Hispanics than non-Hispanic Whites.…”

“…In another study, highly educated and high-income Blacks and Hispanics were more likely to drink alcohol (Assari, Farokhnia, & Mistry, 2019;, smoke cigarette (Assari & Mistry, 2018;Shervin & Ritesh, 2019), and vape e-cigarette (Assari, Mistry, & Bazargan, 2020). This is probably why highly educated and high-income Blacks and Hispanics may be at higher risk of chronic obstructive pulmonary disease (COPD) (Assari, Caldwell, & Bazargan, 2019) and asthma (Assari & Moghani Lankarani, 2018), compared to highly educated non-Hispanic…”

Diminished Returns of Educational Attainment on Heart Disease among Black Americans

“…In addition, we can see MDRs for for mental health indicators such as depression [22], anxiety [23], and risk of attempting suicide [27]. As a result, middle-class Blacks and Hispanics remain at a higher risk of chronic diseases (CDs) [19,28,29], disability [30], hospitalization [31], and mortality [32] even when they have a high SES.…”

“…In addition, highly educated Blacks and Hispanics are more likely to drink alcohol [15,34], smoke cigarettes [18,35], and vape e-cigarettes [36]. This is probably why highly educated Black and Hispanic individuals may be at a higher risk of a wide range of non-communicable diseases such as hypertension [37], chronic obstructive pulmonary disease (COPD) [29] Some of the mechanisms behind these MDRs include societal and structural processes and factors such as residential segregation, extra costs of moving upward in the society [38,39], and a higher level of exposure [8,40,41] and sensitivity to discrimination [42] in ethnic minorities, particularly Blacks. As a result of such societal processes, high SES will be followed with less tangible health effects for Black people than non-Hispanic White people.…”

“…Although high education reduces exposure to risk factors overall [47,48], highly educated Blacks and Hispanics report high levels of environmental risk factors such as stress [39], discrimination [38], and active and passive exposure to smoke [18,33,36]. While the very same SES indicators, such as educational attainment, show a strong impact on lowering non-Hispanic Whites' environmental risk exposures, highly educated Blacks and Hispanics are still at risk of factors that increase their risk to non-communicable illnesses such as hypertension [37], attention deficit hyperactivity disorder (ADHD) [19], asthma [28], and COPD [29].…”