State School Policies as Predictors of Physical and Mental Health: A Natural Experiment in the REGARDS Cohort

Abstract

We used differences in state school policies as natural experiments to evaluate the joint influence of educational quantity and quality on late-life physical and mental health. Using US Census microsample data, historical measures of state compulsory schooling and school quality (term length, student-teacher ratio, and attendance rates) were combined via regression modeling on a scale corresponding to years of education (policy-predicted years of education (PPYEd)). PPYEd values were linked to individual-level records for 8,920 black and 14,605 white participants aged ≥45 years in the Reasons for Geographic and Racial Differences in Stroke study (2003–2007). Linear and quantile regression models estimated the association between PPYEd and Physical Component Summary (PCS) and Mental Component Summary (MCS) from the Short Form Health Survey. We examined interactions by race and adjusted for sex, birth year, state of residence at age 6 years, and year of study enrollment. Higher PPYEd was associated with better median PCS (β = 1.28, 95% confidence interval (CI): 0.40, 1.49) and possibly better median MCS (β = 0.46, 95% CI: –0.01, 0.94). Effect estimates were higher among black (vs. white) persons (PCS × race interaction, β = 0.22, 95% CI: –0.62, 1.05, and MCS × race interaction, β = 0.18; 95% CI: –0.08, 0.44). When incorporating both school quality and duration, this quasiexperimental analysis found mixed evidence for a causal effect of education on health decades later.

Quality of Education and Late-Life Cognitive Function in a Population-Based Sample From Puerto Rico

“…Using a representative sample of older Puerto Rican older adults, we found that childhood quality of education was positively related to both years of education and to baseline cognitive functioning in late life. The results generally fit with past research on the relationship between quality of education and adult health and cognition from samples based elsewhere ( Brenowitz et al, 2020 ; Crowe et al, 2013 ; Garcy & Berliner, 2018 ; Sisco et al, 2015 ). Past studies have similarly found that indicators of quality of education are more strongly associated with cross-sectional cognitive performance than change in cognition over time ( Carvalho et al, 2015 ; Crowe et al, 2013 ; Sisco et al, 2015 ).…”

State-Level Indicators of Childhood Educational Quality and Incident Dementia in Older Black and White Adults

“…We assessed 3 state-level administrative indicators of school quality included in a previously compiled data set: school term length (ie, days in the academic year), student-teacher ratio (ie, ratio of students to instructional staff), and attendance rates (ie, fraction of enrolled children who attended on an average day). The data had been extracted from state and federal education reports, usually available biennially .…”

“…25 These indicators were selected because they were most consistently reported across states during most of the 20th century. 25 Consistent with prior research, we used birth year (from KPNC medical records) and self-reported birth state (from the MHCs) to link individuals to school quality measures at enrollment age when participants were aged 6 years. 18,26 State of birth has been shown to be a good proxy for state of school attendance in similar birth cohorts, as young children rarely move out of state between birth and school-starting age.…”

Perspective on the “African American participation in Alzheimer disease research: Effective strategies” workshop, 2018

“…29 When studying how education might affect ADRD risk across racial lines, it is important to examine educational quality rather than rely solely on years of education, and how it varies by region and racial group. 30,31 African Americans who were educated in the South, even if they migrated to the North later, generally had less time in school. 31 Just looking at years of education is inaccurate because a school year in the South and North were not equivalent; school years in the South were shorter with less class time and this lesser educational duration was associated with later cognitive differences.…”

“…Data from the Kaiser Permanente Northern California (KPNC) Health System cohort indicates increased risk of dementia for people born in states with an increased stroke risk compared to those born outside of these states, and this increased risk was greater for African Americans than non‐Hispanic whites 29 . When studying how education might affect ADRD risk across racial lines, it is important to examine educational quality rather than rely solely on years of education, and how it varies by region and racial group 30,31 . African Americans who were educated in the South, even if they migrated to the North later, generally had less time in school 31 .…”