Key result
While college education was associated with lower odds of heart disease overall (OR 0.71), this protective effect was significantly diminished for Black and Hispanic adults compared to non-Hispanic White adults.
Why the study?
It was unknown whether marginalization-related diminished returns—smaller health benefits of high socioeconomic status for racial and ethnic minorities—apply to the effects of education on heart disease.
Does higher educational attainment reduce the odds of heart disease equally across racial and ethnic groups in American adults?
Cross-Sectional (n=25,659)
Does higher educational attainment reduce the odds of heart disease equally across racial and ethnic groups in American adults?
Odds Ratio: 0.71 (95% CI 0.62–0.82)
p-value: p=<0.001
The protective effect of higher educational attainment against heart disease is significantly diminished for Black and Hispanic Americans compared to non-Hispanic White Americans, highlighting persistent health inequities across socioeconomic levels.
Education may yield smaller heart disease protection for minorities; extends MDRs framework but leaves open equity interventions.
BACKGROUND: Socioeconomic Status (SES) indicators, such as educational attainment, are social determinants of heart disease. Marginalization related Diminished Returns (MDRs) refer to smaller health benefits of high SES for racial and ethnic minorities compared to the majority group. It is still unknown, however, if MDRs also apply to the effects of education on heart disease. PURPOSE: Using a nationally representative sample, we explored racial/ethnic variation in the link between educational attainment and heart disease among American adults. METHODS: We analyzed data (n=25,659) from a nationally representative survey of American adults in 2013. The first wave of the Population Assessment of Tobacco and Health - Adult (PATH-Adult) study was used. The independent variable was education (college graduate, high school graduate, less than a high school diploma). The dependent variable was any heart disease. Age and gender were the covariates. Race, as well as ethnicity, were the moderators. Logistic regressions were used to analyze the data. RESULTS: Individuals with higher educational attainment had lower odds of heart disease. Race and ethnicity showed statistically significant interactions with education, suggesting that the protective effect of higher education on reducing odds of heart disease was smaller for Hispanic and Black people than for non-Hispanic and White individuals. CONCLUSION: Education reduces the risk of heart disease better among non-Hispanic Whites than for Hispanics and Blacks. Therefore, we may expect a disproportionately higher than expected risk of heart disease in Hispanics and Blacks with high educational attainment. Future research should test if the presence of high levels of environmental and behavioral risk factors contribute to the high risk of heart disease in highly educated Black and Hispanic Americans. Policymakers should not reduce health inequalities to just gaps in SES because disparities are present across SES levels, with high SES Blacks and Hispanics remaining at risk of health problems.
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Assari et al. (2020) conducted a cross-sectional in Heart disease (n=25,659). Educational attainment (College graduate) vs. Less than high school graduate was evaluated on Any heart disease (OR 0.71, 95% CI 0.62-0.82, p=<0.001). While college education was associated with lower odds of heart disease overall (OR 0.71), this protective effect was significantly diminished for Black and Hispanic adults compared to non-Hispanic White adults.
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