Association between education, CV health varies by race, ethnicity
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Higher levels of education were associated with achieving more metrics of ideal CV health in white Americans, but not in Americans of other races and ethnicities, researchers reported.
Amber E. Johnson, MD, MS, MBA, FACC, assistant professor of medicine at the University of Pittsburgh School of Medicine and staff physician at the VA Pittsburgh Health System, and colleagues analyzed the association between educational attainment — less than high school, high school graduate, some college or college graduate — and category of attainment of the American Heart Association’s Life’s Simple 7 metrics — ideal, intermediate or poor — by race/ethnicity.
‘Important question’
“We chose to study this important question because we suspected that, as social determinants of health, race and educational level would interact in their association with cardiovascular health,” Johnson told Healio. “Others had previously documented race as a predictor of heart health. Still others had documented the relationship of education and health. We took those basic findings a step further by looking at the combined relationship with cardiac health. Furthermore, my team and I chose to study the Life's Simple 7 measure as a way to operationalize cardiovascular health. Too often, we measure poor outcomes. We chose to measure ideal heart health as a way to show positive outcomes in this nationally representative sample.”
The analysis included 7,771 participants from the National Health and Nutrition Examination Survey (median age, 48 years; 48% men; 15% Hispanic; 10.5% non-Hispanic Black; 5.2% non-Hispanic Asian) who had complete data on Life’s Simple 7 metrics.
The Life’s Simple 7 score consists of seven metrics: smoking, BMI, physical activity, diet, total cholesterol, BP and blood glucose. For each metric, a participant received a score of 0 for poor, 1 for intermediate or 2 for ideal. The overall scores were stratified by 0 to 4 (poor), 5 to 9 (intermediate) and 10 to 14 (ideal).
In the overall cohort, as educational attainment increased, so did likelihood of meeting ideal CV health criteria, even after adjustment for age, sex, history of CVD, health insurance, access to health care and income to poverty ratio (OR for college degree vs. less than high school = 4.12; 95% CI, 2.7-5.08; P < .01), Johnson and colleagues found.
Variation by race, ethnicity
However, the magnitude of the association varied by race and ethnicity (P for interaction < .01). For non-Hispanic white participants, completing high school was associated with elevated odds for better CV health (OR = 1.46; 95% CI, 1.06-2.02), but that was not true for non-Hispanic Black participants (OR = 0.99; 95% CI, 0.69-1.43), Hispanic participants (OR = 1.25; 95% CI, 0.95-1.64) non-Hispanic Asian participants (OR = 1.05; 95% CI, 0.66-1.65), according to the researchers.
“Educational attainment should be accessible for all, but unfortunately we see disturbing patterns of structural barriers for minoritized individuals in the country. Our findings also show a race-based difference in the translation of educational attainment into upward social mobility. Some have argued that education is the ‘great equalizer’ for social justice, but our findings suggest otherwise,” Johnson told Healio. “Barriers for equitable preventive health may include the lack of accessible primary care, inability to incorporate physical activity into one’s routine (due to work or home requirements) or living in communities where heart-healthy lifestyles are not achievable.”
For more information:
Amber E. Johnson, MD, MS, MBA, FACC, can be reached at johnsonae2@upmc.edu; Twitter: @amberjohnsonmd.
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