Differential Returns to State-Level Educational Quality in Cardiovascular Health by Race: Early-Life Exposures and Late-Life Health

Anusha Vable
Thu Nguyen, University of California, San Francisco
David H. Rehkopf, Stanford University
Maria Glymour, University of California, San Francisco
Rita Hamad, University of California, San Francisco

Cardiovascular disease (CVD) is strongly patterned by educational attainment, however, educational quality is rarely examined. We examine relationships between state-level educational quality and CVD, and test for heterogeneities by race. Health and Retirement Study respondent data were linked to a state-level composite educational quality index, comprised of school term length, student-to-teacher ratio, and per-pupil expenditures. Race/ethnicity was White, Black, and Hispanic. Analysis models predicting self-reported (N=23,045) and objectively measured (N=8,925) CVD outcomes were adjusted for individual and state-level confounders; heterogeneities were evaluated using educational quality by race interaction terms. There was little relationship between educational quality and CVD outcomes overall or among Whites. Among Blacks, higher state-level educational quality predicted poorer heart disease ever-smoking, uncontrolled blood pressure, and stroke outcomes, but lower obesity; patterns were similar among Hispanics. Higher state-level educational quality was associated with both better and worse cardiovascular outcomes among minorities; research examining mechanisms is warranted.

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 Presented in Session 11. Health & Mortality 2