Quality and quantity: The association of state-level educational policies with later life cardiovascular disease

• Published in: Preventive medicine Vol. 126; p. 105750
• Main Authors: Hamad, Rita, Nguyen, Thu T., Glymour, M. Maria, Vable, Anusha, Manly, Jennifer J., Rehkopf, David H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2019
• Subjects: Aged, 80 and over; Blood Pressure - physiology; Cardiovascular disease; Cardiovascular Diseases - epidemiology; Cholesterol - analysis; Cross-Sectional Studies; Educational attainment; Educational Status; Female; Humans; Male; Myocardial Infarction - epidemiology; Nutrition Surveys; Policy evaluation; Risk Factors; Socioeconomic status; United States; United States; CVD; CRP; HDL; Socioeconomic status; Policy evaluation; Cardiovascular disease; NHANES; Educational attainment
• ISSN: 0091-7435; 1096-0260
• DOI: 10.1016/j.ypmed.2019.06.008

Education is a powerful predictor of cardiovascular morbidity and mortality. While the majority of the literature has focused on years of educational attainment or degree attainment, fewer studies examine the role of educational quality in the prevention of cardiovascular disease (CVD). We tested the hypothesis that average state-level educational quality was associated with CVD, linking state-level data on educational quality with individual demographic and health data from multiple waves of the National Health and Nutrition Examination Survey (N = 34,770). We examined thirteen CVD-related outcomes—including blood pressure, cholesterol, and heart attack—to understand the multiple pathways through which educational quality may influence CVD. The primary predictor was a composite index of educational quality, combining state-level measures of student-teacher ratios, per-pupil expenditures, and school term length. We fit multivariable models, regressing each outcome on the educational quality composite index and adjusting for individual- and state-level covariates. We also assessed whether the association between state educational quality and CVD differed for less educated individuals. Overall, higher educational quality was associated with less smoking (OR = 0.86, 95%CI: 0.77, 0.97), but there was no statistically significant association for the other 12 outcomes. Interaction tests indicated that less educated individuals benefited less from higher educational quality relative to those with more education for several outcomes. Our study suggests that state-level educational quality is not strongly associated with CVD, and that this null association overall may mask heterogeneous benefits that accrue disproportionately to those with higher levels of education. •We tested whether state-level educational quality was associated with heart disease.•Higher quality predicted less smoking, but was not associated with other outcomes.•Those with higher educational attainment benefited more from increased quality.•Educational interventions may need to focus on improving both quality and quantity.