少数族裔教育程度对住院风险的回报递减：全国健康访谈调查（NHIS）
Minorities' Diminished Returns of Educational Attainment on Hospitalization Risk: National Health Interview Survey (NHIS).
作者信息
Assari Shervin, Bazargan Mohsen
机构信息
Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA.
Department of Family Medicine, UCLA, Los Angeles, CA.
出版信息
Hosp Pract Res. 2019 Summer;4(3):86-91. doi: 10.15171/HPR.2019.17. Epub 2019 Sep 18.
BACKGROUND
As suggested by the Minorities' Diminished Returns (MDRs) theory, educational attainment shows a weaker protective effect for racial and ethnic minority groups compared to non-Hispanic Whites. This pattern, however, is never shown for hospitalization risk.
OBJECTIVES
This cross-sectional explored racial and ethnic variation in the association between educational attainment and hospitalization in the US.
METHODS
Data came from the National Health Interview Survey (NHIS 2015). The total sample was 28,959 American adults. Independent variables were educational attainment and hospitalization. The main outcome was hospitalization during the last 12 months. Age, gender, employment, marital status, region, obesity, and the number of cardiovascular conditions were covariates. Race and ethnicity were the effect modifiers. Logistic regression models were utilized to analyze the data.
RESULTS
From all participants, 16.2% were Black and 11.6 were Hispanic, with a mean age of 51 years old. Overall, higher education levels were associated with lower odds of hospitalization, independent of all confounders. Educational attainment showed significant interactions with race (OR =1.04, 95% CI = 1.01 - 1.08) and ethnicity (OR = 1.04, 95% CI =1.01 -1.07) on hospitalization, indicating smaller protective effects of educational attainment on hospitalization of Hispanics and Blacks than non-Hispanic Whites.
CONCLUSION
The protective effect of educational attainment on population health is smaller for Blacks and Hispanics compared to non-Hispanic Whites. To prevent health disparities, there is a need to minimize diminished returns of educational attainment for racial and ethnic minorities. To do so, there is a need for innovative and bold economic, public, and social policies that do not limit themselves to equalizing socioeconomic status but also help minorities leverage their available resources and gain tangible outcomes.
背景
正如少数群体回报递减（MDRs）理论所表明的那样，与非西班牙裔白人相比，教育程度对种族和族裔少数群体的保护作用较弱。然而，这种模式在住院风险方面从未显现出来。
目的
本横断面研究探讨了美国教育程度与住院之间关联中的种族和族裔差异。
方法
数据来自国家健康访谈调查（2015年NHIS）。总样本为28,959名美国成年人。自变量为教育程度和住院情况。主要结局是过去12个月内的住院情况。年龄、性别、就业、婚姻状况、地区、肥胖和心血管疾病数量为协变量。种族和族裔为效应修饰因素。采用逻辑回归模型分析数据。
结果
在所有参与者中，16.2%为黑人，11.6%为西班牙裔，平均年龄为51岁。总体而言，在不考虑所有混杂因素的情况下，较高的教育水平与较低的住院几率相关。教育程度在住院方面与种族（OR = 1.04，95% CI = 1.01 - 1.08）和族裔（OR = 1.04，95% CI = 1.01 - 1.07）存在显著交互作用，表明教育程度对西班牙裔和黑人住院的保护作用小于非西班牙裔白人。
结论
与非西班牙裔白人相比，教育程度对黑人和西班牙裔人群健康的保护作用较小。为了预防健康差距，有必要尽量减少种族和族裔少数群体教育程度的回报递减。为此，需要创新且大胆的经济、公共和社会政策，这些政策不仅限于实现社会经济地位平等，还应帮助少数群体利用其可用资源并获得切实成果。
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