美国黑人中教育程度对心脏病的回报递减。
Diminished Returns of Educational Attainment on Heart Disease among Black Americans.
作者信息
Assari Shervin, Cobb Sharon, Saqib Mohammed, Bazargan Mohsen
机构信息
Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
School of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
出版信息
Open Cardiovasc Med J. 2020;14:5-12. doi: 10.2174/1874192402014010005. Epub 2020 Apr 16.
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.
背景
社会经济地位（SES）指标，如教育程度，是心脏病的社会决定因素。与边缘化相关的收益递减（MDRs）是指与多数群体相比，高社会经济地位对少数种族和族裔群体的健康益处较小。然而，MDRs是否也适用于教育对心脏病的影响尚不清楚。
目的
使用具有全国代表性的样本，我们探讨了美国成年人中教育程度与心脏病之间联系的种族/族裔差异。
方法
我们分析了2013年一项具有全国代表性的美国成年人调查的数据（n = 25,659）。使用了烟草与健康人口评估 - 成人（PATH - Adult）研究的第一波数据。自变量是教育程度（大学毕业、高中毕业、高中文凭以下）。因变量是任何心脏病。年龄和性别是协变量。种族以及族裔是调节变量。使用逻辑回归分析数据。
结果
教育程度较高的个体患心脏病的几率较低。种族和族裔与教育程度显示出具有统计学意义的相互作用，这表明高等教育对降低西班牙裔和黑人患心脏病几率的保护作用比对非西班牙裔和白人个体的保护作用小。
结论
教育对非西班牙裔白人降低心脏病风险的效果比对西班牙裔和黑人更好。因此，我们可能预计教育程度高的西班牙裔和黑人患心脏病的风险会高于预期。未来的研究应测试高水平的环境和行为风险因素是否导致受过高等教育的美国黑人和西班牙裔心脏病风险较高。政策制定者不应将健康不平等仅仅归结为社会经济地位的差距，因为在社会经济地位的各个层面都存在差异，高社会经济地位的黑人和西班牙裔仍然面临健康问题的风险。
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