Yue Dahai, Ponce Ninez A, Needleman Jack, Ettner Susan L
Department of Health Policy and Management, University of Maryland School of Public Health, 4200 Valley Drive, College Park, MD, 20742, USA.
Department of Health Policy and Management, University of California, Los Angeles, USA.
SSM Popul Health. 2021 Sep 14;15:100918. doi: 10.1016/j.ssmph.2021.100918. eCollection 2021 Sep.
There has been little research on the relationship between education and healthcare utilization, especially for racial/ethnic minorities. This study aimed to examine the association between education and hospitalizations, investigate the mechanisms, and disaggregate the relationship by gender, race/ethnicity, and age groups.
A retrospective cohort analysis was conducted using data from the 1992-2016 US Health and Retirement Study. The analytic sample consists of 35,451 respondents with 215,724 person-year observations. We employed a linear probability model with standard errors clustered at the respondent level and accounted for attrition bias using an inverse probability weighting approach.
On average, compared to having an education less than high school, having a college degree or above was significantly associated with an 8.37 pp (95% CI, -9.79 pp to -7.95 pp) lower probability of being hospitalized, and having education of high school or some college was related to 3.35 pp (95% CI, -4.57 pp to -2.14 pp) lower probability. The association slightly attenuated after controlling for income but dramatically reduced once holding health conditions constant. Specifically, given the same health status and childhood environment conditions, compared to those with less than high school degree, college graduates saw a 1.79 pp (95% CI, -3.16 pp to -0.42 pp) lower chance of being hospitalized, but the association for high school graduates became indistinguishable from zero. Additionally, the association was larger for females, whites, and those younger than 78. The association was statistically significantly smaller for black college graduates than their white counterparts, even when health status is held constant.
Educational attainment is a strong predictor of hospitalizations for middle-aged and older US adults. Health mediates most of the education-hospitalization gradients. The heterogeneous results across age, gender, race, and ethnicity groups should inform further research on health disparities.
关于教育与医疗保健利用之间的关系，尤其是针对少数种族/族裔群体的研究较少。本研究旨在探讨教育与住院之间的关联，调查其中的机制，并按性别、种族/族裔和年龄组对这种关系进行分类分析。
使用1992 - 2016年美国健康与退休研究的数据进行回顾性队列分析。分析样本包括35451名受访者，共215724人年观察数据。我们采用线性概率模型，标准误在受访者层面聚类，并使用逆概率加权法来处理失访偏差。
平均而言，与高中以下学历相比，拥有大学学位及以上学历与住院概率显著降低8.37个百分点（95%置信区间，-9.79个百分点至-7.95个百分点）相关，高中学历或部分大学学历与住院概率降低3.35个百分点（95%置信区间，-4.57个百分点至-2.14个百分点）相关。在控制收入后，这种关联略有减弱，但一旦健康状况保持不变，关联则大幅降低。具体而言，在相同的健康状况和童年环境条件下，与高中学历以下的人相比，大学毕业生住院的可能性降低1.79个百分点（95%置信区间，-3.16个百分点至-0.42个百分点），但高中学历者的关联与零无显著差异。此外，女性、白人以及78岁以下人群的这种关联更大。即使健康状况保持不变，黑人大学毕业生的这种关联在统计学上也显著小于白人同龄人。
教育程度是美国中老年成年人住院情况的有力预测指标。健康状况在很大程度上介导了教育与住院之间的梯度关系。不同年龄、性别、种族和族裔群体的异质性结果应为进一步研究健康差异提供参考。
