Division of Cardiology University of Pittsburgh School of Medicine Pittsburgh PA.
UPMC Heart and Vascular Institute Pittsburgh PA.
J Am Heart Assoc. 2022 Jan 18;11(2):e023438. doi: 10.1161/JAHA.121.023438. Epub 2022 Jan 5.
Background Educational attainment is protective for cardiovascular health (CVH), but the benefits of education may not persist across racial and ethnic groups. Our objective was to determine whether the association between educational attainment and ideal CVH differs by race and ethnicity in a nationally representative sample. Methods and Results Using the National Health and Nutrition Examination Survey, we determined the distribution of ideal CVH, measured by Life's Simple 7, across levels of educational attainment. We used multivariable ordinal logistic regression to assess the association between educational attainment (less than high school, high school graduate, some college, college graduate) and Life's Simple 7 category (ideal, intermediate, poor), by race and ethnicity (Asian, Black, Hispanic, White). Covariates were age, sex, history of cardiovascular disease, health insurance, access to health care, and income-poverty ratio. Of 7771 National Health and Nutrition Examination Survey participants with complete data, as level of educational attainment increased, the criteria for ideal health were more often met for most metrics. After adjustment for covariates, effect of education was attenuated but remained significant (<0.01). Those with at least a college degree had 4.12 times the odds of having an ideal Life's Simple 7 compared with less than high school (95% CI, 2.70-5.08). Among all racial and ethnic groups, as level of educational attainment increased, so did Life's Simple 7. The magnitude of the association between education and CVH varied by race and ethnicity (interaction <0.01). Conclusions Our findings demonstrate that educational attainment has distinct associations with ideal CVH that differs by race and ethnicity. This work demonstrates the need to elucidate barriers preventing individuals from racial and ethnic minority groups from achieving equitable CVH.
背景:教育程度对心血管健康(CVH)具有保护作用,但教育的益处可能不会在不同种族和族裔群体中持续存在。我们的目的是确定在具有全国代表性的样本中,教育程度与理想 CVH 之间的关联是否因种族和族裔而异。
方法和结果:我们使用国家健康和营养检查调查(National Health and Nutrition Examination Survey),确定了由 Life's Simple 7 衡量的理想 CVH 在不同教育程度水平上的分布。我们使用多变量有序逻辑回归来评估教育程度(低于高中、高中毕业生、部分大学、大学毕业生)与 Life's Simple 7 类别(理想、中等、差)之间的关联,按种族和族裔(亚裔、黑种人、西班牙裔、白种人)进行分层。协变量为年龄、性别、心血管疾病史、医疗保险、获得医疗保健的机会和收入-贫困率。在具有完整数据的 7771 名国家健康和营养检查调查参与者中,随着教育程度的提高,大多数指标达到理想健康的标准更为常见。在调整了协变量后,教育的作用减弱,但仍然具有统计学意义(<0.01)。至少有大学学历的人具有理想 Life's Simple 7 的可能性是高中以下学历的人的 4.12 倍(95%CI,2.70-5.08)。在所有种族和族裔群体中,随着教育程度的提高,Life's Simple 7 的水平也随之提高。教育程度与 CVH 之间的关联程度因种族和族裔而异(交互作用<0.01)。
结论:我们的研究结果表明,教育程度与理想 CVH 之间存在明显的关联,而这种关联因种族和族裔而异。这项工作表明,需要阐明阻碍少数族裔个体实现平等 CVH 的障碍。
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