按性别和种族划分的教育与血压之间的差异关联。

Differential associations between education and blood pressure by gender and race.

作者信息

Pacca Lucia, Irish Amanda M, dP Duarte Catherine, Riley Alicia R, Pletcher Mark J, Bailey Zinzi D, Vable Anusha M

机构信息

Department of Family and Community Medicine, University of California San Francisco, Pride Hall, 2540 23rd Street, 5th Floor, 94110, San Francisco, CA, USA.

Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA.

出版信息

BMC Public Health. 2025 Jul 2;25(1):2278. doi: 10.1186/s12889-025-23409-5.

DOI:10.1186/s12889-025-23409-5

PMID:40604536

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12220582/

Abstract

BACKGROUND

Previous research suggests education is inversely associated with blood pressure, but little work has examined whether this relationship differs by race and gender jointly. Identifying the most vulnerable groups may inform hypertension prevention strategies. In this population-based study, we investigate the association between education and blood pressure overall and across race-by-gender subgroups.

METHODS

Our analytic sample included participants aged 50 + to the US Health and Retirement Study data from 2006 to 2008 ( = 24,526). Our exposure was education, measured as self-reported years of schooling and modeled as a spline with a knot and discontinuity at 12 years representing high school diploma. We used generalized estimating equations to estimate the relationship between education and repeated measurements of two blood pressure outcomes: systolic blood pressure (SBP) and hypertension (HTN), then included race-by-gender interactions with education to evaluate differential associations. All models were adjusted for age, birthplace, parents’ education, and survey year.

RESULTS

Mean age was 64.4 years, mean SBP was 129.9 mmHg, and HTN prevalence was 63.1%. Overall, below 12 years, each additional year of education was not associated with blood pressure, while twelve years of schooling was associated with lower blood pressure (b=-1.02; 95% CI: -2.04, 0.00 for SBP) and each additional year of education after 12 years was associated with lower SBP and lower odds of HTN (e.g., SBP: b=-0.75 mmHg; 95% CI: -0.88, -0.62). We observed some differential relationships by demographic subgroup such that, among Black men, 12 years of education predicted higher odds of HTN compared to White men (interaction OR = 1.60; 95% CI: 1.02, 2.52), and each additional year of education after 12 years was associated with larger SBP benefits for White, Hispanic and Black women compared to White men.

CONCLUSIONS

We found an overall protective relationship between more education and blood pressure/hypertension such that each additional year of college education was associated with lower blood pressure/hypertension, particularly among White and Hispanic women. However, we also found evidence of diminished benefits to high school degree attainment among Black men compared to other groups in hypertension prevalence.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s12889-025-23409-5.

摘要

背景

先前的研究表明教育程度与血压呈负相关，但很少有研究探讨这种关系在种族和性别上是否存在差异。确定最脆弱的群体可能有助于制定高血压预防策略。在这项基于人群的研究中，我们调查了教育程度与总体血压以及不同种族-性别亚组之间的关联。

方法

我们的分析样本包括2006年至2008年美国健康与退休研究数据中年龄在50岁及以上的参与者（n = 24,526）。我们的暴露因素是教育程度，以自我报告的受教育年限衡量，并建模为一个样条，在12年处有一个节点和断点，代表高中文凭。我们使用广义估计方程来估计教育程度与两次血压测量结果（收缩压（SBP）和高血压（HTN））之间的关系，然后纳入教育程度与种族-性别的交互作用以评估差异关联。所有模型均对年龄、出生地、父母教育程度和调查年份进行了调整。

结果

平均年龄为64.4岁，平均收缩压为129.9 mmHg，高血压患病率为63.1%。总体而言，在12年以下，每增加一年教育与血压无关，而12年的教育与较低的血压相关（收缩压：b = -1.02；95% CI：-2.04, 0.00），12年后每增加一年教育与较低的收缩压和较低的高血压几率相关（例如，收缩压：b = -0.75 mmHg；95% CI：-0.88, -0.62）。我们观察到不同人口亚组之间存在一些差异关系，例如，在黑人男性中，与白人男性相比，12年的教育预示着更高的高血压几率（交互作用OR = 1.60；95% CI：1.02, 2.52），并且与白人男性相比，12年后每增加一年教育，白人、西班牙裔和黑人女性的收缩压获益更大。