Quality and quantity: The association of state-level educational policies with later life cardiovascular disease

Hamad, Rita; Nguyen, Thu T.; Glymour, M. Maria; Vable, Anusha M.; Manly, Jennifer J.; Rehkopf, David H.

doi:10.1016/j.ypmed.2019.06.008

Cited by 7 publications

(13 citation statements)

References 61 publications

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“…Future studies may consider other educational quality indicators that may also be relevant in order to better understand what aspects of educational quality to prioritize in state-level educational policy considerations. More work is also needed to best determine a composite index for educational quality, as state educational policies may address multiple aspects of educational quality concurrently …”

Section: Discussionmentioning

confidence: 99%

“…33 As educational quality may be associated with a Black or White individual's dementia risk differently during this period (1908-1937 based on the birth years available in our analytic sample), we also assessed possible effect modification by race using both interaction terms and race-stratified analyses. 26 We tested for significance of race by educational quality interaction terms using the Wald test of equality of coefficients. 34 In a sensitivity analysis, we adjusted for educational attainment to evaluate changes in effect estimates due to potentially mediating socioeconomic pathways.…”

Section: Discussionmentioning

confidence: 99%

“…25 Consistent with prior research, we used birth year (from KPNC medical records) and self-reported birth state (from the MHCs) to link individuals to school quality measures at enrollment age when participants were aged 6 years. 18,26 State of birth has been shown to be a good proxy for state of school attendance in similar birth cohorts, as young children rarely move out of state between birth and school-starting age. 27 We reverse coded the studentteacher ratio measure such that higher levels indicated better quality, consistent with the other quality indicators.…”

Section: Educational Qualitymentioning

confidence: 99%

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State-Level Indicators of Childhood Educational Quality and Incident Dementia in Older Black and White Adults

et al. 2023

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ImportanceHigher educational attainment is associated with reduced dementia risk, but the role of educational quality is understudied, presenting a major evidence gap, especially as it may contribute to racial inequities.ObjectiveTo evaluate the association between state-level educational quality during childhood and dementia risk.Design, Setting, and ParticipantsThis cohort study analyzed longitudinal data collected from January 1, 1997, through December 31, 2019 (23-year follow-up period). The sample comprised members of Kaiser Permanente Northern California (KPNC), a large integrated health care delivery system, who completed an optional survey during 1964-1972. Eligible individuals were US born; non-Hispanic Black or non-Hispanic White; aged 65 years or older as of January 1, 1996; were still alive; and did not have a dementia diagnosis or lapse in KPNC membership greater than 90 days between January 1 and December 31, 1996.ExposuresHistorical state-level administrative indicators of school quality (school term length, student-teacher ratio, and attendance rates) linked to participants using birth state and birth year (with a 6-year lag) and divided into tertiles using the pooled sample.Main Outcomes and MeasuresDementia diagnoses from electronic health records between 1997 and 2019 were analyzed between March 1 and August 31, 2022. The associations of educational quality with incident dementia were estimated using Cox proportional hazards regression models.ResultsAmong 21 450 KPNC members who participated in the optional survey, individuals born before availability of educational quality records (n = 87) and missing educational attainment (n = 585) were excluded. The final analytic sample was 20 778 individuals (56.5% women, 43.5% men; mean [SD] age, 74.7 [6.5] years; 18.8% Black; 81.2% White; 41.0% with less than high school education). Among Black individuals, 76.2% to 86.1% (vs 20.8%-23.3% of White individuals) attended schools in states in the lowest educational quality tertiles. Highest (vs lowest) educational quality tertiles were associated with lower dementia risk (student-teacher ratio: hazard ratio [HR], 0.88 [95% CI, 0.83-0.94]; attendance rates: HR, 0.80 [95% CI, 0.73-0.88]; term length: HR, 0.79 [95% CI, 0.73-0.86]). Effect estimates did not differ by race and were not attenuated by adjustment for educational attainment.Conclusions and RelevanceIn this cohort study, lower state-average educational quality was more common among Black individuals and associated with higher dementia risk. Differential investment in high-quality education due to structural racism may contribute to dementia disparities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Educational Qualitymentioning

confidence: 99%

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State-Level Indicators of Childhood Educational Quality and Incident Dementia in Older Black and White Adults

et al. 2023

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“…This matters for CVD, since educational attainment is associated with reduced risk of obesity and smoking-strong CVD risk factors-as well as mortality [9]. Furthermore, existing studies generally quantify education as years or credentials completed [9][10][11]; few measure differences in quality or other aspects of schooling [12,13].…”

Section: Introductionmentioning

confidence: 99%

School racial segregation and long-term cardiovascular health among Black adults in the US: A quasi-experimental study

et al. 2022

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Background Cardiovascular disease (CVD) disproportionately affects United States black adults. This is increasingly acknowledged to be due to inequitable distribution of health-promoting resources. One potential contributor is inequities in educational opportunities, although it is unclear what aspects of education are most salient. School racial segregation may affect cardiovascular health by increasing stress, constraining socioeconomic opportunities, and altering health behaviors. We investigated the association between school segregation and black adults’ CVD risk. Methods and findings We leveraged a natural experiment created by quasi-random (i.e., arbitrary) timing of local court decisions since 1991 that released school districts from court-ordered desegregation. We used the Panel Study of Income Dynamics (PSID) (1991 to 2017), linked with district-level school segregation measures and desegregation court order status. The sample included 1,053 black participants who ever resided in school districts that were under a court desegregation order in 1991. The exposure was mean school segregation during observed schooling years. Outcomes included several adult CVD risk factors and outcomes. We fitted standard ordinary least squares (OLS) multivariable linear regression models, then conducted instrumental variables (IV) analysis, using the proportion of schooling years spent in districts that had been released from court-ordered desegregation as an instrument. We adjusted for individual- and district-level preexposure confounders, birth year, and state fixed effects. In standard linear models, school segregation was associated with a lower probability of good self-rated health (−0.05 percentage points per SD of the segregation index; 95% CI: −0.08, −0.03; p < 0.001) and a higher probability of binge drinking (0.04 percentage points; 95% CI: 0.002, 0.07; p = 0.04) and heart disease (0.01 percentage points; 95% CI: 0.002, 0.15; p = 0.007). IV analyses also found that school segregation was associated with a lower probability of good self-rated health (−0.09 percentage points; 95% CI: −0.17, −0.02, p = 0.02) and a higher probability of binge drinking (0.17 percentage points; 95% CI: 0.04, 0.30, p = 0.008). For IV estimates, only binge drinking was robust to adjustments for multiple hypothesis testing. Limitations included self-reported outcomes and potential residual confounding and exposure misclassification. Conclusions School segregation exposure in childhood may have longstanding impacts on black adults’ cardiovascular health. Future research should replicate these analyses in larger samples and explore potential mechanisms. Given the recent rise in school segregation, this study has implications for policies and programs to address racial inequities in CVD.

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“…Testing the unique effect of educational quality on BMI and central adiposity in adulthood and hypothesized mediators Major disparities in health by socioeconomic status persist in the Unites States despite enormous health care expenditures and decades of codi ed commitment to reducing health disparities (e.g., Healthy People 2010, 2020, and 2030; National Center for Health Statistics, 2010). Education is one indicator of socioeconomic status that has been consistently associated with multiple indicators of health, including cardiometabolic disease and risk factors for poor cardiometabolic health such as greater BMI and central adiposity (Hamad et al, 2018;Hamad et al, 2019). However, common measures of education used to inform policy and interventions on health outcomes may vastly underestimate the importance of education.…”

Section: Introductionmentioning

confidence: 99%

Is educational quality, not just educational attainment, associated with cardiometabolic health: A test in two samples

Cundiff

Lin

Faulk

et al. 2022

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Educational quality may be a closer correlate of physical health than more commonly used measures of educational attainment (e.g., years in school). We examined whether a widely-used performance-based measure of educational quality is more closely associated with cardiometabolic health than educational attainment (highest level of education completed), and whether perceived control, executive functioning, and health literacy link educational quality to cardiometabolic health. In two samples, educational quality was associated with cardiometabolic health above and beyond educational attainment, other demographic factors (age, ethnoracial category, sex), and fluid intelligence. Counter to expectations, neither perceived control, executive function, nor health literacy significantly mediated the association between educational quality and cardiometabolic health. Findings add to the growing literature suggesting that current operationalizations of the construct of education likely underestimate the association between education and multiple forms of health. To the extent that educational programs may have been overlooked based on the apparent size of associations with outcomes, such actions may have been premature.

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Quality and quantity: The association of state-level educational policies with later life cardiovascular disease

Cited by 7 publications

References 61 publications

State-Level Indicators of Childhood Educational Quality and Incident Dementia in Older Black and White Adults

State-Level Indicators of Childhood Educational Quality and Incident Dementia in Older Black and White Adults

School racial segregation and long-term cardiovascular health among Black adults in the US: A quasi-experimental study

Is educational quality, not just educational attainment, associated with cardiometabolic health: A test in two samples

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