Educational Attainment, Race, and Ethnicity as Predictors for Ideal Cardiovascular Health: From the National Health and Nutrition Examination Survey

Abstract

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 (P<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 P<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.

Keywords: cardiovascular health; educational status; race and ethnicity.

Figure 1. Achievement of ideal cardiovascular health metrics by level of educational attainment and race and ethnicity.

*Diet data include intermediate category because almost none in any category achieved ideal diet. AA indicates associate of arts; GED, general equivalency degree; HS, high school; and LS7, Life’s Simple 7.

Figure 2. Association between race and ethnicity and ideal cardiovascular health stratified by level of educational attainment.

Increased educational attainment increases odds of having better cardiovascular health within each racial and ethnic group but with significant differences in the strength of association between racial and ethnic groups. The dotted line represents odds of 1, which is no significant difference in Life’s Simple 7 (LS7) at that level of educational attainment as compared with the less than high school (HS) group for each race. Bars that cross the dotted line mean that the group does not have a significant difference in LS7 when compared with the lowest educational attainment group (ie, no significant benefit of education on LS7). AA indicates associate of arts; GED, general equivalency degree; and NH, non‐Hispanic.