Education and inequalities in risk scores for coronary heart disease and body mass index: evidence for a population strategy.
BACKGROUND
Concerns have been raised that education may have greater benefits for persons at high risk of coronary heart disease (CHD) than for those at low risk.


METHODS
We estimated the association of education (less than high school, high school, or college graduates) with 10-year CHD risk and body mass index (BMI), using linear and quantile regression models, in the following two nationally representative datasets: the 2006 wave of the Health and Retirement Survey and the 2003-2008 National Health and Nutrition Examination Survey (NHANES).


RESULTS
Higher educational attainment was associated with lower 10-year CHD risk for all groups. However, the magnitude of this association varied considerably across quantiles for some subgroups. For example, among women in NHANES, a high school degree was associated with 4% (95% confidence interval = -9% to 1%) and 17% (-24% to -8%) lower CHD risk in the 10th and 90th percentiles, respectively. For BMI, a college degree was associated with uniform decreases across the distribution for women, but with varying increases for men. Compared with those who had not completed high school, male college graduates in the NHANES sample had a BMI that was 6% greater (2% to 11%) at the 10th percentile of the BMI distribution and 7% lower (-10% to -3%) at the 90th percentile (ie, overweight/obese). Estimates from the Health and Retirement Survey sample and the marginal quantile regression models showed similar patterns.


CONCLUSIONS
Conventional regression methods may mask important variations in the associations between education and CHD risk.
Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA 02115, USA. szeliu@harvard.hsph.edu
Sze Yan
SY
Liu
Ichiro
I
Kawachi
M Maria
MM
Glymour
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003327:Coronary Disease / Q000209:etiology* / Q000517:prevention & control; D004522:Educational Status; D005260:Female; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D016018:Least-Squares Analysis; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D018570:Risk Assessment; D012307:Risk Factors; D057566:Self Report; D014481:United States