Rita Hamad|Thu T. Nguyen|Jay Bhattacharya|M. Maria Glymour|David H. Rehkopf
Educational attainment and cardiovascular disease in the United States: A quasi-experimental instrumental variables analysis
University of California, San Francisco|University of California, San Francisco|Stanford University|University of California, San Francisco|Stanford University
ongoing debate whether education socioeconomic status ses inputs cardiovascular disease cvd prediction algorithms clinical risk adjustment models also unclear whether intervening education affect cvd part controversy regarding whether education determinant cvd merely correlated due confounding reverse causation took advantage natural experiment estimate populationlevel effects educational attainment cvd related risk factorswe took advantage variation united states statelevel compulsory schooling laws csls natural experiment associated geographic temporal differences minimum number years children required attend school linked census data educational attainment n approximately 54 million childhood outcomes adulthood using cohort data 19922012 waves health retirement study hrs n 30853 serial crosssectional data 19712012 waves national health nutrition examination survey nhanes n 44732 examined selfreported cvd outcomes related risk factors well relevant serum biomarkers using instrumental variables iv analysis found increased educational attainment associated reduced smoking hrs 0036 95ci 006 002 p 001 nhanes 0032 95ci 005 002 p 001 depression hrs 0049 95ci 007 003 p 001 triglycerides nhanes 0039 95ci 006 001 p 001 heart disease hrs 0025 95ci 004 0002 p 001 improvements highdensity lipoprotein hdl cholesterol hrs 150 95ci 034 249 p 001 nhanes 086 95ci 032 148 p 001 increased bmi hrs 020 95ci 0002 040 p 005 nhanes 013 95ci 001 032 p 005 total cholesterol hrs 273 95ci 009 497 p 003 findings crossvalidated across data sets robust inclusion state fixed effects limitations included residual confounding use selfreported outcomes analyses possibly limited generalizability recent cohortsthis study provides rigorous populationlevel estimates association educational attainment cvd findings may guide future implementation interventions address social determinants cvd strengthen argument including educational attainment prediction algorithms primary prevention guidelines cvd