Educational attainment and cardiovascular disease in the United States: A quasi-experimental instrumental variables analysis

Rita Hamad, Thu T Nguyen, Jay Bhattacharya, M Maria Glymour and David H Rehkopf

PLOS Medicine, 2019, vol. 16, issue 6, 1-19

Abstract: Background: There is ongoing debate about whether education or socioeconomic status (SES) should be inputs into cardiovascular disease (CVD) prediction algorithms and clinical risk adjustment models. It is also unclear whether intervening on education will affect CVD, in part because there is controversy regarding whether education is a determinant of CVD or merely correlated due to confounding or reverse causation. We took advantage of a natural experiment to estimate the population-level effects of educational attainment on CVD and related risk factors. Methods and findings: We took advantage of variation in United States state-level compulsory schooling laws (CSLs), a natural experiment that was associated with geographic and temporal differences in the minimum number of years that children were required to attend school. We linked census data on educational attainment (N = approximately 5.4 million) during childhood with outcomes in adulthood, using cohort data from the 1992–2012 waves of the Health and Retirement Study (HRS; N = 30,853) and serial cross-sectional data from 1971–2012 waves of the National Health and Nutrition Examination Survey (NHANES; N = 44,732). We examined self-reported CVD outcomes and related risk factors, as well as relevant serum biomarkers. Using instrumental variables (IV) analysis, we found that increased educational attainment was associated with reduced smoking (HRS β −0.036, 95%CI: −0.06, −0.02, p

Date: 2019
References: Add references at CitEc
Citations: View citations in EconPapers (2)

Downloads: (external link)
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002834 (text/html)
https://journals.plos.org/plosmedicine/article/fil ... 02834&type=printable (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:plo:pmed00:1002834

DOI: 10.1371/journal.pmed.1002834

Access Statistics for this article

More articles in PLOS Medicine from Public Library of Science
Bibliographic data for series maintained by plosmedicine ().