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Education and Inequalities in Risk Scores for Coronary Heart Disease and Body Mass Index: Evidence for a Population Strategy

Liu, Sze Yan; Kawachi, Ichiro; Glymour, M. Maria

doi: 10.1097/EDE.0b013e318261c7cc
Cardiovascular Disease

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.

Conclusion: Conventional regression methods may mask important variations in the associations between education and CHD risk.

From the Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA.

Submitted 13 July 2010; accepted 28 May 2012.

Supported by grants from the American Heart Association, W.K. Kellogg Foundation and the Kellogg Health Scholars Program.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article ( This content is not peer-reviewed or copy-edited; it is the sole responsibility of the author.

Editor's note: A commentary on this article appears on page 665.

Correspondence: Sze Yan Liu, Harvard School of Public Health, 677 Huntington Avenue Boston, MA 02115. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.