Display options
Share it on

J Med Res Innov. 2020;4(2). doi: 10.32892/jmri.212. Epub 2020 May 31.

Blacks' Diminished Health Returns of Educational Attainment: Health and Retirement Study.

Journal of medical research and innovation

Shervin Assari

Affiliations

  1. Charles R Drew University of Medicine and Science.

PMID: 34966877 PMCID: PMC8713725 DOI: 10.32892/jmri.212

Abstract

BACKGROUND: Education level reduces the risk of health problems such as poor self-rated health (SRH), high body mass index (BMI), and depressive symptoms (DS). Marginalization - related Diminished Returns (MDRs), however, refer to smaller health benefits of socioeconomic status (SES) indicators particularly educational attainment for the members of racial minority groups such as non-Hispanic Blacks compared to the majority group (non-Hispanic Whites). It is not known, however, if MDRs also hold for middle-age and older adults over a long period of time.

AIMS: The current study used a nationally representative data set to explore racial variation in the predictive utility of baseline education level on protecting people against poor SRH, BMI, and DS.

METHODS: Data for this analysis were borrowed from the Health and Retirement Study (HRS 1992-ongoing), a nationally representative longitudinal study that followed 10,023 middle-aged and older adults (50+ years old) for up to 26 years. From this number, 1877 (18.7%) were non-Hispanic Black Americans, and 8,146 (81.3%) were non-Hispanic White Americans. Education level was the independent variable. We used cluster analysis to categorize individuals to low and high-risk groups (outcome) based on SRH, BMI, and DS over 26 years. Age and gender were the covariates. Race was the moderator.

RESULTS: Overall, high education level reduced the odds of poor SRH, BMI, and DS over the 26 years of follow up. Interactions were observed between race and education on all three health outcomes indicating smaller protective effects of baseline educational attainment on poor health over time, regardless of the outcome.

CONCLUSIONS: In line with the MDRs, highly educated non-Hispanic Black Americans remain at high risk for poor health across domains, a risk which is unexpected given their education. The risk of all health outcomes, however, is lowest for non-Hispanic White Americans with highest education. Policies that exclusively focus on equalizing racial gaps in SES (e.g., education) may fail to eliminate the racial and ethnic health inequalities because of the racial inequalities in the marginal health return of education. Public policies must equalize education quality and address structural and environmental barriers that are disproportionately more common in the lives of non-Hispanic Black Americans, even at high education levels. Future research should test how contextual factors, segregation, labor market practices, childhood poverty, and education quality reduces the health return of education for highly educated non-Hispanic Black Americans.

Keywords: African Americans; Blacks; Educational Attainment; Ethnic Groups; Race; Socioeconomic Position; Socioeconomic Status

Conflict of interest statement

Conflicts of Interest The author declares that they have no conflicts of interest.

References

  1. Int J Epidemiol. 2014 Apr;43(2):576-85 - PubMed
  2. J Family Reprod Health. 2019 Sep;13(3):132-140 - PubMed
  3. J (Basel). 2018 Dec;1(1):29-41 - PubMed
  4. Health Econ. 2010 Jul;19(7):855-71 - PubMed
  5. Brain Sci. 2018 Apr 20;8(4): - PubMed
  6. Behav Sci (Basel). 2018 Apr 27;8(5): - PubMed
  7. Womens Health Bull. 2019 Jul;6(3): - PubMed
  8. Behav Sci (Basel). 2018 Apr 19;8(4): - PubMed
  9. Front Public Health. 2016 Apr 21;4:67 - PubMed
  10. Demography. 1999 Nov;36(4):445-60 - PubMed
  11. Children (Basel). 2019 Aug 26;6(9): - PubMed
  12. Eur Respir J. 1999 May;13(5):1109-14 - PubMed
  13. Brain Sci. 2018 Jul 27;8(8): - PubMed
  14. Behav Sci (Basel). 2019 Jan 14;9(1): - PubMed
  15. J Racial Ethn Health Disparities. 2017 Jun;4(3):385-396 - PubMed
  16. Healthcare (Basel). 2018 Apr 23;6(2): - PubMed
  17. Annu Rev Public Health. 2018 Apr 1;39:273-289 - PubMed
  18. Soc Sci Med. 2013 Nov;97:7-14 - PubMed
  19. J Thorac Dis. 2017 Jun;9(6):1547-1556 - PubMed
  20. J Med Res Innov. 2019;3(2): - PubMed
  21. Behav Sci (Basel). 2018 Nov 21;8(11): - PubMed
  22. J Health Soc Behav. 2015 Sep;56(3):297-306 - PubMed
  23. J Health Soc Behav. 1997 Mar;38(1):21-37 - PubMed
  24. Int J Environ Res Public Health. 2019 Sep 21;16(19): - PubMed
  25. J Tehran Heart Cent. 2015;10(1):24-33 - PubMed
  26. Soc Sci Med. 2005 Jan;60(1):191-204 - PubMed
  27. Brain Sci. 2018 Sep 12;8(9): - PubMed
  28. J Health Econ Dev. 2019 Spring;1(1):21-31 - PubMed
  29. Brain Sci. 2018 Jul 30;8(8): - PubMed
  30. J Gerontol B Psychol Sci Soc Sci. 2014 May;69(3):470-81 - PubMed
  31. Brain Sci. 2018 May 31;8(6): - PubMed
  32. Brain Sci. 2018 Oct 29;8(11): - PubMed
  33. Appl Neuropsychol. 2004;11(1):37-46 - PubMed
  34. Int J Health Policy Manag. 2017 Aug 05;7(1):1-9 - PubMed
  35. Int J Environ Res Public Health. 2018 Sep 21;15(10): - PubMed
  36. Aging Med (Milton). 2019 Jun;2(2):104-111 - PubMed
  37. Arch Clin Neuropsychol. 2013 Aug;28(5):485-91 - PubMed
  38. J Gerontol B Psychol Sci Soc Sci. 2015 Jul;70(4):557-67 - PubMed
  39. Health Equity. 2019 Apr 11;3(1):138-144 - PubMed
  40. Behav Sci (Basel). 2019 Mar 11;9(3): - PubMed
  41. Ann Epidemiol. 2005 Sep;15(8):572-8 - PubMed
  42. Healthcare (Basel). 2018 Jun 12;6(2): - PubMed
  43. J Int Neuropsychol Soc. 2002 Mar;8(3):341-8 - PubMed
  44. J Black Psychol. 2016 Jun;42(3):221-243 - PubMed
  45. J Racial Ethn Health Disparities. 2019 Oct;6(5):1001-1010 - PubMed
  46. Children (Basel). 2018 Jun 10;5(6): - PubMed
  47. Int J Health Serv. 1991;21(2):229-35 - PubMed
  48. Am J Geriatr Psychiatry. 2020 Feb;28(2):205-216 - PubMed
  49. J Am Geriatr Soc. 2006 Jun;54(6):898-905 - PubMed
  50. Brain Sci. 2018 Jun 12;8(6): - PubMed
  51. Age Ageing. 1990 Mar;19(2):91-6 - PubMed
  52. Int J Health Serv. 1989;19(2):311-4 - PubMed
  53. Int Psychogeriatr. 2009 Dec;21(6):1096-104 - PubMed
  54. BMJ. 1998 May 30;316(7145):1636-42 - PubMed
  55. Soc Sci Med. 2011 Feb;72(4):591-9 - PubMed
  56. Eur J Investig Health Psychol Educ. 2020 Mar;10(1):10-17 - PubMed
  57. Children (Basel). 2018 May 01;5(5): - PubMed
  58. J Racial Ethn Health Disparities. 2018 Apr;5(2):375-386 - PubMed
  59. J Urban Health. 2018 Feb;95(1):21-35 - PubMed
  60. Thorax. 1999 Aug;54(8):737-41 - PubMed
  61. J Mens Health. 2012 Jun;9(2):127-136 - PubMed
  62. J Geriatr Psychiatry Neurol. 2020 Jul;33(4):214-222 - PubMed
  63. Int J Radiat Oncol Biol Phys. 1990 Dec;19(6):1627-8 - PubMed
  64. Soc Psychiatry Psychiatr Epidemiol. 2012 Mar;47(3):373-81 - PubMed
  65. J Med Res Innov. 2020;4(1): - PubMed
  66. Healthcare (Basel). 2018 Jan 09;6(1): - PubMed
  67. Lancet. 1990 Nov 17;336(8725):1238-40 - PubMed
  68. Psychol Aging. 2017 Mar;32(2):118-130 - PubMed
  69. J Clin Exp Neuropsychol. 2003 Aug;25(5):680-90 - PubMed
  70. Int J Travel Med Glob Health. 2019 Fall;7(4):135-141 - PubMed
  71. J Aging Health. 2011 Oct;23(7):1027-49 - PubMed
  72. Behav Sci (Basel). 2019 Sep 24;9(10): - PubMed
  73. Front Public Health. 2016 May 20;4:100 - PubMed
  74. Am J Epidemiol. 2017 Oct 1;186(7):805-814 - PubMed
  75. J Health Psychol. 2015 Dec;20(12):1613-25 - PubMed
  76. J Alzheimers Dis. 2019;71(2):549-557 - PubMed
  77. Hosp Pract Res. 2019 Summer;4(3):86-91 - PubMed
  78. Brain Sci. 2018 Jun 29;8(7): - PubMed
  79. Behav Sci (Basel). 2018 May 17;8(5): - PubMed
  80. BMC Public Health. 2011 Jan 17;11:42 - PubMed
  81. Int J Biomed Eng Clin Sci. 2019 Jun;5(2):16-23 - PubMed
  82. J Health Econ Dev. 2019 Spring;1(1):1-11 - PubMed
  83. JAMA Netw Open. 2020 Jan 3;3(1):e1919393 - PubMed
  84. Brain Sci. 2017 Nov 24;7(12): - PubMed
  85. Behav Sci (Basel). 2018 Sep 20;8(10): - PubMed

Publication Types

Grant support