Document Type : Original Article
Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, USA
Department of Family Medicine, UCLA, Los Angeles, USA
Background: As suggested by the Minorities’ Diminished Returns (MDRs) theory, educational attainment shows a weaker protective effect for racial and ethnic minority groups compared to non-Hispanic Whites. This pattern, however, is never shown for hospitalization risk.
Objectives: This cross-sectional study explored racial and ethnic variations in the association between educational attainment and hospitalization in the United States.
Methods: Data came from the National Health Interview Survey (NHIS 2015). The total sample was 28,959 American adults. Independent variables was educational attainment. The main outcome was hospitalization during the last 12 months. Age, gender, employment, marital status, region, obesity, and number of cardiovascular conditions were covariates. Race and ethnicity were the effect modifiers. Logistic regression models were utilized to analyze the data.
Results: From all participants, 16.2% were Black and 11.6% were Hispanic with a mean age of 51 years. Overall, higher education levels were associated with lower odds of hospitalization, independent of all confounders. Educational attainment showed significant interactions with race (odds ratio [OR] =1.04, 95% CI = 1.01-1.08) and ethnicity (OR = 1.04, 95% CI =1.01-1.07) on hospitalization, indicating smaller protective effects of educational attainment on hospitalization of Hispanics and Blacks than non-Hispanic Whites.
Conclusion: The protective effects of educational attainment on population health are smaller for Blacks and Hispanics compared to non-Hispanic Whites. To prevent health disparities, the diminished returns of educational attainment should be minimized for racial and ethnic minorities. To do so, there is a need for innovative and bold economic, public, and social policies that do not limit themselves to equalizing socioeconomic status, but also help minorities leverage their available resources and gain tangible outcomes.
- Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099-1104. doi:10.1016/S0140-6736(05)71146-6.
- Marmot M. The Status Syndrome: How Social Standing Affects Our Health and Longevity. London: Bloomsbury Press; 2004.
- Marmot M. Economic and social determinants of disease. Bull World Health Organ. 2001;79(10):988-989.
- Assari S, Moghani Lankarani M. Income Gradient in Renal Disease Mortality in the United States. Front Med (Lausanne). 2017;4:190. doi:10.3389/fmed.2017.00190.
- Moghani Lankarani M, Assari S. Diabetes, hypertension, obesity, and long-term risk of renal disease mortality: Racial and socioeconomic differences. J Diabetes Investig. 2017;8(4):590-599. doi:10.1111/jdi.12618.
- Remes H, Martikainen P, Valkonen T. Mortality inequalities by parental education among children and young adults in Finland 1990-2004. J Epidemiol Community Health. 2010;64(2):136-141. doi:10.1136/jech.2008.082388.
- Farmer MM, Ferraro KF. Are racial disparities in health conditional on socioeconomic status? Soc Sci Med. 2005;60(1):191-204. doi:10.1016/j.socscimed.2004.04.026.
- Phelan JC, Link BG, Diez-Roux A, Kawachi I, Levin B. “Fundamental causes” of social inequalities in mortality: a test of the theory. J Health Soc Behav. 2004;45(3):265-285. doi:10.1177/002214650404500303.
- Mackenbach JP, Bos V, Andersen O, et al. Widening socioeconomic inequalities in mortality in six Western European countries. Int J Epidemiol. 2003;32(5):830-837. doi:10.1093/ije/dyg209.
- Kunst AE, Groenhof F, Mackenbach JP, Health EW. Occupational class and cause specific mortality in middle aged men in 11 European countries: comparison of population based studies. EU Working Group on Socioeconomic Inequalities in Health. BMJ. 1998;316(7145):1636-1642. doi:10.1136/bmj.316.7145.1636.
- Assari S. Number of Chronic Medical Conditions Fully Mediates the Effects of Race on Mortality; 25-Year Follow-Up of a Nationally Representative Sample of Americans. J Racial Ethn Health Disparities. 2017;4(4):623-631. doi:10.1007/s40615-016-0266-4.
- Assari S. Cross-Country Differences in the Additive Effects of Socioeconomics, Health Behaviors and Medical Comorbidities on Disability among Older Adults with Heart Disease. J Tehran Heart Cent. 2015;10(1):24-33.
- Assari S, Lankarani MM. Does Multi-morbidity Mediate the Effect of Socioeconomics on Self-rated Health? Cross-country Differences. Int J Prev Med. 2015;6:85. doi:10.4103/2008-7802.164413.
- Assari S. Cross-country variation in additive effects of socio-economics, health behaviors, and comorbidities on subjective health of patients with diabetes. J Diabetes Metab Disord. 2014;13(1):36. doi:10.1186/2251-6581-13-36.
- Assari S, Moghani Lankarani R, Moghani Lankarani M. Cross-country differences in the association between diabetes and disability. J Diabetes Metab Disord. 2014;13(1):3. doi:10.1186/2251-6581-13-3.
- Assari S. Health disparities due to diminished return among black Americans: Public policy solutions. Soc Issues Policy Rev. 2018;12(1):112-145. doi:10.1111/sipr.12042.
- Assari S. Unequal Gain of Equal Resources across Racial Groups. Int J Health Policy Manag. 2018;7(1):1-9. doi:10.15171/ijhpm.2017.90.
- Assari S. Family Income Reduces Risk of Obesity for White but Not Black Children. Children (Basel). 2018;5(6). doi:10.3390/children5060073.
- Assari S. The Benefits of Higher Income in Protecting against Chronic Medical Conditions Are Smaller for African Americans than Whites. Healthcare (Basel). 2018;6(1). doi:10.3390/healthcare6010002.
- Assari S, Caldwell CH. Family Income at Birth and Risk of Attention Deficit Hyperactivity Disorder at Age 15: Racial Differences. Children (Basel). 2019;6(1). doi:10.3390/children6010010.
- Assari S, Farokhnia M, Mistry R. Education Attainment and Alcohol Binge Drinking: Diminished Returns of Hispanics in Los Angeles. Behav Sci (Basel). 2019;9(1). doi:10.3390/bs9010009.
- Assari S. Socioeconomic Status and Self-Rated Oral Health; Diminished Return among Hispanic Whites. Dent J (Basel). 2018;6(2). doi:10.3390/dj6020011.
- Assari S, Mistry R. Diminished Return of Employment on Ever Smoking Among Hispanic Whites in Los Angeles. Health Equity. 2019;3(1):138-144. doi:10.1089/heq.2018.0070.
- Chakraborty BM, Chakraborty R. Sensitivity and specificity of body mass index as a definition of the obesity component of metabolic syndrome. Coll Antropol. 2007;31(4):943-947.
- Assari S, Preiser B, Kelly M. Education and Income Predict Future Emotional Well-Being of Whites but Not Blacks: A Ten-Year Cohort. Brain Sci. 2018;8(7). doi:10.3390/brainsci8070122.
- Assari S. Educational Attainment and Exercise Frequency in American Women; Blacks’ Diminished Returns. Womens Health Bull. 2019;6(3). doi:10.5812/whb.87413.
- Assari S, Caldwell CH, Mincy R. Family Socioeconomic Status at Birth and Youth Impulsivity at Age 15; Blacks’ Diminished Return. Children (Basel). 2018;5(5). doi:10.3390/children5050058.
- Assari S. Parental Educational Attainment and Academic Performance of American College Students; Blacks’ Diminished Returns. J Health Econ Dev. 2019;1(1):21-31.
- Assari S. Socioeconomic Determinants of Systolic Blood Pressure; Minorities’ Diminished Returns. J Health Econ Dev. 2019;1(1):1-11.
- Assari S. Education Attainment and Obesity: Differential Returns Based on Sexual Orientation. Behav Sci (Basel). 2019;9(2). doi:10.3390/bs9020016.
- Assari S, Bazargan M. Educational Attainment and Subjective Health and Well-Being; Diminished Returns of Lesbian, Gay, and Bisexual Individuals. Behav Sci (Basel). 2019;9(9). doi:10.3390/bs9090090.
- Assari S. Parental Educational Attainment and Mental Well- Being of College Students; Diminished Returns of Blacks. Brain Sci. 2018;8(11). doi:10.3390/brainsci8110193.
- Assari S. Blacks’ Diminished Return of Education Attainment on Subjective Health; Mediating Effect of Income. Brain Sci. 2018;8(9). doi:10.3390/brainsci8090176.
- Assari S, Moghani Lankarani M. Race and Urbanity Alter the Protective Effect of Education but not Income on Mortality. Front Public Health. 2016;4:100. doi:10.3389/fpubh.2016.00100.
- Assari S, Caldwell CH, Zimmerman MA. Family Structure and Subsequent Anxiety Symptoms; Minorities’ Diminished Return. Brain Sci. 2018;8(6). doi:10.3390/brainsci8060097.
- Assari S, Moghani Lankarani M. Poverty Status and Childhood Asthma in White and Black Families: National Survey of Children’s Health. Healthcare (Basel). 2018;6(2). doi:10.3390/healthcare6020062.
- Assari S, Thomas A, Caldwell CH, Mincy RB. Blacks’ Diminished Health Return of Family Structure and Socioeconomic Status; 15 Years of Follow-up of a National Urban Sample of Youth. J Urban Health. 2018;95(1):21-35. doi:10.1007/s11524-017-0217-3.
- Assari S. High Income Protects Whites but Not African Americans against Risk of Depression. Healthcare (Basel). 2018;6(2). doi:10.3390/healthcare6020037.
- Assari S. Social Determinants of Depression: The Intersections of Race, Gender, and Socioeconomic Status. Brain Sci. 2017;7(12). doi:10.3390/brainsci7120156.
- Assari S, Moghani Lankarani M, Caldwell CH. Does Discrimination Explain High Risk of Depression among High- Income African American Men? Behav Sci (Basel). 2018;8(4). doi:10.3390/bs8040040.
- Assari S, Schatten HT, Arias SA, Miller IW, Camargo CA, Boudreaux ED. Higher Educational Attainment is Associated with Lower Risk of a Future Suicide Attempt Among Non- Hispanic Whites but not Non-Hispanic Blacks. J Racial Ethn Health Disparities. 2019;6(5):1001-1010. doi:10.1007/s40615-019-00601-z.
- Assari S, Moghani Lankarani M. Educational attainment promotes fruit and vegetable intake for whites but not blacks. J. 2018;1(1):29-41. doi:10.3390/j1010005.
- Assari S, Mistry R. Educational Attainment and Smoking Status in a National Sample of American Adults; Evidence for the Blacks’ Diminished Return. Int J Environ Res Public Health. 2018;15(4). doi:10.3390/ijerph15040763.
- Assari S. Race, Intergenerational Social Mobility and Stressful Life Events. Behav Sci (Basel). 2018;8(10). doi:10.3390/bs8100086.
- Assari S, Moghani Lankarani M. Workplace Racial Composition Explains High Perceived Discrimination of High Socioeconomic Status African American Men. Brain Sci. 2018;8(8). doi:10.3390/brainsci8080139.
- Assari S. Does School Racial Composition Explain Why High Income Black Youth Perceive More Discrimination? A Gender Analysis. Brain Sci. 2018;8(8). doi:10.3390/brainsci8080140.
- Assari S, Bazargan M. Unequal Effects of Educational Attainment on Workplace Exposure to Second-Hand Smoke by Race and Ethnicity; Minorities’ Diminished Returns in the National Health Interview Survey (NHIS). J Med Res Innov. 2019;3(2). doi:10.32892/jmri.179.