Shervin Assari; Mona Darvishi; Arash Rahmani; Seyedeh Mohaddeseh Khatami; Izadrad Najand; Babak Najand; Hossein Zare
Abstract
Background: The broad scientific community generally associates high socioeconomic status (SES) with better health. However, the protective effects of high educational attainment on health may be weaker for racial and ethnic minorities than non-Latino White individuals. It is important to study whether ...
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Background: The broad scientific community generally associates high socioeconomic status (SES) with better health. However, the protective effects of high educational attainment on health may be weaker for racial and ethnic minorities than non-Latino White individuals. It is important to study whether this difference holds for chronic pain among Black and Latino individuals.Objectives: To compare the association between educational attainment and chronic pain in the US, considering the racial and ethnic background of individuals.Methods: The current study used baseline data from the Population Assessment of Tobacco and Health (PATH-Adults) study. All participants were 18+years old. A total number of 28204 Non-Latino, Latino, White, and Black individuals were enrolled. The outcome was chronic pain treated as a continuous measure. The predictor was educational attainment. Moderators were race and ethnicity.Results: Our linear regressions in the pooled sample showed that higher educational attainment was associated with a lower level of chronic pain; however, this association was weaker for Latinos and Blacks compared to non-Latino and White individuals. Our stratified models also showed that higher educational attainment was more consistently associated with a lower level of chronic pain for non-Latino White individuals than racial and ethnic minorities.Conclusion: The presumed protective effect of educational attainment against chronic pain among individuals varies between different racial and ethnic groups. Future research should test the role of stressful jobs and working conditions in weakening the protective effects of SES against chronic pain for Blacks and Latinos compared to non-Latino White individuals.
Shervin Assari; Babak Najand; Ali Ayoubian
Abstract
Background: Age is a major determinant of chronic respiratory disease (CRD). This is important because CRD have a main role in shaping morbidity and mortality of individuals and populations. However, less research is done on whether age-related changes in development of CRD differ across diverse racial ...
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Background: Age is a major determinant of chronic respiratory disease (CRD). This is important because CRD have a main role in shaping morbidity and mortality of individuals and populations. However, less research is done on whether age-related changes in development of CRD differ across diverse racial groups.Objectives: Using a conceptual model that considers race as a proxy of racism rather than genetics and attributing racial differences to sociological rather than biological differences, this study was conducted to explore racial differences in the effects of age on CRD. Based on Marginalization-related Diminished Returns (MDRs) framework, we expect diminished relevance of risk and resources for marginalized people due to racism, segregation, and social stratification.Methods: Using data from baseline PATH-Adults data, we included 23761 adults. The independent variable was age treated as a categorical variable. The primary outcome was presence of any CRD including asthma, bronchitis, emphysema, and chronic obstructive pulmonary disease (COPD). Sex and education were the covariates. Race, as a proxy of racism, was the moderator. To analyze the data, we used logistic regression mode with and without interaction term between age and race.Results: Higher age was associated with higher odds of CRD, while sex, and socioeconomic status (SES) was controlled. In line with the MDRs framework, the positive association between age and CRD was weaker for Black than White adults.Conclusion: Under racism, age loses some of its effect as a major determinant of CRD across racialized groups.
Shervin Assari
Abstract
Background: As shown by Minorities’ Diminished Returns (MDRs), ethnic minorities show weaker than expected effects of education level on health outcomes. However, this pattern is better demonstrated for health behaviors and health care utilization than satisfaction with care. Additionally, more ...
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Background: As shown by Minorities’ Diminished Returns (MDRs), ethnic minorities show weaker than expected effects of education level on health outcomes. However, this pattern is better demonstrated for health behaviors and health care utilization than satisfaction with care. Additionally, more is known about MDRs in African Americans than the Latino population. Thus, there is a need to study MDRs of education on healthcare satisfaction in highly educated African American and Latino individuals. Objectives: We tested ethnic differences in the association between education level and satisfaction with healthcare among American adults. Methods: The National Health Interview Survey (2015) included 24,835 adults who were Latino, non-Latino, African American, or White. The independent variable was education level. The dependent variable was satisfaction with healthcare. Age, gender, marital status, employment, region, physical health (self-rated health, and chronic diseases, body mass index), and mental health (psychological distress) were the covariates. Ethnicity was the moderator. Logistic regression was used for data analysis. Results: Higher education level was associated with higher satisfaction with healthcare in White but not African Americans. In the pooled sample, African American ethnicity showed a significant statistical interaction with education level suggesting a significantly smaller effect of high educational attainment on satisfaction with healthcare for African Americans than White adults. A similar interaction could not be found for Latino ethnicity, suggesting that education similarly enhances healthcare satisfaction for Latino and non-Latino adults. Conclusion: High education level boosts satisfaction with healthcare for Whites but not African Americans.
Shervin Assari
Abstract
Background: Prostate cancer screening is more commonly utilized by highly educated people. As shown by marginalization-related diminished returns (MDRs), the effects of socioeconomic status (SES) such as education on the health outcomes are considerably smaller for ethnic minorities than for Whites. ...
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Background: Prostate cancer screening is more commonly utilized by highly educated people. As shown by marginalization-related diminished returns (MDRs), the effects of socioeconomic status (SES) such as education on the health outcomes are considerably smaller for ethnic minorities than for Whites. The role of MDRs as a source of ethnic health disparities is, however, still unknown. Objectives: The current study had two aims: first, to explore the association between years of schooling and having taken a prostate-specific antigen (PSA) test among men in the US, and second, to explore ethnic differences in this association. Methods: This study was a secondary analysis of data from the National Health Interview Survey (NHIS-2015). The data of 5,053 men aged 55 years or older who were either Latino, non-Latino, African–American, or White were analyzed. Years of schooling was the independent variable. The dependent variable was taking a PSA test sometime during one’s lifetime. Age, region, and employment were the control variables. Ethnicity was the focal moderating variable. Binary logistic regression was used for data analysis. Results: A higher number of years of schooling was associated with higher odds of having taken a PSA test, net of all confounders. Ethnicity showed a significant statistical interaction with years of schooling on having taken a PSA test. This interaction was suggestive of a smaller slope for Latino men than non-Latino men. White and African American men did not show differential effects of years of schooling on having taken a PSA test. Conclusion: Similar to the MDRs patterns in other domains, non-Latino White men show more health gain from their years of schooling than Latino men. Highly educated Latino men still need programs to encourage their use of prostate cancer screening.
Shervin Assari; Mohsen Bazargan
Abstract
Background: The Minorities’ Diminished Returns (MDRs) theory suggests that the health effect of educational attainment is considerably smaller for members of racial and ethnic minority groups than for Whites. Objective: The current study explored the racial and ethnic differences in the association ...
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Background: The Minorities’ Diminished Returns (MDRs) theory suggests that the health effect of educational attainment is considerably smaller for members of racial and ethnic minority groups than for Whites. Objective: The current study explored the racial and ethnic differences in the association between educational attainment and Breast Physical Exam (BPE) among women in the U.S. Methods: The National Health Interview Survey (NHIS 2015) included 12 510 women who were Hispanic or non-Hispanic Black or White people. The independent variable was the level of educational attainment. The dependent variable was lifetime BPE. Age, region, marital status, and employment were the covariates. Race and ethnicity were the focal moderators. Logistic regressions were used for data analysis. Results: Overall, higher educational attainment was associated with higher odds of BPE, net of all confounders (odds ratio [OR]=1.11, 95% CI=1.09-1.13). Ethnicity showed a significant statistical interaction with educational attainment on BPE (OR=0.96, 95% CI=0.93-1.00), which was suggestive of a smaller effect of high education attainment on BPE for Hispanic than non-Hispanic women. The same interaction could not be found for the comparison of White and Black women (OR = 0.98, 95% CI =0.94-1.02). Conclusion: In line with other domains, non-Hispanic White women show a larger amount of health gain from their educational attainment than Hispanic women. It is not ethnicity or class but ethnicity and class that shapes how people engage in pro-health behaviors. This result may help hospitals and healthcare systems to better reduce health disparities in their target populations.