Differential associations between education and blood pressure by gender and race
Abstract Background Previous research suggests education is inversely associated with blood pressure, but little work has examined whether this relationship differs by race and gender jointly. Identifying the most vulnerable groups may inform hypertension prevention strategies. In this population-ba...
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2025-07-01
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| Online Access: | https://doi.org/10.1186/s12889-025-23409-5 |
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| author | Lucia Pacca Amanda M Irish Catherine dP Duarte Alicia R Riley Mark J Pletcher Zinzi D Bailey Anusha M Vable |
| author_facet | Lucia Pacca Amanda M Irish Catherine dP Duarte Alicia R Riley Mark J Pletcher Zinzi D Bailey Anusha M Vable |
| author_sort | Lucia Pacca |
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| description | Abstract Background Previous research suggests education is inversely associated with blood pressure, but little work has examined whether this relationship differs by race and gender jointly. Identifying the most vulnerable groups may inform hypertension prevention strategies. In this population-based study, we investigate the association between education and blood pressure overall and across race-by-gender subgroups. Methods Our analytic sample included participants aged 50 + to the US Health and Retirement Study data from 2006 to 2008 (N = 24,526). Our exposure was education, measured as self-reported years of schooling and modeled as a spline with a knot and discontinuity at 12 years representing high school diploma. We used generalized estimating equations to estimate the relationship between education and repeated measurements of two blood pressure outcomes: systolic blood pressure (SBP) and hypertension (HTN), then included race-by-gender interactions with education to evaluate differential associations. All models were adjusted for age, birthplace, parents’ education, and survey year. Results Mean age was 64.4 years, mean SBP was 129.9 mmHg, and HTN prevalence was 63.1%. Overall, below 12 years, each additional year of education was not associated with blood pressure, while twelve years of schooling was associated with lower blood pressure (b=-1.02; 95% CI: -2.04, 0.00 for SBP) and each additional year of education after 12 years was associated with lower SBP and lower odds of HTN (e.g., SBP: b=-0.75 mmHg; 95% CI: -0.88, -0.62). We observed some differential relationships by demographic subgroup such that, among Black men, 12 years of education predicted higher odds of HTN compared to White men (interaction OR = 1.60; 95% CI: 1.02, 2.52), and each additional year of education after 12 years was associated with larger SBP benefits for White, Hispanic and Black women compared to White men. Conclusions We found an overall protective relationship between more education and blood pressure/hypertension such that each additional year of college education was associated with lower blood pressure/hypertension, particularly among White and Hispanic women. However, we also found evidence of diminished benefits to high school degree attainment among Black men compared to other groups in hypertension prevalence. |
| format | Article |
| id | doaj-art-2aad24876ffe4e48b3042e2efe8147f2 |
| institution | Kabale University |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | BMC Public Health |
| spelling | doaj-art-2aad24876ffe4e48b3042e2efe8147f22025-08-20T04:01:40ZengBMCBMC Public Health1471-24582025-07-0125111310.1186/s12889-025-23409-5Differential associations between education and blood pressure by gender and raceLucia Pacca0Amanda M Irish1Catherine dP Duarte2Alicia R Riley3Mark J Pletcher4Zinzi D Bailey5Anusha M Vable6Department of Family and Community Medicine, University of California San FranciscoDepartment of Family and Community Medicine, University of California San FranciscoDepartment of Epidemiology and Population Health, Stanford UniversitySociology Department, University of California Santa CruzDepartment of Epidemiology & Biostatistics, University of California San FranciscoDepartment of Epidemiology and Community Health, University of MinnesotaDepartment of Family and Community Medicine, University of California San FranciscoAbstract Background Previous research suggests education is inversely associated with blood pressure, but little work has examined whether this relationship differs by race and gender jointly. Identifying the most vulnerable groups may inform hypertension prevention strategies. In this population-based study, we investigate the association between education and blood pressure overall and across race-by-gender subgroups. Methods Our analytic sample included participants aged 50 + to the US Health and Retirement Study data from 2006 to 2008 (N = 24,526). Our exposure was education, measured as self-reported years of schooling and modeled as a spline with a knot and discontinuity at 12 years representing high school diploma. We used generalized estimating equations to estimate the relationship between education and repeated measurements of two blood pressure outcomes: systolic blood pressure (SBP) and hypertension (HTN), then included race-by-gender interactions with education to evaluate differential associations. All models were adjusted for age, birthplace, parents’ education, and survey year. Results Mean age was 64.4 years, mean SBP was 129.9 mmHg, and HTN prevalence was 63.1%. Overall, below 12 years, each additional year of education was not associated with blood pressure, while twelve years of schooling was associated with lower blood pressure (b=-1.02; 95% CI: -2.04, 0.00 for SBP) and each additional year of education after 12 years was associated with lower SBP and lower odds of HTN (e.g., SBP: b=-0.75 mmHg; 95% CI: -0.88, -0.62). We observed some differential relationships by demographic subgroup such that, among Black men, 12 years of education predicted higher odds of HTN compared to White men (interaction OR = 1.60; 95% CI: 1.02, 2.52), and each additional year of education after 12 years was associated with larger SBP benefits for White, Hispanic and Black women compared to White men. Conclusions We found an overall protective relationship between more education and blood pressure/hypertension such that each additional year of college education was associated with lower blood pressure/hypertension, particularly among White and Hispanic women. However, we also found evidence of diminished benefits to high school degree attainment among Black men compared to other groups in hypertension prevalence.https://doi.org/10.1186/s12889-025-23409-5Cardiovascular diseaseBlood pressureHypertensionEducationDifferential returnsRacial and ethnic groups |
| spellingShingle | Lucia Pacca Amanda M Irish Catherine dP Duarte Alicia R Riley Mark J Pletcher Zinzi D Bailey Anusha M Vable Differential associations between education and blood pressure by gender and race BMC Public Health Cardiovascular disease Blood pressure Hypertension Education Differential returns Racial and ethnic groups |
| title | Differential associations between education and blood pressure by gender and race |
| title_full | Differential associations between education and blood pressure by gender and race |
| title_fullStr | Differential associations between education and blood pressure by gender and race |
| title_full_unstemmed | Differential associations between education and blood pressure by gender and race |
| title_short | Differential associations between education and blood pressure by gender and race |
| title_sort | differential associations between education and blood pressure by gender and race |
| topic | Cardiovascular disease Blood pressure Hypertension Education Differential returns Racial and ethnic groups |
| url | https://doi.org/10.1186/s12889-025-23409-5 |
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