Diminished Returns of Educational Attainment on Heart Disease among Black Americans

Shervin Assari1, *, Sharon Cobb2, Mohammed Saqib3, Mohsen Bazargan1, 4
1 Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
2 School of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
3 Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
4 Department of Family Medicine, UCLA, Los Angeles, CA, USA

Article Metrics

CrossRef Citations:
Total Statistics:

Full-Text HTML Views: 1990
Abstract HTML Views: 904
PDF Downloads: 535
Total Views/Downloads: 3429
Unique Statistics:

Full-Text HTML Views: 1051
Abstract HTML Views: 535
PDF Downloads: 373
Total Views/Downloads: 1959

Creative Commons License
© 2020 Assari et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA; Tel.: +734-232-0445, Fax: +734-615-8739; E-mail:



Socioeconomic Status (SES) indicators, such as educational attainment, are social determinants of heart disease. Marginalization related Diminished Returns (MDRs) refer to smaller health benefits of high SES for racial and ethnic minorities compared to the majority group. It is still unknown, however, if MDRs also apply to the effects of education on heart disease.


Using a nationally representative sample, we explored racial/ethnic variation in the link between educational attainment and heart disease among American adults.


We analyzed data (n=25,659) from a nationally representative survey of American adults in 2013. The first wave of the Population Assessment of Tobacco and Health - Adult (PATH-Adult) study was used. The independent variable was education (college graduate, high school graduate, less than a high school diploma). The dependent variable was any heart disease. Age and gender were the covariates. Race, as well as ethnicity, were the moderators. Logistic regressions were used to analyze the data.


Individuals with higher educational attainment had lower odds of heart disease. Race and ethnicity showed statistically significant interactions with education, suggesting that the protective effect of higher education on reducing odds of heart disease was smaller for Hispanic and Black people than for non-Hispanic and White individuals.


Education reduces the risk of heart disease better among non-Hispanic Whites than for Hispanics and Blacks. Therefore, we may expect a disproportionately higher than expected risk of heart disease in Hispanics and Blacks with high educational attainment. Future research should test if the presence of high levels of environmental and behavioral risk factors contribute to the high risk of heart disease in highly educated Black and Hispanic Americans. Policymakers should not reduce health inequalities to just gaps in SES because disparities are present across SES levels, with high SES Blacks and Hispanics remaining at risk of health problems.

Keywords: Socioeconomic position, Socioeconomic status, Educational attainment, Ethnicity, Race, Ethnic groups, African Americans, Blacks, Heart disease.