Non-Hispanic Black Americans’ Diminished Protective Effects of Educational Attainment and Employment against Cardiometabolic Diseases: NHANES 1999-2016

Background: While Socioeconomic Status (SES) indicators such as educational attainment and employment are among the major drivers of health and illness, the health returns of SES indicators may differ across racial groups. Built on the Marginalization-Related Diminished Returns framework (MDRs) that refers to weaker health effects of SES indicators for marginalized and minoritized groups than non-Hispanic White people, we conducted this study with two aims: First, to test the association between educational attainment and employment with Cardio Metabolic Diseases (CMDs), and second, to test racial variations in these associations. Methods: This cross-sectional study used the National Health and Nutrition Examination Survey (NHANES 1999-2016) data. Participants included 29,230 adults who were either non-Hispanic White or non-Hispanic Black. We measured the following: race, demographic factors (age and sex, and marital status), SES (educational attainment and employment), behaviors (smoking, drinking, and exercise), health insurance, and CMDs (diabetes, stroke, hypertension, and congestive heart failure). Weighted Poisson regression models were used in Stata to adjust for the complex sample design of the NHANES. Models without and with interactions were performed in the pooled sample. We also ran racestratified models. Results: Overall, high educational attainment and employment showed inverse associations with some CMDs. As documented by statistical interactions between race and our SES indicators, we observed weaker inverse associations between educational attainment and employment with some CMDs. Racestratified models also confirmed our main analysis; however, the results varied across CMD conditions. Conclusion: We observed that SES indicators such as educational attainment and employment have differential associations for racial groups. Compared to non-Hispanic White people, non-Hispanic Black people remain at CMDs risk across the full SES spectrum. This finding is in line with the MDRs framework and may be due to the structural racism, social stratification, and marginalization of non-Hispanic Black Americans.