{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:51:00Z","timestamp":1793317860495,"version":"4.5.0"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,1,18]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Educational attainment is protective for cardiovascular health (CVH), but the benefits of education may not persist across racial and ethnic groups. Our objective was to determine whether the association between educational attainment and ideal CVH differs by race and ethnicity in a nationally representative sample.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Using the National Health and Nutrition Examination Survey, we determined the distribution of ideal CVH, measured by Life\u2019s Simple 7, across levels of educational attainment. We used multivariable ordinal logistic regression to assess the association between educational attainment (less than high school, high school graduate, some college, college graduate) and Life\u2019s Simple 7 category (ideal, intermediate, poor), by race and ethnicity (Asian, Black, Hispanic, White). Covariates were age, sex, history of cardiovascular disease, health insurance, access to health care, and income\u2013poverty ratio. Of 7771 National Health and Nutrition Examination Survey participants with complete data, as level of educational attainment increased, the criteria for ideal health were more often met for most metrics. After adjustment for covariates, effect of education was attenuated but remained significant (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01). Those with at least a college degree had 4.12 times the odds of having an ideal Life\u2019s Simple 7 compared with less than high school (95% CI, 2.70\u20135.08). Among all racial and ethnic groups, as level of educational attainment increased, so did Life\u2019s Simple 7. The magnitude of the association between education and CVH varied by race and ethnicity (interaction\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Our findings demonstrate that educational attainment has distinct associations with ideal CVH that differs by race and ethnicity. This work demonstrates the need to elucidate barriers preventing individuals from racial and ethnic minority groups from achieving equitable CVH.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.121.023438","type":"journal-article","created":{"date-parts":[[2022,1,5]],"date-time":"2022-01-05T13:04:10Z","timestamp":1641387850000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":55,"title":["Educational Attainment, Race, and Ethnicity as Predictors for Ideal Cardiovascular Health: From the National Health and Nutrition Examination Survey"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1252-0735","authenticated-orcid":false,"given":"Amber E.","family":"Johnson","sequence":"first","affiliation":[{"name":"Division of Cardiology University of Pittsburgh School of Medicine Pittsburgh PA"},{"name":"UPMC Heart and Vascular Institute Pittsburgh PA"},{"name":"Veterans Affairs Pittsburgh Health System Pittsburgh PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon M.","family":"Herbert","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Graduate School of Public Health University of Pittsburgh PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Stokes","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of Pittsburgh School of Medicine Pittsburgh PA"},{"name":"UPMC Heart and Vascular Institute Pittsburgh PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria M.","family":"Brooks","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Graduate School of Public Health University of Pittsburgh PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Belinda L.","family":"Needham","sequence":"additional","affiliation":[{"name":"University of Michigan School of Public Health Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5075-3604","authenticated-orcid":false,"given":"Jared W.","family":"Magnani","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of Pittsburgh School of Medicine Pittsburgh PA"},{"name":"UPMC Heart and Vascular Institute Pittsburgh PA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2011.0746"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000158136.76824.04"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.24.2.343"},{"key":"e_1_3_1_5_2","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2014-005222","article-title":"Association of socioeconomic status measured by education, and cardiovascular health: a population\u2010based cross\u2010sectional study","volume":"4","author":"Jankovi\u0107 S","year":"2014","unstructured":"Jankovi\u0107 S, Stojisavljevi\u0107 D, Jankovi\u0107 J, Eri\u0107 M, Marinkovi\u0107 J. Association of socioeconomic status measured by education, and cardiovascular health: a population\u2010based cross\u2010sectional study. BMJ Open. 2014;4:e005222. doi: 10.1136\/bmjopen\u20102014\u2010005222","journal-title":"BMJ Open"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.112.967893"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199307083290208"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/0898264315620590"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.192703"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.2174\/1874192402014010005"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.003954"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.030836"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000004222"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1047-2797(97)80012-9"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.2009.05339.x"},{"key":"e_1_3_1_16_2","unstructured":"Centers for Disease Control and Prevention . National Health and Nutrition Examination Survey: survey methods and analytic guidelines. 2018. Available at: https:\/\/wwn.cdc.gov\/nchs\/nhanes\/analyticguidelines.aspx. Accessed March 8 2020."},{"key":"e_1_3_1_17_2","unstructured":"US Department of Agriculture . USDA Food and Nutrient Database for Dietary Studies 2015\u20102016. Food Surveys Research Group Home Page. 2018. Available at: http:\/\/www.ars.usda.gov\/nea\/bhnrc\/fsrg. Accessed March 8 2020."},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.011648"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.15171\/ijhpm.2017.90"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.18865\/ed.30.4.637"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2004.04.026"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.280.4.356"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/clc.22757"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2013.04.012"},{"key":"e_1_3_1_25_2","unstructured":"Egerter S Braveman P Sadegh\u2010Nobari T Grossman\u2010Kahn R Dekker M. Education and health. 2011. Available at: https:\/\/www.rwjf.org\/en\/library\/research\/2011\/05\/education\u2010matters\u2010for\u2010health.html. Accessed February 3 2021."},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.162086599"},{"key":"e_1_3_1_27_2","unstructured":"Suhrcke M de Paz Nieves C. The impact of health and health behaviours on educational outcomes in high\u2010income countries: a review of the evidence. Copenhagen WHO Regional Office for Europe. 2011. Available at: https:\/\/www.euro.who.int\/__data\/assets\/pdf_file\/0004\/134671\/e94805.pdf. Accessed February 4 2021."},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.009273"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487313485513"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1080\/01419870.2010.543139"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2004.060749"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2018.09.017"},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-018-2682-z"},{"key":"e_1_3_1_34_2","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-soc-073014-112305"},{"key":"e_1_3_1_35_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000936"},{"key":"e_1_3_1_36_2","doi-asserted-by":"publisher","DOI":"10.1177\/0002764213487340"},{"key":"e_1_3_1_37_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.20983"},{"key":"e_1_3_1_38_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0063254"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.121.023438","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:20:45Z","timestamp":1715599245000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.121.023438"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,18]]},"references-count":37,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2022,1,18]]}},"alternative-id":["10.1161\/JAHA.121.023438"],"URL":"https:\/\/doi.org\/10.1161\/jaha.121.023438","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,18]]},"assertion":[{"value":"2021-08-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-11-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-01-05","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e023438"}}