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The Impact of Educational Attainment on Observed Race/Ethnic Disparities in Inflammatory Risk in the 2001–2008 National Health and Nutrition Examination Survey

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  • Gniesha Y. Dinwiddie

    (African American Studies Department, University of Maryland, College Park, MD 20742, USA
    Maryland Population Research Center, University of Maryland, College Park, MD 20742, USA)

  • Ruth E. Zambrana

    (Women’s Studies Department, University of Maryland, College Park, MD 20742, USA
    Consortium on Race, Gender and Ethnicity, University of Maryland, College Park, MD 20742, USA)

  • Lauren A. Doamekpor

    (National Center for Health Research, Washington, DC 20036, USA)

  • Lenny Lopez

    (Department of Medicine, University of California, San Francisco, CA 94121, USA)

Abstract

Inflammation has shown to be an independent predictor of cardiovascular disease (CVD) and growing evidence suggests Non-Hispanic Blacks (NHBs) and certain Hispanic subgroups have higher inflammation burden compared to Non-Hispanic Whites (NHWs). Socioeconomic status (SES) is a hypothesized pathway that may account for the higher inflammation burden for race/ethnic groups yet little is known about the biological processes by which SES “gets under the skin” to affect health and whether income and education have similar or distinct influences on elevated inflammation levels. The current study examines SES (income and education) associations with multiple levels of C-Reactive Protein (CRP), an important biomarker of inflammation, in a sample of 13,362 NHWs, 7696 NHBs and 4545 Mexican Americans (MAs) in the United States from the 2001 to 2008 National Health and Nutrition Examination Survey. After adjusting for age, sex, and statin use, NHBs and MAs had higher intermediate and high CRP levels compared to NHWs. Income lessened the magnitude of the association for both race/ethnic groups. The greater intermediate and high CRP burden for NHBs and MAs was strongly explained by educational attainment. MAs were more vulnerable to high CRP levels for the lowest ( i.e. , less than nine years) and post high school ( i.e. , associates degree) educational levels. After additional adjustment for smoking, heavy drinking, high waist circumference, high blood pressure, diabetes and statin use, the strength of the association between race/ethnicity and inflammation was reduced for NHBs with elevated intermediate (RR = 1.31; p ≤ 0.001) and high CRP levels (RR = 1.14; p ≤ 0.001) compared to NHWs but the effect attenuated for MAs for both intermediate (RR = 0.74; p ≤ 0.001) and high CRP levels (RR = 0.38; p ≤ 0.001). These findings suggest educational attainment is a powerful predictor of elevated CRP levels in race/ethnic populations and challenges studies to move beyond examining income as a better predictor in the SES-inflammation pathway.

Suggested Citation

  • Gniesha Y. Dinwiddie & Ruth E. Zambrana & Lauren A. Doamekpor & Lenny Lopez, 2015. "The Impact of Educational Attainment on Observed Race/Ethnic Disparities in Inflammatory Risk in the 2001–2008 National Health and Nutrition Examination Survey," IJERPH, MDPI, vol. 13(1), pages 1-13, December.
    • Handle: RePEc:gam:jijerp:v:13:y:2015:i:1:p:42-:d:61054
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    References listed on IDEAS

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    1. Pamela Herd & Amelia Karraker & Elliot Friedman, 2012. "The Social Patterns of a Biological Risk Factor for Disease: Race, Gender, Socioeconomic Position, and C-reactive Protein," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 67(4), pages 503-513.
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    3. Dinwiddie, G.Y. & Zambrana, R.E. & Garza, M.A., 2014. "Exploring risk factors in Latino cardiovascular disease: The role of education, nativity, and gender," American Journal of Public Health, American Public Health Association, vol. 104(9), pages 1742-1750.
    4. Gruenewald, Tara L. & Cohen, Sheldon & Matthews, Karen A. & Tracy, Russell & Seeman, Teresa E., 2009. "Association of socioeconomic status with inflammation markers in black and white men and women in the Coronary Artery Risk Development in Young Adults (CARDIA) study," Social Science & Medicine, Elsevier, vol. 69(3), pages 451-459, August.
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