Educational Differences in Risk of All-Cause Mortality After Acute Cardiovascular Events: Examining Cohort and Gender Variations

Abstract

Acute cardiovascular events are prevalent in older adults. In this study, following a sample of respondents from the 1996–2016 Health and Retirement Study after diagnosis of myocardial infarction or stroke, we used discrete-time event history models to study mortality post diagnosis. We found an educational gradient in mortality following myocardial infarction or stroke with the better educated surviving longer, even as the gradient was weaker for stroke. Cohort variations existed with the educational gradients stronger for more recent cohorts (Silent and Boomer) as compared with the GI cohort. Gender interacted with cohort to shape mortality such that men from the Silent and Boomer cohorts benefited the most from high school and some college education. Mediation analysis showed that the educational differences in mortality are accounted for by spousal educational attainment, wealth, Medicaid coverage, change in health behaviors, and comorbidities.

Keywords

education mortality cohort gender cardiovascular HRS

Get full access to this article

View all access options for this article.

References

Allison

P. D.

(1982). Discrete-time methods for the analysis of event histories. Sociological Methodology, 13, 61–98.

Arias

Heron

J. Q.

(2017). United States life tables, 2013: National vital statistics reports; vol 66 no 3. National Center for Health Statistics.

Benjamin

E. J.

Muntner

Alonso

Bittencourt

M. S.

Callaway

C. W.

Carson

A. P.

Chamberlain

A. M.

Chang

A. R.

Cheng

Das

S. R.

Delling

F. N.

Djousse

Elkind

M. S. V.

Ferguson

J. F.

Fornage

Jordan

L. C.

Khan

S. S.

Kissela

B. M.

Knutson

K. L.

,…On behalf of American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2019). Heart disease and stroke statistics—2019 update: A report from the American Heart association. Circulation, 139(10), e56–528.

Breen

Karlson

K. B.

Holm

(2013). Total, direct, and indirect effects in logit and probit models. Sociological Methods & Research, 42(2), 164–191.

Carr

Springer

K. W.

(2010). Advances in families and health research in the 21st century. Journal of Marriage and Family, 72(3), 743–761.

Case

Deaton

(2015). Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences, 112(49), 15078–15083.

Centers for Disease Control and Prevention. (2020a). Heart disease facts. Retrieved January 8, 2020, from https://www.cdc.gov/heartdisease/facts.htm

Centers for Disease Control and Prevention. (2020b). Stroke facts. Retrieved January 8, 2020, from https://www.cdc.gov/stroke/facts.htm

Chang

V. W.

Lauderdale

D. S.

(2009). Fundamental cause theory, technological innovation, and health disparities: The case of cholesterol in the era of statins. Journal of Health and Social Behavior, 50(3), 245–260.

10.

Coady

Johnson

Hakes

Sorlie

(2014). Individual education, area income, and mortality and recurrence of myocardial infarction in a Medicare cohort: The National Longitudinal Mortality Study. BMC Public Health, 14, 705.

11.

DiPrete

T. A.

Buchmann

(2006). Gender-specific trends in the value of education and the emerging gender gap in college completion. Demography, 43(1), 1–24.

12.

Fan

Qian

(2019). Rising educational gradients in mortality among U.S. whites: What are the roles of marital status and educational homogamy? Social Science & Medicine, 235, 112365.

13.

Glied

Lleras-Muney

(2008). Technological innovation and inequality in health. Demography, 45(3), 741–761.

14.

Grundy

Tomassini

(2010). Marital history, health and mortality among older men and women in England and Wales. BMC Public Health, 10, 554.

15.

Hadley

(2007). Insurance coverage, medical care use, and short-term health changes following an unintentional injury or the onset of a chronic condition. JAMA, 297(10), 1073–1084.

16.

Henretta

J. C.

(2010). Lifetime marital history and mortality after age 50. Journal of Aging and Health, 22(8), 1198–1212.

17.

Hernandez

E. M.

Margolis

Hummer

R. A.

(2016). Educational and gender differences in health behavior changes after a gateway diagnosis. Journal of Aging and Health, 30(3), 342–364.

18.

Hoxby

C. M.

(2009). The changing selectivity of American colleges. Journal of Economic Perspectives, 23(4), 95–118.

19.

Isen

Stevenson

(2011). Women’s education and family behaviour: Trends in marriage, divorce and fertility. In Shoven

(Ed.), Demography and the economy (pp. 107–142). University of Chicago Press.

20.

Johnson-Lawrence

Zajacova

Sneed

(2017). Education, race/ethnicity, and multimorbidity among adults aged 30-64 in the National Health Interview Survey. SSM-Population Health, 3, 366–372.

21.

Kitagawa

E. M.

Hauser

P. M.

(1973). Differential mortality in the United States: A study in socioeconomic epidemiology. Harvard University Press.

22.

Kristofferzon

M.-L.

Lofmark

Carlsson

(2003). Myocardial infarction: Gender differences in coping and social support. Journal of Advanced Nursing, 44(4), 360–374.

23.

Kulkarni

Alexander

K. P.

Ltyle

Heiss

Peterson

E. D.

(2006). Long-term adherence with cardiovascular drug regimens. American Heart Journal, 151(1), 185–191.

24.

Lauderdale

D. S.

(2001). Education and survival: Birth cohort, period, and age effects. Demography, 38, 551–561.

25.

Link

B. G.

Phelan

(1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, Spec No, 80–94.

26.

Lundberg

Pollak

R. A.

Stearns

(2016). Family inequality: Diverging patterns in marriage, cohabitation, and childbearing. Journal of Economic Perspectives, 30(2), 79–102.

27.

Margolis

(2013). Educational differences in healthy behavior changes and adherence among middle-aged Americans. Journal of Health and Social Behavior, 54(3), 353–368.

28.

Masters

R. K.

Hummer

R. A.

Powers

D. A.

(2012). Educational differences in U.S. adult mortality: A cohort perspective. American Sociological Review, 77(4), 548–572.

29.

Mirowsky

Ross

C. E.

(2003). Education, social status, and health. Aldine de Gruyter.

30.

Montez

Hummer

Hayward

Woo

Rogers

(2011). Trends in the educational gradient of U.S. adult mortality from 1986 through 2006 by race, gender, and age group. Research on Aging, 33(2), 145–171.

31.

Ofstedal

M. B.

Weir

D. R.

Chen

K. T.

Wagner

(2011). Updates to HRS sample weights. University of Michigan.

32.

Ornish

Scherwitz

L. W.

Billings

J. H.

Brown

S. E.

Gould

K. L.

Merritt

T. A.

Sparler

Armstrong

W. T.

Ports

T. A.

Kirkeeide

R. L.

Hogeboom

Brand

R. J.

(1998). Intensive lifestyle changes for reversal of coronary heart disease. JAMA, 280, 2001–2007.

33.

Pennlert

Asplund

Glader

E.-L.

Norrving

Eriksson

(2017). Socioeconomic status and the risk of stroke recurrence: Persisting gaps observed in a nationwide Swedish Study 2001 to 2012. Stroke, 48, 1518–1523.

34.

Phelan

J. C.

Link

B. G.

Tehranifar

(2010). Social conditions as fundamental causes of health inequalities: Theory, evidence, and policy implications. Journal of Health and Social Behavior, 51(1_supp.), S28–S40.

35.

Rasmussen

J. N.

Chong

Alter

(2007). Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction. JAMA, 297(2), 177–186.

36.

Rier

(2010). The patient’s experience of Illness. In Bird

C. E.

Conrad

Fremont

A. M.

(Eds.), Handbook of medical sociology (6th ed., pp. 163–178). Vanderbilt University Press.

37.

Schiøtz

Stockmarr

Høst

Glümer

Frølich

(2017). Social disparities in the prevalence of multimorbidity—A register-based population study. BMC Public Health, 17, 422.

38.

Umberson

Thomeer

M. B.

Kroeger

R. A.

Reczek

Donnelly

(2016). Instrumental- and emotion-focused care work during physical health events: Comparing gay, lesbian, and heterosexual marriages. Journal of Gerontology, 72(3), 498–509.

39.

Warren

J. R.

Hernandez

E. M.

(2007). Did socioeconomic inequalities in morbidity and mortality change in the United States over the course of the twentieth century? Journal of Health and Social Behavior, 48, 335–351.

40.

Weir

D. R.

(2016). Validating mortality ascertainment in the health and retirement study. Survey Research Center, Institute for Social Research, University of Michigan. https://hrs.isr.umich.edu/sites/default/files/biblio/Weir_mortality_ascertainment.pdf

41.

Williams

J. C.

Boushey

(2010). The three faces of work–family conflict: The poor, the professionals, and the missing middle. Center for American Progress and Center for WorkLife Law. https://www.americanprogress.org/issues/economy/reports/2010/01/25/7194/the-three-faces-of-work-family-conflict/

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.37 MB