Shervin Assari - Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, USA
Mohsen Bazargan - Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, USA

Background: As suggested by the Minorities’ Diminished Returns (MDRs) theory, educational attainment shows a weaker protective effect for racial and ethnic minority groups compared to non-Hispanic Whites. This pattern, however, is never shown for hospitalization risk. Objectives: This cross-sectional study explored racial and ethnic variations in the association between educational attainment and hospitalization in the United States. Methods: Data came from the National Health Interview Survey (NHIS ۲۰۱۵). The total sample was ۲۸,۹۵۹ American adults. Independent variables was educational attainment. The main outcome was hospitalization during the last ۱۲ months. Age, gender, employment, marital status, region, obesity, and number of cardiovascular conditions were covariates. Race and ethnicity were the effect modifiers. Logistic regression models were utilized to analyze the data. Results: From all participants, ۱۶.۲% were Black and ۱۱.۶% were Hispanic with a mean age of ۵۱ years. Overall, higher education levels were associated with lower odds of hospitalization, independent of all confounders. Educational attainment showed significant interactions with race (odds ratio [OR] =۱.۰۴, ۹۵% CI = ۱.۰۱-۱.۰۸) and ethnicity (OR = ۱.۰۴, ۹۵% CI =۱.۰۱-۱.۰۷) on hospitalization, indicating smaller protective effects of educational attainment on hospitalization of Hispanics and Blacks than non-Hispanic Whites. Conclusion: The protective effects of educational attainment on population health are smaller for Blacks and Hispanics compared to non-Hispanic Whites. To prevent health disparities, the diminished returns of educational attainment should be minimized for racial and ethnic minorities. To do so, there is a need for innovative and bold economic, public, and social policies that do not limit themselves to equalizing socioeconomic status, but also help minorities leverage their available resources and gain tangible outcomes.

Race, ethnicity, educational attainment, Minorities’ Diminished Returns, Socioeconomic status, Hospitalization