PRI Population Health Working Group

PRI Population Health Working Group

November 11th - 2:00 pm

Dave Baker and Erik Hernandez

"What Long-term Effect did Exceptional Mid-20^th Century Educational Expansion have on the Type 2 Diabetes Epidemic?"

Abstract

The type 2 diabetes epidemic is a leading cause of mortality and comorbidity in the U.S., and significantly contributes to the nation’s epidemiologic transition to a greater chronic disease burden. Although earlier education attainment is established as a major social factor in the fundamental cause of disease paradigm, the long-term impact of the education attainment gradient with type 2 diabetes has been less considered than have race/ethnicity and gender disparities. An informative case is the exceptionally rapid education expansion in the U.S. emerging just after WWII and accelerating for several decades paralleling the worsening of the type 2 diabetes epidemic. Nationally-representative samples of four cohorts of 60-64-year-olds, whose start and end of schooling occurred at different periods over the rapid mid-century expansion in the supply and demand, are compared. After conditioning on four demographic factors known to associate with prevalence, across all the cohorts greater education attainment substantially reduces the odds of diagnosis of type 2 diabetes by age 60-65 to a slightly greater degree than the known reduction in life-long odds associated with females, and equal to about a quarter of the large reduction of odds among whites. Then, a mediation analysis supports known somw pathways of the long-term effect on type 2 diabetes. Lastly, a decomposition analysis of the education gradients reveals that the massive education upgrading at mid-century likely lessened the epidemic significantly even as it worsened over the period. For example[BDP2] , preventing an additional million persons from the ages 60-64 born in 1950-54 cohort would have been diagnosed with type 2 diabetes. Implications of the findings for future forecasting type 2 diabetes prevalence and the broader role of the demography of educational expansion in the epidemiological transition are considered.
 
Information: JD Daw (jddaw@psu.edu)