Impact of Social Position on the Effect of Cardiovascular Risk Factors on Self-Rated Health

Objectives. We assessed the impact of education level on the association between self-rated health and cardiovascular risk factors (blood pressure, glycosylated hemoglobin level, and total cholesterol and triglyceride levels). Methods. We used data from the National Health and Nutrition Examination Survey for the years 2001 through 2004 (4015 men and 4066 women). Multivariate analyses were performed with a logistic regression model. Results. After adjustment for age and ethnicity, among women with high glycosylated hemoglobin levels, the most-educated women had poorer self-rated health compared with the least-educated women (odds ratio [OR] =4.61; 95% confidence interval [CI]=2.90, 7.34 vs OR=2.59; 95% CI=1.60, 4.20, respectively; interaction test, P=0.06). The same was true among women with high cholesterol levels (OR=2.23; 95% CI=1.40, 3.56 vs OR=1.13; 95% CI=0.85, 1.49, respectively; interaction test, P=0.06). Among men, the impact of education level on the association between self-rated health and any cardiovascular risk factors (measured or self-reported) was not significant. Conclusions. The impact of cardiovascular risk factors on self-rated health was higher for highly educated women, which could lead to underestimation of health inequalities between socioeconomic groups when self-rated health is used as an indicator of objective health. (Am J Public Health. 2009;99:1278-1284. doi:10.2105/AJPH.2008.147934)