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Article Open Access January 23, 2025

Diminished Returns of Educational Attainment on Hypertension Prevalence among American Indian and Alaska Native Adults: National Health Interview Survey 2023

Shervin Assari 1, 2, 3, 4,* and Hossein Zare 5, 6
1
Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
2
Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
3
Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
4
Marginalization-Related Diminished Returns (MDRs) Center, Los Angeles, CA, United States
5
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
6
School of Business, University of Maryland Global Campus (UMGC), Adelphi, MD, United States
Publihed in: Current Research in Public Health (Volume 4, Issue 1, 2025)
Page(s): 11-21
DOI: 10.31586/gjcd.2025.1148
Received
August 21, 2024
Revised
October 16, 2024
Accepted
November 19, 2024
Published
January 23, 2025
Keywords
Minorities' Diminished Returns; Educational Attainment; Hypertension Risk; American Indian and Alaska Native (AIAN) Adults; National Health Interview Survey; Racial Health Disparities; Structural Inequities; Social Determinants of Health; Labor Market Discrimination; Cardiovascular Health; Health Inequalities; Social Stratification; Public Health Interventions; Systemic Racism; Intergenerational Trauma
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright: Copyright © The Author(s), 2025. Published by Scientific Publications
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APA Style
Assari, S. , & Zare, H. (2025). Diminished Returns of Educational Attainment on Hypertension Prevalence among American Indian and Alaska Native Adults: National Health Interview Survey 2023. Current Research in Public Health, 4(1), 11-21. https://doi.org/10.31586/gjcd.2025.1148
ACS Style
Assari, S. ; Zare, H. Diminished Returns of Educational Attainment on Hypertension Prevalence among American Indian and Alaska Native Adults: National Health Interview Survey 2023. Current Research in Public Health 2025 4(1), 11-21. https://doi.org/10.31586/gjcd.2025.1148
Chicago/Turabian Style
Assari, Shervin, and Hossein Zare. 2025. "Diminished Returns of Educational Attainment on Hypertension Prevalence among American Indian and Alaska Native Adults: National Health Interview Survey 2023". Current Research in Public Health 4, no. 1: 11-21. https://doi.org/10.31586/gjcd.2025.1148
AMA Style
Assari S, Zare H. Diminished Returns of Educational Attainment on Hypertension Prevalence among American Indian and Alaska Native Adults: National Health Interview Survey 2023. Current Research in Public Health. 2025; 4(1):11-21. https://doi.org/10.31586/gjcd.2025.1148 
@Article{crph1148,
AUTHOR = {Assari, Shervin and Zare, Hossein},
TITLE = {Diminished Returns of Educational Attainment on Hypertension Prevalence among American Indian and Alaska Native Adults: National Health Interview Survey 2023},
JOURNAL = {Current Research in Public Health},
VOLUME = {4},
YEAR = {2025},
NUMBER = {1},
PAGES = {11-21},
URL = {https://www.scipublications.com/journal/index.php/GJCD/article/view/1148},
ISSN = {2831-5162},
DOI = {10.31586/gjcd.2025.1148},
ABSTRACT = {Background: Research on Minorities’ Diminished Returns (MDRs) consistently reveals that social determinants of health, especially educational attainment, do not yield equal health benefits across racial and ethnic groups in the United States. MDRs suggest that social stratification, segregation, lower education quality, and labor market discrimination contribute to diminished health returns of education among minoritized groups. However, few studies have tested the relevance of MDRs in American Indian and Alaska Native (AIAN) populations compared to non-Hispanic White adults. Objectives: This study aimed to examine the strength of the inverse association between educational attainment and hypertension prevalence, hypothesizing that the protective effect of education on hypertension risk is reduced among AIAN adults relative to non-Hispanic Whites. Methods: Using data from the 2023 National Health Interview Survey (NHIS), we analyzed a nationally representative sample of adults aged 18 and older. Logistic regression models examined the association between educational attainment and self-reported hypertension diagnosis, stratified by racial/ethnic group (AIAN vs. non-Hispanic White). Models were adjusted for key covariates, including age, gender, income, and insurance status. Results: Higher educational attainment was associated with a lower prevalence of hypertension in the combined sample of AIAN and non-Hispanic White adults. However, this protective association was significantly weaker among AIAN adults compared to non-Hispanic White adults, as evidenced by a significant interaction between race and education. Conclusion: AIAN adults exhibit a higher prevalence of hypertension even at higher levels of educational attainment compared to non-Hispanic White adults, supporting the relevance of MDRs for AIAN populations. This finding underscores the need for public health interventions that address structural barriers and contextual factors unique to AIAN populations. Policies focused solely on educational access may be insufficient to reduce hypertension risk among AIAN adults without addressing broader social and structural inequities.},
}
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%A Zare, Hossein
%D 2025
%J Current Research in Public Health

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%T Diminished Returns of Educational Attainment on Hypertension Prevalence among American Indian and Alaska Native Adults: National Health Interview Survey 2023
%M doi:10.31586/gjcd.2025.1148
%U https://www.scipublications.com/journal/index.php/GJCD/article/view/1148

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AB  - Background: Research on Minorities’ Diminished Returns (MDRs) consistently reveals that social determinants of health, especially educational attainment, do not yield equal health benefits across racial and ethnic groups in the United States. MDRs suggest that social stratification, segregation, lower education quality, and labor market discrimination contribute to diminished health returns of education among minoritized groups. However, few studies have tested the relevance of MDRs in American Indian and Alaska Native (AIAN) populations compared to non-Hispanic White adults. Objectives: This study aimed to examine the strength of the inverse association between educational attainment and hypertension prevalence, hypothesizing that the protective effect of education on hypertension risk is reduced among AIAN adults relative to non-Hispanic Whites. Methods: Using data from the 2023 National Health Interview Survey (NHIS), we analyzed a nationally representative sample of adults aged 18 and older. Logistic regression models examined the association between educational attainment and self-reported hypertension diagnosis, stratified by racial/ethnic group (AIAN vs. non-Hispanic White). Models were adjusted for key covariates, including age, gender, income, and insurance status. Results: Higher educational attainment was associated with a lower prevalence of hypertension in the combined sample of AIAN and non-Hispanic White adults. However, this protective association was significantly weaker among AIAN adults compared to non-Hispanic White adults, as evidenced by a significant interaction between race and education. Conclusion: AIAN adults exhibit a higher prevalence of hypertension even at higher levels of educational attainment compared to non-Hispanic White adults, supporting the relevance of MDRs for AIAN populations. This finding underscores the need for public health interventions that address structural barriers and contextual factors unique to AIAN populations. Policies focused solely on educational access may be insufficient to reduce hypertension risk among AIAN adults without addressing broader social and structural inequities.
DO  - Diminished Returns of Educational Attainment on Hypertension Prevalence among American Indian and Alaska Native Adults: National Health Interview Survey 2023
TI  - 10.31586/gjcd.2025.1148
ER  -