More schooling is associated with lower hemoglobin A1c at the high-risk tail of the distribution: an unconditional quantile regression analysis
Abstract Background Risk of diabetes increases exponentially with higher levels of glycosylated hemoglobin (HbA1c). Education is inversely associated with average HbA1c, however, differential associations between education and HbA1c across the HbA1c distribution have not been evaluated. Methods Heal...
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2025-06-01
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| author | Jillian Hebert Amanda M. Irish Aayush Khadka Abigail Arons Alicia R. Riley Elbert S. Huang Anusha M. Vable |
| author_facet | Jillian Hebert Amanda M. Irish Aayush Khadka Abigail Arons Alicia R. Riley Elbert S. Huang Anusha M. Vable |
| author_sort | Jillian Hebert |
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| description | Abstract Background Risk of diabetes increases exponentially with higher levels of glycosylated hemoglobin (HbA1c). Education is inversely associated with average HbA1c, however, differential associations between education and HbA1c across the HbA1c distribution have not been evaluated. Methods Health and Retirement Study data (N = 21,732) was used to evaluate the association between education (linear terms among those with < 12 years and ≥ 12 years of education) and first recorded HbA1c (2003–2016) at the mean using linear regression, and at the 1st-99th quantiles of the marginal outcome distribution using unconditional quantile regressions, controlling for birth year, race and ethnicity, gender, birthplace, parental education, and year of HbA1c measurement. Results Mean HbA1c was 5.9%; 16.6% of participants had HbA1c above the diabetes diagnostic threshold of 6.5%. For those with fewer than 12 years of schooling, there was no association between education and HbA1c at the mean or across the quantiles. For those with 12 or more years of schooling, an additional year of education was negatively associated with mean HbA1c (βOLS=-0.02, 95% confidence interval (CI) -0.03,-0.02); a one-year increase in mean education was associated with lower HbA1c across the distribution, but the magnitude was larger at higher quantiles (βq50=-0.02, 95%CI -0.02,-0.01; βq90=-0.06, 95%CI -0.09,-0.04). Conclusions Educational attainment is inversely associated with HbA1c among those with 12 or more years of schooling, with larger point estimates for those in the high-risk tail of the HbA1c distribution. |
| format | Article |
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| institution | Kabale University |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMC |
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| series | BMC Public Health |
| spelling | doaj-art-eacc4989dfc9427d8995daf084269c9e2025-08-20T03:26:43ZengBMCBMC Public Health1471-24582025-06-0125111110.1186/s12889-025-23063-xMore schooling is associated with lower hemoglobin A1c at the high-risk tail of the distribution: an unconditional quantile regression analysisJillian Hebert0Amanda M. Irish1Aayush Khadka2Abigail Arons3Alicia R. Riley4Elbert S. Huang5Anusha M. Vable6Department of Family and Community Medicine, University of CaliforniaDepartment of Family and Community Medicine, University of CaliforniaDepartment of Family and Community Medicine, University of CaliforniaDepartments of Internal Medicine and Pediatrics, University of California, San FranciscoDepartment of Sociology, University of California, Santa CruzDepartments of Medicine and Public Health Sciences, University of ChicagoDepartment of Family and Community Medicine, University of CaliforniaAbstract Background Risk of diabetes increases exponentially with higher levels of glycosylated hemoglobin (HbA1c). Education is inversely associated with average HbA1c, however, differential associations between education and HbA1c across the HbA1c distribution have not been evaluated. Methods Health and Retirement Study data (N = 21,732) was used to evaluate the association between education (linear terms among those with < 12 years and ≥ 12 years of education) and first recorded HbA1c (2003–2016) at the mean using linear regression, and at the 1st-99th quantiles of the marginal outcome distribution using unconditional quantile regressions, controlling for birth year, race and ethnicity, gender, birthplace, parental education, and year of HbA1c measurement. Results Mean HbA1c was 5.9%; 16.6% of participants had HbA1c above the diabetes diagnostic threshold of 6.5%. For those with fewer than 12 years of schooling, there was no association between education and HbA1c at the mean or across the quantiles. For those with 12 or more years of schooling, an additional year of education was negatively associated with mean HbA1c (βOLS=-0.02, 95% confidence interval (CI) -0.03,-0.02); a one-year increase in mean education was associated with lower HbA1c across the distribution, but the magnitude was larger at higher quantiles (βq50=-0.02, 95%CI -0.02,-0.01; βq90=-0.06, 95%CI -0.09,-0.04). Conclusions Educational attainment is inversely associated with HbA1c among those with 12 or more years of schooling, with larger point estimates for those in the high-risk tail of the HbA1c distribution.https://doi.org/10.1186/s12889-025-23063-xUnconditional quantile regressionDistributional effectsEffect heterogeneityDiabetesUS Health and Retirement Study (HRS) |
| spellingShingle | Jillian Hebert Amanda M. Irish Aayush Khadka Abigail Arons Alicia R. Riley Elbert S. Huang Anusha M. Vable More schooling is associated with lower hemoglobin A1c at the high-risk tail of the distribution: an unconditional quantile regression analysis BMC Public Health Unconditional quantile regression Distributional effects Effect heterogeneity Diabetes US Health and Retirement Study (HRS) |
| title | More schooling is associated with lower hemoglobin A1c at the high-risk tail of the distribution: an unconditional quantile regression analysis |
| title_full | More schooling is associated with lower hemoglobin A1c at the high-risk tail of the distribution: an unconditional quantile regression analysis |
| title_fullStr | More schooling is associated with lower hemoglobin A1c at the high-risk tail of the distribution: an unconditional quantile regression analysis |
| title_full_unstemmed | More schooling is associated with lower hemoglobin A1c at the high-risk tail of the distribution: an unconditional quantile regression analysis |
| title_short | More schooling is associated with lower hemoglobin A1c at the high-risk tail of the distribution: an unconditional quantile regression analysis |
| title_sort | more schooling is associated with lower hemoglobin a1c at the high risk tail of the distribution an unconditional quantile regression analysis |
| topic | Unconditional quantile regression Distributional effects Effect heterogeneity Diabetes US Health and Retirement Study (HRS) |
| url | https://doi.org/10.1186/s12889-025-23063-x |
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