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This Article Full Text Full Text (PDF) All Versions of this Article: AJPH.2008.147934v1 99/7/1278    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Delpierre, C. Articles by Lang, T. PubMed PubMed Citation Articles by Delpierre, C. Articles by Lang, T. Related Collections Epidemiology Global Health Public Health Practice

Cyrille Delpierre, PhD, Valérie Lauwers-Cances, MD, Geetanjali D. Datta, ScD, MPH, Lisa Berkman, PhD and Thierry Lang, MD, PhD

Cyrille Delpierre, Valérie Lauwers-Cances, and Thierry Lang are with Inserm UMR558, Toulouse, France. Geetanjali D. Datta is with the Department of Epidemiology, Harvard School of Public Health, Boston, MA. At the time of the study, Lisa Berkman was with the Department of Society, Human Development and Health, Harvard School of Public Health, Boston.

Correspondence: Requests for reprints should be sent to Cyrille Delpierre, PhD, 37 allées Jules Guesde 31073, Toulouse, France (e-mail: cyrildelpierre{at}yahoo.fr).

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.