Abstract P573: Educational Assortative Mating and Cardiovascular Outcomes

Abstract

Objective: To estimate the association between educational assortative mating and cardiovascular outcomes among postmenopausal women in the Women’s Health Initiative study. Background: Between 1970 and 2015, the number of dual professional couples almost tripled. For instance, the likelihood of male attorneys marrying female lawyers and male doctors marrying female doctors has increased. Studies have proposed that educational assortative mating—people marry those with similar educational attainment--affects health disparities through increasing income inequality, creating differential levels of healthcare access, and based on the social cognitive theory, exchanging health knowledge and sharing healthy behaviors. Methods: We compared women living in three homogenous educational pairings; married women and spouses who both have 1) a high school degree or lower, 2) an associate or college degree, and 3) an MS, Ph.D., or professional degree. We used logistic regression models for prevalent outcomes (HTN, CHD, HF) at WHI baseline and Cox proportional hazard regression models for incident outcomes, all adjusted for age and total household income. To consider effect modification by membership in different racial or ethnic groups, we also conducted a stratified analysis. Results: We found significant associations between educational assortative mating and all cardiovascular outcomes within all groups of women. We found higher odds of prevalent cardiovascular outcomes ranging from 47 to 98 percent and a higher hazard of incident outcomes ranging from 24 to 56 percent. The strongest associations were found for prevalent and incident heart failure among Black women. Conclusion: This study provides evidence that educational assortative mating is likely a contributor to widening disparities in cardiovascular outcomes within and between racial groups of women.