Low-educated Adults Research Articles

Incentive effects of cash benefit among low-skilled young adults: Applying a regression discontinuity design

In 2014, the Danish Government implemented an active labour market reform directed at unemployed young adults under 30 years of age with low educational qualifications. The reform replaced the (unemployment) cash benefits with a lower education benefit for many of the unemployed aged under 30 and obliged the low-skilled in this group to enrol in a regular general or vocational (VET) education program. This paper exploits the sharp discontinuity that occurs at age 30 to estimate the joint effect of higher benefits and the cessation of educational obligations on the share receiving cash benefits and the share enrolled in education. We estimate the effects by applying a regression discontinuity design. We report results for the group of low educated young adults and for subgroups facing different economic incentives. The results establish that reaching age 30 creates an incentive to apply for cash benefits, and we find strong evidence that a significant increase in the share of cash benefit recipients relates to a corresponding reduction in the share of young adults enrolled in education. When including subgroups the size of the effect increases, and the results demonstrate that the effects are strongest among previous education benefit recipients. This indicates that the results are mainly driven mainly by individuals reverting to cash benefits.

Can Labor Market Policies Reduce Deaths of Despair?

Do minimum wages and the earned income tax credit (EITC) mitigate rising “deaths of despair?” We leverage state variation in these policies over time to estimate event study and difference-in-differences models of deaths due to drug overdose, suicide, and alcohol-related causes. Our causal models find no significant effects on drug or alcohol-related mortality, but do find significant reductions in non-drug suicides. A 10 percent minimum wage increase reduces non-drug suicides among low-educated adults by 2.7 percent, and the comparable EITC figure is 3.0 percent. Placebo tests and event-study models support our causal research design. Increasing both policies by 10 percent would likely prevent a combined total of more than 700 suicides each year.

" Si lo hacemos así, en la escuela nos regañarían”. Discursos matemáticos locales de adultos con baja escolaridad

Enfocado en la educación matemática de jóvenes y adultos (EMDJA), este artículo registra los intereses educativos que las personas quisieran incluir en su educación contrastándolos con la forma en la que se presentan los contenidos del currículo matemático para dicha población. Se define Discurso matemático con base en estudios socioculturales lingüísticos y la definición de Discurso de Gee (2001, 2004), entendida como una serie de “coordinaciones (‘una danza’) de personas, lugares, tiempos, acciones, interacciones, expresiones verbales y no verbales, símbolos, cosas, herramientas y tecnologías que muestran ciertas identidades y actividades asociadas”. Este estudio cualitativo se basa en entrevistas que exploran los Discursos matemáticos subyacentes a los intereses educativos de adultos con baja escolaridad. El objetivo de esta investigación es registrar algunos elementos que posibilitarían fortalecer el puente entre lo que las instituciones consideran que se tiene que enseñar y lo que las personas adultas quieren aprender. Desde este análisis, se concluye precisando la necesidad de consolidar el currículo matemático para la EMDJA en tres aspectos: de agencia y de participación, aquéllas relacionadas con el fortalecimiento de la identidad de las personas adultas y el cuestionamiento a la génesis temporal de los conceptos matemáticos que se usa en los currículos.

A Study on the Activation of the National Lifelong Learning Account System

이 연구는 성인이 정규교육과정을 마치고 수행한 학습의 결과를 체계적으로 누적 기록하고 관리함으로써 국민의 평생학습 참여를 촉진하고자 하는 평생학습계좌제의 활성화 방안을 마련하는 데 목적이 있다. 연구목적을 달성하기 위해 첫째, 국가 수준의 평생학습계좌제 운영 실태와 둘째, 외국의 평생학습계좌제 운영 실태를 확인하였으며, 이를 통해 얻은 연구결과는 다음과 같다. 첫째, 평생교육기관에서 실시하는 평생학습이력의 연계기능이 확대되고 강화되어야 하며, 지속적인 평생학습이력관리시스템의 기능 개선과 고도화가 필요하다. 둘째, 학습자의 학습비용을 지원해야 한다. 국가평생교육진흥원으로부터 평가인정 받은 학습과목을 저소득자 등 소외계층, 저학력 성인, 학교 밖 청소년들이 수강할 경우 수강료를 면제해 주는 것이 필요하다. 셋째, 평생학습담당인력의 전문성 강화가 필요하다. 전문성 강화를 위해 선결되어야 하는 조건은 담당자들의 신분에 대한 안정성이 확보되어야 한다. 넷째, 학습자 풀(Pool) 및 인적 자원 네트워크 구축이 필요하다. 다섯째, 지역 거점 평생학습관 체제 구축이 필요하다. 평생교육 담당자들은 각 지역사회마다 갖는 특수성과 공통된 이념이나 목적을 함께 지향하고, 각종 인적 물적 자원 운영의 효율화를 도모하며, 당사자 간의 강점을 강화하고 약점을 보완할 수 있다는 점에서 지역 단위의 평생교육기관 연계시스템 구축이 무엇보다 필요하다. 여섯째, 평생학습계좌제에 대한 대국민 홍보를 강화해야 한다. 일곱째, 평생학습계좌제 참여 평생교육기관의 지원이 필요하다. 참여기관에 대한 실질적인 인센티브 부여 방안이 필요하다. 여덟째, 평생학습계좌를 통해 누적된 학습 결과를 활용할 수 있는 경로를 다양하게 개발하는 것이 필요하다.The purpose of this study is to establish a plan to revitalize the lifelong learning account system as a system to promote human resource development and management and the participation of the people in lifelong learning by systematically accumulating, recording and managing the results of various learning that adults have performed since the completion of the regular curriculum. To achieve the purpose of this study, first, what is the actual condition of the operation of the lifelong learning account system at the national level? Second, what is the actual condition of the operation of the lifelong learning account system in foreign countries? The results of this study are as follows: First, the connection function of lifelong learning history conducted by public institutions should be expanded and strengthened.,In addition, it is necessary to improve and improve the function of the continuous lifelong learning history management system. It is necessary to exempt the tuition fee when the underprivileged, low-educated adults, and students who are suspended from school, such as low-income families, take the learning courses approved by the National Lifelong Education Promotion Agency. Third, it is necessary to strengthen the professionalism of lifelong learning managers. The conditions that should be preceded for strengthening professionalism should be secured for the stability of the status of the persons in charge. Fourth, it is necessary to build a pool of learners and a human resource network. Fifth, it is necessary to establish a lifelong learning center system in the local base. The people in charge of the community should establish a lifelong learning institution linkage system at the local level in that they can aim at the specificity and common ideology or purpose of each community, promote the efficiency of various resource operations, and make use of the strengths among the parties in connection and supplement the weaknesses. Sixth, public relations should be strengthened for the lifelong learning account system. Seventh, lifelong learning account system participation support is needed. It is necessary to provide practical incentives to participating organizations. Eighth, it is necessary to develop various ways to utilize accumulated learning results through lifelong learning accounts.

SOCIAL AND PSYCHOLOGICAL FACTORS AND COGNITIVE FUNCTION: FINDINGS FROM INTERNATIONAL SURVEYS

This symposium examines how social and psychological factors including formal schooling, subjective memory, and neuropsychological symptoms impact cognitive function among older adults in China and the U.S. The first paper used the WHO’s Study on global AGEing and adult health Wave-1 data to examine the relationship between subjective cognitive function, perceived memory decline, and objective cognitive function among older adults in China. The results showed worse subjective cognitive function was associated with poorer working memory and verbal fluency, whereas greater perceived memory decline was associated only with poorer working memory. Furthermore, using data from the Health and Retirement Study, the second paper applied group-based trajectory modeling to assess dual trajectories of subjective memory impairment and objective cognitive decline. Four distinct dual-trajectory typologies were identified, suggesting complex co-occurring changes in subjective memory and objective cognition in older adults. The third paper characterized the trajectories of three neuropsychological symptoms (pain, insomnia, and depression) prior to dementia onset. Using data from the National Health and Aging Trends Study, the study found older adults with dementia exhibit distinct trajectory of depression before dementia onset than those without dementia. Trajectories of pain and insomnia did not differ before dementia onset. The last paper examined the effect of education on cognitive decline among lower educated older adults using data from the Longitudinal Study of Older Adults in Anhui Province, China. Results suggest that older adults with some formal schooling had slower cognitive decline; the gap in cognition between the literate and illiterate widened with age.

Factors associated with child neglect in Indonesia: Findings from National Socio-Economic Survey

This study aimed to identify the factors that affect the incidence rate of neglected children in Indonesia by considering the household effect. Neglect is a form of child abuse by not fulfilling or ignoring their basic needs. Neglected children are a complex social problem. This is a multidimensional problem, since the cause cannot be seen only based on individual characteristics, but it must also consider the household variation effect. The data was collected from a secondary source, namely the Socio-Culture and Education Module of the 2012 National Socio-Economic Survey (NSES-SCEM) that consisted of 75,000 households' data. The response variable was the child status of neglect, while the explanatory variables included a child's background characteristics at individual and household level. Two-level binary logistic regression with a random effect was applied. The regression model results show that neglected children were more commonly boys, had one or both parents dead, were younger in age, have another neglected child in the households, have disabilities, live in an uninhabitable house, headed by young and/or lower educated adults, had lower economic status, have higher underage family members, had unemployed parents, and lived with one of her/his parents. The current study found that the individual and household level remains an important aspect of child neglect in Indonesia. Policies in Indonesia should be directed to improve household welfare and to create a specific intervention to identify and assist vulnerable children in society.

Predictors of Episodic Memory Performance Across Educational Strata: Multiple-Group Comparisons.

Low educational attainment is a risk factor for more rapid cognitive aging, but there is substantial variability in cognitive trajectories within educational groups. The aim of this study was to determine the factors that confer resilience to memory decline within educational strata. We selected 2573 initially nondemented White, African American, and Hispanic participants from the longitudinal community-based Washington Heights/Inwood Columbia Aging Project who had at least two visits. We estimated initial memory (intercept) and the rate of memory decline (slope) using up to five occasions of measurement. We classified groups according to the educational attainment groups as low (≤5 years), medium (6-11 years), and high (≥12 years). We used a multiple-group latent growth model to identify the baseline predictors of initial memory performance and rate of memory decline across groups. The model specification considered the influence of demographic, socioeconomic, biomedical, and cognitive variables on the intercept and the slope of memory trajectory. Our results indicated that the three educational groups do not benefit from the same factors. When allowed to differ across groups, the predictors were related to cognitive outcomes in the highly educated group, but we found no unique predictor of cognition for the low educated older adults. These findings highlight that memory-protective factors may differ across older adults with distinct educational backgrounds, and the need to evaluate a broader range of potential resilience factors for older adults with few years of school.

The Relationship Between Health Insurance and Early Retirement: Evidence from the Affordable Care Act

This paper investigates the effect of the Affordable Care Act’s Medicaid expansion on the retirement decision of low-educated adults aged 55–64. I employ a difference-in-differences strategy that exploits the timing and expansion decisions of states for adults without dependent children. I find that the expansions increase Medicaid enrollment for both men and women. The estimates also suggest that the expansions result in women retiring early, whereas there is no significant change in the retirement behavior of men. These findings imply that the effect of health insurance on women’s retirement decisions may depend on men’s labor market responses to health insurance.

What factors explain socioeconomic inequalities in adults' television-related sitting time?

There are considerable socioeconomic inequalities in television-related sitting time, but there is little evidence for the explanatory mechanisms. We used a cohort of Belgian adults (25-60 years) and older adults (≥65 years) to examine the social cognitive, home environmental and health-related factors contributing to socioeconomic differences in television-related sitting. We included 301 adults and 258 older adults (total n = 559). Linear regression analyses were used to examine the associations of education and occupational status with television-related sitting time, adjusted for age and gender. We assessed the explanatory power of social cognitive, home environmental and health-related factors using the traditional 'change-in-estimation method'. Those with low and medium education, respectively, engaged in 54 and 28 minutes per day more television-related sitting time than those with high education. We found no association between occupational status and television-related sitting time. Social cognitive factors explained 54% of the difference in television-related sitting time between those with low and high education, while home environmental factors only explained 6%, and health-related variables explained 10% of these differences. We found no occupational inequalities in television-related sitting time. Social cognitive variables such as attitude and modelling of the partner explained a large part of the educational inequalities in television-related sitting time. If confirmed by future studies, a focus on social cognition may help reduce sedentary behaviours in low-educated adults and diminish inequalities in sedentary behaviours.

The Evidence on Early Retirement After the Affordable Care Act's Medicaid Expansion

This paper investigates the effect of the Affordable Care Act's (ACA) Medicaid expansion on the retirement decision of low-educated adults aged 55-64. Using data from the American Community Survey, I employ a difference-in-differences strategy that exploits the timing and expansion decisions of states for adults without dependent children (childless adults). I find that the expansions increase Medicaid enrollment for both men and women. The estimates also suggest that the expansions and Medicaid enrollment result in women retiring early, whereas there is no significant change in the retirement behavior of men. These findings imply that the effect of health insurance on women's retirement decisions may depend on men's labor market responses to health insurance.

A typology of education and training provisions for low educated adults: categories and definitions

It is Europe’s ambition to be a strong knowledge based economy. The European Commission recognises the role of lifelong learning in achieving this aim. However, exploring participation rates in post-compulsory learning, it is clear that access to education and training is unequally distributed in society. We know that participation rates vary by socio-economic and socio-demographic groups, as well as by country. However, the role of education and training institutions in facilitating and enabling participation is less well known and deserves further in-depth attention. In order to fill this gap, we scrutinised definitions and categorisations of adult education provisions as published by the leading international organisations in the field of education and training. We paid specific attention to opportunities available for the lowest educated adults in society. Based on our review, we constructed a new typology consisting of seven categories for addition to the knowledge base and use in our own Horizon 2020 project. The categories are: (1) basic skills and basic education, (2) second chance education at upper secondary levels, (3) post-secondary VET, (4) apprenticeships, (5) training that forms part of Active Labour Market Policies, (6) workplace or job-related learning and (7) personal or social learning.

Toronto Alexithymia Scale: Adaptation of the Brazilian Version to Low-Educated Adults

Abstract: For the purpose of studying Alexithymia in low-educated adults, we intend to adapt the Brazilian version of the Toronto Alexithymia Scale (TAS-26) and to verify its internal consistency. With that aim, we translated the original TAS-26 (English) to Portuguese, adopting a colloquial language, without content distortion. An exploratory qualitative study interviewed 50 women (38-65 years, education <9 years) and identified comprehension difficulties in 22 items, that needed adaptation. A professional translator performed the back-translation of the adapted TAS-26, that was applied to a new sample of women (90 with chronical pain and 90 without pain, 38-65 years, education <9 years) to evaluate its internal consistency. Only four items (1/2/3/16) of the pre-existing Brazilian version (appropriate to university students) did not require modification. The internal consistency (Cronbach’s alpha) was satisfactory for total score (0.65) and elevated for factor 1 (0.87). The adapted Brazilian version of TAS-26 is appropriate to low-educated adults.

Disparities in Disability by Educational Attainment Across US States.

To examine how disparities in adult disability by educational attainment vary across US states. We used the nationally representative data of more than 6 million adults aged 45 to 89 years in the 2010-2014 American Community Survey. We defined disability as difficulty with activities of daily living. We categorized education as low (less than high school), mid (high school or some college), or high (bachelor's or higher). We estimated age-standardized disability prevalence by educational attainment and state. We assessed whether the variation in disability across states occurs primarily among low-educated adults and whether it reflects the socioeconomic resources of low-educated adults and their surrounding contexts. Disparities in disability by education vary markedly across states-from a 20 percentage point disparity in Massachusetts to a 12-point disparity in Wyoming. Disparities vary across states mainly because the prevalence of disability among low-educated adults varies across states. Personal and contextual socioeconomic resources of low-educated adults account for 29% of the variation. Efforts to reduce disparities in disability by education should consider state and local strategies that reduce poverty among low-educated adults and their surrounding contexts.

The Impact of the ACA Medicaid Expansions on Health Insurance Coverage through 2015 and Coverage Disparities by Age, Race/Ethnicity, and Gender.

Examine the ACA Medicaid expansion effects on Medicaid take-up and private coverage through 2015 and coverage disparities by age, race/ethnicity, and gender. 2011-2015 American Community Survey for 3,137,989 low-educated adults aged 19-64years. Difference-in-differences regressions accounting for national coverage trends and state fixed effects. Expansion effects doubled in 2015 among low-educated adults, with a nearly 8 percentage-point increase in Medicaid take-up and 6 percentage-point decline in uninsured rate. Significant coverage gains were observed across virtually all examined groups by age, gender, and race/ethnicity. Take-up and insurance declines were strongest among younger adults and were generally close by gender and race/ethnicity. Despite the increased take-up however, coverage disparities remained sizeable, especially for young adults and Hispanics who had declining but still high uninsured rates in 2015. There was some evidence of private coverage crowd-out in certain subgroups, particularly among young adults aged 19-26years and women, including in both individually purchased and employer-sponsored coverage. The ACA Medicaid expansions have continued to increase coverage in 2015 across the entire population of low-educated adults and have reduced age disparities in coverage. However, there is still a need for interventions that target eligible young and Hispanic adults.

Age and education related preferences for pictograms concerning driving-impairing medicines

Purpose Pictograms can increase public awareness about driving-impairing effects of medicines. However, pictograms that are not clear will negatively affect the comprehension of the message. Older and low educated adults are particularly vulnerable to misunderstandings. Comprehension is expected to be influenced by preference for the type of pictograph, but little is known about the preference of pictograms among drivers of different age groups and education levels. Aim This study aims to investigate older and lower educated adults’ preference for a pictogram (triangle model pictogram versus rating model pictogram) related to the influence of taking driving-impairing medicines on driving fitness. Methods: Interviews among 270 drivers visiting a pharmacy were conducted. Participants were asked about their preference for the best pictogram expressing a warning message and expressing levels of impairment. A comparison between a pictogram with a more complex design (rating model) and an already implemented one (triangle model) was made. Results 74.4% of the participants preferred the rating model to express warning messages and 82.6% preferred this model to express levels of impairment. However, older and low educated participants were more likely to prefer the triangle model over the more complex rating model. Age was the strongest predictor influencing participants’ preference for pictograms to express a warning message and levels of impairment. Young participants (18-39 years old) with high education level had the highest preference for the rating model, whereas older participants (> 60 years old) with low education level showed the lowest preference for this pictogram system. Conclusion Age and education level are sensitive factors to be considered when designing a pictogram. In order to be equally well understood by older and low educated adults, pictograms should have a simple design and make use of familiar objects.

Longitudinal changes in physical activity and sedentary time in adults around retirement age: what is the moderating role of retirement status, gender and educational level?

BackgroundThe start of retirement is an important stage in an (older) adult’s life and can affect physical activity (PA) and/or sedentary behaviors, making it an ideal period to implement health interventions. To identify the most optimal timing of such interventions it is important to determine how PA and sedentary behaviors change not only when making the transition to retirement, but also during the first years of retirement. The main study aim was to examine whether PA and sedentary behaviors change differently in retiring adults compared with recently retired adults. A second aim was to examine potential moderating effects of gender and educational level.MethodsA longitudinal study was conducted in Ghent, Belgium. Baseline measurements took place in 2012–2013 and follow-up data were collected 2 years later. In total, 446 adults provided complete data at both time points. Of the participants 105 adults were not retired at baseline but retired between baseline and follow-up (i.e. retiring) and 341 were already retired at baseline (i.e. recently retired). All participants completed a questionnaire on PA, sedentary behaviors, socio-demographic factors and physical functioning. Repeated measures MANOVAs were conducted in SPSS 22.0. to analyze the data.ResultsLeisure-time cycling increased over time in retiring adults, but decreased in recently retired adults (p < 0.01). (Voluntary) work-related walking and moderate-to-vigorous PA decreased strongly in retiring adults, while slight increases were found in recently retired adults (p < 0.001 and p < 0.01). Passive transport decreased more strongly in recently retired than in retiring adults (p < 0.05), and computer use increased more in retiring adults than in the recently retired group (p < 0.001). Low-educated recently retired adults had the strongest decrease in walking for transport (p < 0.05) and strongest increase in TV viewing time (p < 0.01) and computer use (p < 0.10). For gender, almost no moderating effects were found.ConclusionsFuture interventions should focus on PA and/or specific sedentary behaviors in retiring adults, but should definitely include long-term follow-up, as recently retired adults seem to be prone to lapse into an unhealthy lifestyle. Specific attention should be paid to low-educated adults as they are particularly susceptible to a decrease in PA and increased TV viewing time and computer use.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3792-4) contains supplementary material, which is available to authorized users.

Pumping Iron in Australia: Prevalence, Trends and Sociodemographic Correlates of Muscle Strengthening Activity Participation from a National Sample of 195,926 Adults.

ObjectiveThe current Australian Physical Activity Guidelines recommend that adults engage in regular muscle-strengthening activity (e.g. strength or resistance training). However, public health surveillance studies describing the patterns and trends of population-level muscle-strengthening activity participation are sparse. The aim of this study is to examine the prevalence, trends and sociodemographic correlates of muscle-strengthening activity participation in a national-representative sample of Australians aged 15 years and over.MethodsBetween 2001 and 2010, quarterly cross-sectional national telephone surveys were conducted as part of the Australian Sports Commission's 'Exercise, Recreation and Sport Survey'. Pooled population-weighted proportions were calculated for reporting: [i] no muscle-strengthening activity; [ii] insufficient muscle-strengthening activity, and [iii] sufficient muscle-strengthening activity. Associations with sociodemographic variables were assessed using multiple logistic regression analyses.ResultsOut of 195,926 participants, aged 15–98 years, only 10.4% (95% CI: 10.1–10.7) and 9.3% (95% CI: 9.1–9.5) met the muscle-strengthening activity recommendations in the past two weeks and in the past year, respectively. Older adults (50+ years), and those living in socioeconomically disadvantaged, outer regional/remote areas and with lower education were less likely to report sufficient muscle-strengthening activity (p<0.001). Over the 10-year monitoring period, there was a significant increase in the prevalence of sufficient muscle-strengthening activity (6.4% to 12.0%, p-value for linear trend <0.001).ConclusionsA vast majority of Australian adults did not engage in sufficient muscle-strengthening activity. There is a need for public health strategies to support participation in muscle-strengthening activity in this population. Such strategies should target older and lower educated adults, and those living in socioeconomically disadvantaged, outer regional/remote and areas.

Are area-based initiatives able to improve area safety in deprived areas? A quasi-experimental evaluation of the Dutch District Approach.

BackgroundNumerous area-based initiatives have been implemented in deprived areas across Western-Europe with the aim to improve the socio-economic and environmental conditions in these areas. Only few of these initiatives have been scientifically evaluated for their impact on key social determinants of health, like perceived area safety. Therefore, this study aimed to assess the impact of a Dutch area-based initiative called the District Approach on trends in perceived area safety and underlying problems in deprived target districts.MethodsA quasi-experimental design was used. Repeated cross-sectional data on perceived area safety and underlying problems were obtained from the National Safety Monitor (2005–2008) and its successor the Integrated Safety Monitor (2008–2011). Study population consisted of 133,522 Dutch adults, including 3,595 adults from target districts. Multilevel logistic regression analyses were performed to assess trends in self-reported general safety, physical order, social order, and non-victimization before and after the start of the District Approach mid-2008. Trends in target districts were compared with trends in various control groups.ResultsResidents of target districts felt less safe, perceived less physical and social order, and were victimized more often than adults elsewhere in the Netherlands. For non-victimization, target districts showed a somewhat more positive change in trend after the start of the District Approach than the rest of the Netherlands or other deprived districts. Differences were only statistically significant in women, older adults, and lower educated adults. For general safety, physical order, and social order, there were no differences in trend change between target districts and control groups.ConclusionsResults suggest that the District Approach has been unable to improve perceptions of area safety and disorder in deprived areas, but that it did result in declining victimization rates.

Association between educational status and dual-task performance in young adults.

The influence of educational status on perceptual-motor performance has not been investigated. The single- and dual-task performances of 15 Low educated adults (9 men, 6 women; M age=24.1 yr.; 6-9 yr. of education) and 15 Higher educated adults (8 men, 7 women; M age=24.7 yr.; 10-13 yr. of education) were compared. The perceptual task consisted of verbally classifying two figures (equal or different). The motor task consisted of alternating steps from the floor to a stool. Tasks were assessed individually and simultaneously. Two analyses of variance (2 groups×4 blocks) compared the errors and steps. The Low education group committed more errors and had less improvement on the perceptual task than the High education group. During and after the perceptual-motor task performance, errors increased only in the Low education group. Education correlated to perceptual and motor performance. The Low education group showed more errors and less step alternations on the perceptual-motor task compared to the High education group. This difference on the number of errors was also observed after the dual-task, when the perceptual task was performed alone.

Education, glucose control, and mortality risks among U.S. older adults with diabetes

AimsStudies have shown that diabetes mellitus disproportionately afflicts persons of low socioeconomic status and that the burden of disease is greatest among the disadvantaged. However, our understanding of educational differences in the control of diabetes and its impact on survival is limited. This study investigated the associations among education, hemoglobin A1c (HbA1c), and subsequent mortality in adults with diabetes. MethodsProspective cohort data from the 2006, 2008, and 2010 Health and Retirement Study were linked with biomarker data for U.S. older adults with diabetes (n=3312). Weighted distributions were estimated for all subjects at baseline and by the American Diabetes Association's general guidelines for HbA1c control (<7.0% [53mmol/mol] vs. ≥7.0% [53mmol/mol]). Proportional hazard models were used to estimate educational differences in all-cause mortality by HbA1c level with sequential adjustments for contributing risk factors. ResultsMortality risks associated with HbA1c≥7.0% [53mmol/mol] were significantly greater in lower-educated adults than higher-educated adults (P<0.001). We found that the hazard ratios (HR) associated with HbA1c ≥7.0% [53mmol/mol] were highest among low-educated adults (HR=2.18, 95% CI: 1.62, 2.94) and that a combination of socioeconomic, psychosocial, and behavioral factors accounted for most, but not all, of the associations. ConclusionsEducational differences in HbA1c control have significant implications for mortality and efforts to reduce these disparities should involve more vigilant screening and monitoring of lower-educated adults with diabetes.