Sheepskin effects of education in the 10-year Framingham risk of coronary heart disease

Abstract

While the association between education and adult health is well documented, it is unclear whether quantity (i.e. years of schooling) or credentials (i.e. degrees) drive this association. Individuals with degrees may have better health than their non-credentialed counterparts given similar years of schooling, the so-called "sheepskin" effect. This paper contributes to this line of inquiry by examining associations of educational degree and years of schooling with the Framingham Risk Score, a measure of 10-year risk of coronary heart disease (CHD), using data from a unique birth cohort (the New England Family Study; participants mean age 42 years) with prospective information on childhood health and intelligence quotient (IQ). According to our results, years of schooling were inversely associated with 10-year CHD risk in the unadjusted model but not in the fully adjusted models that included degree attainment. By contrast, associations between degree attainment and 10-year CHD risk remained significant in the fully adjusted models that included years of schooling. College degree holders had 10-year CHD risk 19% (95% CI: -33%, -2%) lower than individuals with HS degrees or less in the fully adjusted models. Subanalyses evaluating sheepskin effects on the individual components of the 10-year CHD risk algorithm showed the expected education gradient was generally noted for each of the individual components, with decreasing prevalence of "high risk" values associated with higher degree credentials. Our results suggest educational credentials provide an additional benefit to risk of coronary heart disease beyond schooling.