Education differentials by race in the diagnosis and management of hypercholesterolemia

Purpose Our objective was to examine education differentials in screening, prevalence, awareness, treatment and control of hypercholesterolemia in three race/ethnic groups. Methods We analyzed data of 14,805 men and women ages ≥20 years, reported as African American, white or Mexican American, who participated in the Third National Health and Nutrition Examination Survey, conducted between 1988–1994. Prevalence of hypercholesterolemia was defined as having a total cholesterol level ≥240mg/dL, or use of lipid-lowering medication. Screening and awareness were determined by self-report, and control was based on National Cholesterol Education Program guidelines. Education levels included: grade school, some high school, high school, some college and ≥college. Results Participants with less education were less likely to have been screened, after adjusting for age, gender, comorbid conditions and BMI (odds ratio were 0.2, 0.2, 0.4. 0.6/0.7 for each increasing education level vs. the highest, in each race/ethnic group; all odds ratios were statistically significant). Multivariate models for awareness (among those with hypercholesterolemia) only showed the lowest education level (vs. highest) to be significantly associated with lower awareness within each race/ethnic group (odds ratios 0.6 for Whites, 0.5 for African Americans and 0.2 for Mexican Americans). There were almost no statistically significant associations between education and prevalence, treatment (among those aware), or control (among those who were treated). Conclusion We found that individuals with less education were less likely to have been screened, and those with the least education were less likely to be aware of their condition. These associations were apparent in each race/ethnic group. Once individuals were aware of their condition, no education differentials were found. Focusing public health policy on increasing screening and awareness for individuals with lower education might greatly improve their chances of preventing or mitigating morbidity related to hypercholesterolemia and subsequent disease.