Lifecourse Educational Trajectories and Hypertension in Midlife: An Application of Sequence Analysis

Background: Higher educational attainment predicts lower hypertension. Yet, associations between nontraditional educational trajectories (eg, interrupted degree programs) and hypertension are less well understood, particularly among structurally marginalized groups who are more likely to experience these non-traditional trajectories. Methods: In National Longitudinal Survey of Youth 1979 cohort data (N = 6 317), we used sequence and cluster analyses to identify groups of similar educational sequences-characterized by timing and type of terminal credential-that participants followed from age 14-48 years. Using logistic regression, we estimated associations between the resulting 10 educational sequences and hypertension at age 50. We evaluated effect modification by individual-level indicators of structural marginalization (race, gender, race and gender, and childhood socioeconomic status [cSES]). Results: Compared to terminal high school (HS) diploma completed at traditional age, terminal GED (OR: 1.32; 95%CI: 1.04, 1.66) or Associate degree after <HS (OR: 1.93; 95%CI: 1.11, 3.35) was associated with higher hypertension. There was some evidence of effect modification. Hypertension associated with delayed HS diploma versus HS diploma at a traditional age (the reference) was lower for Black men than White men (interaction term: 0.44; 95%CI: 0.21, 0.91); similarly, hypertension associated with <HS versus completing HS at a traditional age was lower for people with low cSES than people with high cSES (interaction term: 0.52; 95%CI: 0.30, 0.90). Conclusions: Both type and timing to terminal credential matter for hypertension but effects may vary by experiences of structural marginalization. Documenting the nuanced ways in which complex educational trajectories are associated with health could elucidate underlying mechanisms and inform systems-level interventions for health equity.