Educational Attainment and Risk of Coronary Heart Disease Across Age Groups: Analysis of the 2021 BRFSS National Survey

Background: The literature shows a strong association between level of education and the risk of developing Coronary Heart Disease (CHD). However, the extent to which this association attenuates after accounting for sociodemographic characteristics and cardiovascular risk factors in a survey-weighted national sample warrants further evaluation. Objective: We aimed to assess the association between educational attainment and angina and myocardial infarction (MI) across age groups in a nationally representative U.S. sample. Methods: The study analyzed 2021 Behavioral Risk Factor Surveillance System (BRFSS) data from 438,693 adults, a nationally representative telephone survey of U.S. adults. The dataset was accessed from the Centers for Disease Control and Prevention BRFSS website in February 2023. Angina and MI were identified based on self-reported physician diagnoses. Analyses included adults aged 18 years and older with no missing data for education and outcomes. Results: In survey-weighted analyses with college graduates as the reference group, lower educational attainment was associated with higher odds of angina and MI, compared with college graduates. In the fully adjusted model (Model 2), attending high school was associated with higher odds of angina (OR 1.439) and MI (OR 2.390). Conclusions: Lower educational attainment is associated with higher odds of angina and MI, particularly among younger adults. Although the magnitude of these associations was attenuated after adjustment for sociodemographic and cardiovascular risk factors, the persistence of the association underscores the importance of considering educational disparities in cardiovascular risk assessment.