Combined Effects of Race and Educational Attainment on Physician Visits Over 24 Years in a National Sample of Middle-Aged and Older Americans

Background: The literature on Minorities’ Diminished Returns (MDRs) have shown worse than expected health of the members of
racial and ethnic minority groups particularly Blacks. Theoretically, this effect can be in part due to weaker effects of educational
attainment on preventive care and disease management in highly educated racial and ethnic minorities.
Objectives: The current study explored the racial and ethnic differences in the effect of baseline educational attainment on %
adherance to the routine physician visits among middle-aged and older adults in the US.
Methods: This is a prospective study with 24 years of follow up. The Health and Retirement Study (HRS: 1992-2016) included
10880 middle-aged and older adults who were Hispanic, non-Hispanic, Black or White. The independent variable was educational
attainment. The dependent variable was adherance to the routine physician visits (%). Age, gender, marital status, income, health
behaviors (smoking and drinking) and health (depression, self-rated health, and chronic diseases) were the covariates. Race and
ethnicity were the focal moderators. Linear regression was used for data analysis.
Results: Overall, higher educational attainment was associated with higher % of adherance to the routine physician visits over the
course of follow-up, net of all confounders. Race showed a significant statistical interaction with educational attainment suggesting
of a smaller effect of high education attainment on % adherance to the routine physician visits for Black than White middle-aged
and older adults. A similar interaction could not be found for the comparison of Hispanic and non-Hispanic middle-aged and older
adults.
Conclusion: Educational attainment is associated with a larger increase in preventive and disease management doctor visits for
White than Black middle-aged and older adults. This is a missed opportunity to improve the health of highly educated middle-aged
and older adults. It is not race/ethnicity or class that shapes health behaviors but race/ethnicity and class that shape people’s prohealth behaviors. At least some of the racial health disparities is not due to low SES but diminished returns of SES.