EDUCATIONAL EXPANSION IN POST-WORLD WAR II AND THE DIABETES EPIDEMIC: THE RELATIONSHIP BETWEEN EDUCATION AND TYPE 2 DIABETES MORBIDITY DECOMPOSING CHANGE FOR COHORTS BORN BETWEEN 1935-1954
Open Access
- Author:
- Hernandez, Erik Liet
- Graduate Program:
- Sociology
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- April 16, 2020
- Committee Members:
- David P Baker, Dissertation Advisor/Co-Advisor
David P Baker, Committee Chair/Co-Chair
Melissa Hardy, Committee Member
Maryellen Schaub, Outside Member
John D Iceland, Committee Member
Jennifer Lynne Van Hook, Program Head/Chair - Keywords:
- Education Expansion
Diabetes
Morbidity
Cohort Analysis
Decomposition
Demography
Chronic Disease - Abstract:
- We know that during the Epidemiological Transition (ET), countries experience large shifts in morbidity and mortality. Within ET, sudden and stark increases in population growth occur with mortality decline, as well as a releveling of population growth with fertility decline. With regards to health, morbidity and mortality from infectious diseases declines and morbidity and mortality for chronic disease increase. The increasing prevalence of chronic diseases is associated with increasing changes in food consumption, types of work, and lifestyles. These include increasing obesity, tobacco use, sedentary occupations, and other factors. Type 2 diabetes is a highly prevalent chronic disease in the United States, as well as a leading cause of death and linked to multiple complications. Rapid expansion of diabetes prevalence in the United States is associated with the ET, and forecast projections are bleak. Boyle et al. (2010) estimate that by 2050, approximately one-quarter of the adult US population will be diagnosed with diabetes. In tandem with this expanding chronic disease—and diabetes—prevalence in the United States is the expansion of mass education. In the aftermath of World War II, the G.I. Bill and other social and economic changes brought a rapid expansion in education and large increases in college enrollment and in the proportion of persons completing at least a bachelor degree. Graduating from high school--and especially college--not only became more common, but also viewed as a marker of individual success The paradox is that while both diabetes prevalence and educational attainment have expanded in the United States, there is also an inverse relationship between educational attainment and diabetes. It is well established that persons with higher levels of education are at lower risk of being diagnosed with diabetes than their less educated counterparts. This begs the question, why has diabetes prevalence expanded despite increases in educational attainment? Little research has analyzed the social context of education expansion with diabetes disparities. It is unclear whether the relationship between educational attainment and diabetes has changed across cohorts, or the compositional effect of increasing education in a population. Two types of analyses are conducted on four cohorts (ages 60-64 and born between 1935-1954) collected from 20 years of the National Health Interview Survey. The first set involves logit regression analysis predicting the odds of having ever been diagnosed with diabetes at age 15 or older, including the main independent variable (education) and population composition variables (gender, race-ethnicity, marital status, and region). The second set of analyses involves using the Fairlie (nonlinear) Decomposition procedure estimating the effect of the educational composition on the change in diabetes rate across cohorts controlling for population composition. The results indicate educational expansion acted to limit diabetes growth. The magnitude of the educational gradient did not change, but the compositional effect on diabetes change of the educational expansion was substantially and statistically significant from one cohort to the next across all cohorts. Namely, without educational expansion to limit diabetes growth, there would be approximately an additional million persons ages 60-64 born in 1950-54 diagnosed with diabetes.