Health Disparities
Is Early Childhood Education Quality Associated with Risk of Diabetes Mortality in a Racially Diverse Cohort of Autoworkers? Jess Arbuckle* Jess Arbuckle Arbuckle Arbuckle Arbuckle UC Berkeley Public Health- Epidemiology
Diabetes is the 7th leading cause of death in the United States, and Black adults experience disproportionately higher rates of Type 2 Diabetes Mellitus (T2DM) mortality compared to White adults. While educational attainment is known to influence chronic disease risk, few studies have examined educational quality, and none have focused on educational quality in relation to T2DM in a population that includes Black adults. We assessed the association between the quality of early childhood education and T2DM mortality in an occupational cohort of Black and White unionized Michigan autoworkers who have similar midlife blue-collar jobs with similar access to healthcare. We also examined effect modification by race. The United Autoworkers-General Motors (UAW-GM) cohort includes workers employed for at least three years at three plants in Michigan and followed from 1941 to 2015. The analytic sub-cohort consists of 3,216 male autoworkers born 1920 to 1940, who died before 2007 and could be linked to the 1940 U.S. Census. Using the Census, we examined three county-level measures of early childhood educational quality: student–teacher ratio, % children aged 6-14 enrolled, and % teachers with college education. Cox proportional hazards models were fit to estimate hazard ratios (HR) and 95% confidence intervals (CI), adjusting for race, urban/rural, farm living, North/South, and parental education. Results suggest that of the three education quality measures, only % enrolled provided any protection against T2DM mortality; compared to the lowest category in pooled analysis, the HR was 0.79 (95%CI:0.51-1.21) and 0.53 (95%CI: 0.30-0.95) in the middle and high categories, respectively. There was little evidence of effect modification, although average educational quality of all three measures was higher among White autoworkers. Future studies will examine how work characteristics may mask benefits associated with structural advantages, such as better childhood educational quality.