Characteristics of the Educational Setting and Self-rated Health at Age 40 in the USA

INTRODUCTION:   Educational is a key social determinant of health; it is strongly associated with morbidity and mortality. Specifically, Americans who attained more education rate their overall health as better. The educational experience, though, includes not only educational attainment but also the educational setting. Less is known about the contributions of the school setting, which we seek to elucidate here. 

METHODS:   We used the USA National Longitudinal Survey of Youth 1979 cohort, which followed a nationally representative sample of individuals from adolescence through adulthood (n=7354). School staff reported high school characteristics (e.g., student demographics, student-teacher ratio, drop-out rate). At age 40, participants rated their health as excellent, very good, good, fair, or poor.  We calculated odds ratios using ordered logistic regression, adjusting for race/ethnicity, gender, childhood geography, and parental socioeconomic position, and accounting for sampling design with survey weights.

RESULTS:   For each five percentage point increase in the proportion of the high school student body classified as disadvantaged, individuals had a lower ordered odds of better health at age 40 after adjusting for confounders (OR=0.97, 95%CI: 0.96, 0.99). Student-teacher ratio (OR=0.99, 95%CI: 0.99, 1.00), student racial/ethnic composition (OR=1.00, 95%CI: 1.00, 1.00), and high school dropout proportion (OR=1.00, 95%CI: 1.00, 1.00) were not associated with self-rated health. 

CONCLUSIONS:   In general, high school characteristics are weakly associated with self-rated health at age 40, and only proportion of students who were disadvantaged was statistically significant. American education policymakers already prioritize schools with large proportions of disadvantaged students for funding through Title I; this research suggests that health policymakers may want to as well. As we seek to better understand the nuances of education as a health determinant, future researchers should examine if findings are similar for health outcomes assessed earlier in the life course or for other measures of the high school experience.