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Annals of Epidemiology



Attaining a degree may offer greater opportunities for health than years of schooling alone. This study examines whether there is a degree, or “sheepskin”, effect on the association between education and blood pressure.


Multivariable-adjusted ordinal and linear regression models assessed associations of years of schooling and degree attainment with systolic and diastolic blood pressure in a sample of 552 adults aged 38–47 years.


Years of schooling was inversely associated with systolic blood pressure adjusting for age, gender and race (β=−0.4, 95% CL:−0.7,−0.1 mmHg systolic blood pressure/year of schooling). Additional adjustment for mother’s education, childhood verbal intelligence quotient, childhood health and childhood socioeconomic status had minimal impact on effect size (β= −0.3, 95% CI=−0.7,0.0). However, years of schooling was no longer associated with blood pressure in the fully adjusted model which included additional adjustment for degree attained (β=0.0, 95% CL:−0.5, 0.4). In the fully adjusted model (including adjustment for years of schooling), individuals with a graduate degree still had significantly lower systolic blood pressure than HS degree-holders (e.g. β=−9.2, 95% CL:−15.2,−3.2 for graduate vs. high school degree). Findings were similar for diastolic blood pressure.


The association of years of schooling with blood pressure may be largely due to degree attainment rather than simply the knowledge and skills accumulated due to years of schooling alone.


doi: 10.1016/j.annepidem.2010.11.004

Published Citation

Liu SY, Buka SL, Linkletter CD, Kawachi I, Kubzansky L, Loucks EB. The association between blood pressure and years of schooling versus educational credentials: test of the sheepskin effect. Ann Epidemiol. 2011;21(2):128–138. doi:10.1016/j.annepidem.2010.11.004

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