Mediators of the Association Between Child Education and Adult Health.

IMPORTANCE: Educational attainment is a key social determinant of cardiometabolic disease in adulthood, yet knowledge about the pathways through which educational experiences in childhood may shape cardiometabolic health is limited. OBJECTIVE: To explore whether associations between educational experiences in childhood and cardiometabolic health in adulthood are mediated by adult socioeconomic status and health behaviors. DESIGN, SETTING, AND PARTICIPANTS: Participants were from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development (SECCYD), a birth cohort (1991-2009) recruited to participate in a 30-year assessment (ages 26-31) between January 2018 and December 2022 focused on cardiometabolic health outcomes. EXPOSURES: Exposures were child educational indicators (student social competence, student-teacher relationship quality, classroom emotional and instructional quality, and academic achievement), and adult pathways were mediators (income, educational level, diet quality, activity level, sleep duration, and smoking status). MAIN OUTCOMES AND MEASURES: The primary outcome was a composite measure of metabolic syndrome, in which assessments of waist circumference, systolic and diastolic blood pressure, levels of hemoglobin A1c, C-reactive protein, and high-density lipoprotein were combined to form a single unit-standardized index of cardiometabolic risk (CMR). RESULTS: Among 700 participants (374 female [53.4%]; mean [SD] age, 28.6 [1.2] years; 70 [10.0%] Black, 45 [6.4%] Latino, 552 [78.9%] White, and 33 [4.7%] other), linear regression models supported the role of adult income and adult diet quality as mediators. Independent of covariates (sex, race and ethnicity, child body mass index percentile, and parental socioeconomic status), adult income mediated associations between indicators, including student social competence (b = -0.001; 95% CI, -0.002 to -0.0003; P = .02), student-teacher relationship quality (b = -0.002; 95% CI, -0.004 to -0.001; P = .02), classroom instructional quality (b = -0.012; 95% CI, -0.034 to -0.001; P = .06 for trend), and academic achievement (b = -0.001; 95% CI, -0.002 to -0.0004; P = .02), and adult CMR. Adult diet quality mediated associations between indicators, including student social competence (b = -0.002; 95% CI, -0.004 to -0.001; P < .001) and student-teacher relationship quality (b = -0.003; 95% CI, -0.005 to -0.001; P = .01), and adult CMR. Results for the other candidate mediators were nonsignificant. CONCLUSIONS AND RELEVANCE: In this birth cohort study, results showed that associations between educational experiences in childhood and cardiometabolic health in adulthood were mediated by adult income for 4 of 5 indicators and by adult diet for 2 of 5 indicators. This suggests that, across diverse educational experiences, long-term health benefits may be transmitted through having a higher adult income and a healthier adult diet. Findings offer a developmental framework for understanding the well-established education-health gradient, highlighting opportunities for early health promotion.