Education Expands the Gender Gap in Blood Pressure in China: Evidence from a Comparative Analysis of Birth Cohorts
China has witnessed a greater increase in blood pressure across successive birth cohorts, especially among men, suggesting a widening gender gap in cardiovascular risk profiles. The expanded access to education since the mid-20th century and its differential impact on men’s and women’s cardiovascular health suggest that education may play an important role in this widening gender gap—a topic that remains under-explored. This study assessed the mediating effect of education years in the association between birth cohorts and systolic/diastolic blood pressure and examined whether this mediating effect varied by gender. Data from the China Health and Nutrition Survey (1991–2015) were analyzed using multilevel moderated mediation analysis among adults born between 1950 and 1975. Our estimates indicated that (1) education years had a greater increase among women across cohorts. (2) Higher education years were associated with lower systolic/diastolic blood pressure in women, whereas men did not exhibit similar benefits. (3) Consequently, education years mediated the association between cohorts and systolic/diastolic blood pressure differently by gender. More specifically, improving education years curbed the upward cohort trend in systolic/diastolic blood pressure among women but not among men. Education partially accounts for the widening gender gap in systolic/diastolic blood pressure across cohorts in China. Ensuring educational opportunities could potentially improve cardiovascular health for women. Factors that hinder men from achieving comparable cardiovascular health benefits from increased education years warrant further research.
Authors
- JV Zhao
- Jinjing Wu (ORCID: https://orcid.org/0000-0003-4678-0869)
- Boshen Jiao (ORCID: https://orcid.org/0000-0001-7483-2115)
- Ruiyun Li
- Jie Ma
Institutions
- Shanghai University (CN)
- University of Southern California (US)
- Australian National University (AU)
- Nanjing University of Science and Technology (CN)
- Nanjing Medical University (CN)
- Nanjing University (CN)
Publication Details
- Journal
- Journal of Epidemiology and Global Health
- Published
- 2026-03-11
- DOI
- https://doi.org/10.1007/s44197-026-00516-z
- Primary Topic
- Birth, Development, and Health
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- National Institute for Nutrition and Health
- National Institutes of Health
- China-Japan Friendship Hospital
- National Institute on Aging
- Fogarty International Center
- National Institute of Diabetes and Digestive and Kidney Diseases
- National Institute of Child Health and Human Development
- Eunice Kennedy Shriver National Institute of Child Health and Human Development