Attending an Historically Black College or University and all-cause mortality in US Black adults

Abstract Recent studies suggest that attending a Historically Black College or University (HBCU) versus attending a Predominantly White Institution (PWI) may improve later-life health outcomes for Black adults. No studies have evaluated differences in all-cause mortality. The REGARDS prospective study recruited US adults aged 45 and older during 2003-2007. Black college-goers who attended high school in a state with an HBCU (n = 1960) were classified as ever attending an HBCU or only a PWI (reference). Cox proportional hazards models estimated adjusted mortality ratios (2012–2023) and effect modification by being college-aged before 1955 (during legal racial segregation), 1955-1964 (before the Civil Rights Act), or after 1964. Mean age was 62 years (SD ± 8.2) and 35% attended an HBCU. HBCU versus PWI attendees had negligibly lower all-cause mortality and estimates were imprecise (HR 0.99; CI 0.88, 1.12). Although confidence intervals were wide, those college-aged during 1955-1964 had lower mortality (HR 0.87; CI 0.71, 1.06) but elevated mortality for those college-aged before 1955 (HR 1.03; CI 0.85, 1.24) and after 1964 (HR 1.46; CI 0.91, 2.33). Inconsistent with prior work, we found little evidence that HBCU attendance was associated with lower mortality yet could not rule out substantial protective or harmful effect modification by college-aged years.