Associations of county-level school expenditure around time of birth and cardiovascular health in young adulthood

Background: Area-level investment in education may influence individual health. We evaluated whether county-level public school expenditure per student around time of birth was associated with cardiovascular health (CVH) in young adulthood. Methods: Among Future of Families and Child Wellbeing Study participants enrolled at birth and followed through year 22, we used multivariable linear regression to evaluate the associations of annual school expenditure per student in the county of residence at birth (low: z-score ≤ -0.5; intermediate: z-score -0.5 to 0.5; high: z-score ≥0.5) with cardiovascular risk factors and Life’s Essential 8 (LE8) scores at year 22, adjusting for sociodemographic characteristics. Results: Among 1089 participants (54% female), annual county-level expenditure per student was: low, $4020–6245; intermediate, $6317–7392; high, $7561–9902. By year 22, 9% of participants graduated college, 41% had some college education, and 39% graduated high school; mean LE8 score was 69 (SD 14). Compared with living in a high expenditure county at birth, living in a low expenditure county was associated with 7.5 mg/dL higher non-HDL-C (95% CI 2.9, 12.0) and 3.4-point lower LE8 cholesterol score (95% CI -6.6, -0.23) in young adulthood; and living in an intermediate expenditure county was associated with a 2.3-point lower LE8 glucose score in young adulthood (95% CI -4.6, -0.04). There was no significant difference in overall LE8 score. Conclusions: Living in a county with lower school expenditure per student around time of birth was associated some worse CVH factors in young adulthood. County-level school expenditure is likely a reflection of a county’s socioeconomic standing. Policies that increase funding for children’s education may improve CVH in young adulthood.