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A tuition-free college education has become a reality in places like New York, San Francisco and other areas nationwide — a deal that may also bestow a longer, healthier life to graduates.

Federal statistics show that, on average, 25-year-olds with a bachelor’s degree live about nine years longer than those who didn’t graduate from high school. College graduates are also healthier, with lower rates of obesity and smoking compared to high school dropouts, according to the Centers for Disease Control and Prevention.

Education is a big factor behind the decisions people make, including lifestyle choices, said Yasuhiko Kubota, M.D., who led a recent study that found the more education a person has, the less likely they are to develop heart disease or have a stroke.

“How people behave can be affected largely by education during their childhood and young adulthood,” said Kubota, a former cardiovascular surgeon who is now a researcher at the Osaka Center for Cancer and Cardiovascular Disease Prevention in Japan.

In the study, published in JAMA Internal Medicine, the lifetime risk of cardiovascular disease was 55 percent among those with a grade school education compared to 36 percent for those who attended graduate school. With more education comes a better job and a higher salary, Kubota said, but even after researchers accounted for those factors, more diplomas still resulted in a lower risk.

The study is among dozens to look at the relationship between educational attainment and health in the United States. For many Americans, college is a prohibitively expensive prospect. Only about a third of U.S. adults have a college degree, according to the U.S. Census Bureau.

Experts say initiatives to make college more affordable to more people could help future generations. But education-related disparities must also be tackled in the doctor’s office, said Jennifer Karas Montez, Ph.D., an assistant professor of sociology in the Maxwell School of Citizenship and Public Affairs at Syracuse University who researches social determinants of health, women’s health and mortality.

Doctors should know patients’ education level, said Karas Montez, who was not involved in the recent study.

“The best treatment in the world is not going to be effective if the person doesn’t understand it and if their life circumstances prevent them from following through on it,” she said.

But federal, state and local education agencies must also dedicate more funding to provide quality education for young Americans, Karas Montez said.

“The beauty of it is that we can change it, right? You can’t change your age, you can change your education.”

Heart disease is the No. 1 killer of Americans and stroke is No. 5. Data from the CDC appear to back up what researchers are finding: People without a high school diploma — roughly 28 million U.S. adults — are disproportionately affected by these top killers.

Nearly 14 percent of Americans with heart disease did not graduate high school. By comparison, 11.5 percent of heart disease patients have at least some college education, according to the CDC.

“Education shapes health and mortality,” said Karas Montez. “If I had to pick three pieces of information about somebody and predict their life expectancy, I would want to know age, sex and education level. It’s that important.”