Abstract
BackgroundInvesting in offspring's human capital has been suggested as an effective strategy for parents to improve their living conditions at older ages. A few studies have assessed the role of children's schooling in parental survival in high-income countries, but none have considered lower-resource settings with limited public wealth transfers and high adult mortality. MethodsWe followed 17,789 parents between January 2003 and August 2015 in a large population-based open cohort in rural KwaZulu-Natal, South Africa. We used Cox proportional hazards models to investigate the association between offspring's schooling and time to parental death. We assessed the association separately by parental sex and for four cause of death groups. ResultsA one year increase in offspring's schooling attainment was associated with a 5% decline in the hazard of maternal death (adjusted Hazard Ratio [aHR]: 0.95, 95%CI: 0.94–0.97) and a 6% decline in the hazard of paternal death (aHR: 0.94, 95%CI: 0.92–0.96), adjusting for a wide range of demographic and socio-economic variables of the parent and their children. Among mothers, the association was strongest for communicable, maternal, perinatal and nutritional conditions (aHR: 0.87, 95%CI: 0.82–0.92) and AIDS and tuberculosis (aHR: 0.92, 95%CI: 0.89–0.96), and weakest for injuries. Among fathers, the association was strongest for injuries (aHR: 0.87, 95%CI: 0.79–0.95) and AIDS and tuberculosis (aHR: 0.92, 95%CI: 0.89–0.96), and weakest for non-communicable diseases. ConclusionHigher levels of schooling in offspring are associated with increased parental survival in rural South Africa, particularly for mothers at risk of communicable disease mortality and fathers at risk of injury mortality. Offspring's human capital may be an important factor for health disparities, particularly in lower-resource settings.
Highlights
Since 2000, the Africa Centre for Population Health has collected longitudinal demographic, social, and economic data on over 100,000 people living in a 432 km2 demographic surveillance area (DSA) in uMkhanyakude District, in northern KwaZulu Natal (KZN)
Prior to the roll-out of public-sector antiretroviral therapy (ART), adult life expectancy in the DSA was 49.2 (Bor et al, 2013) with over half of the population deaths attributed to HIV (Herbst et al, 2011)
Median highest years of schooling among offspring was substantially larger than the schooling attainment of their parents (12 [IQR: 10e12] for offspring of both mothers and fathers)
Summary
Given the strong empirical relationship between schooling and socioeconomic status, investing in their children's human capital may be one of the most effective strategies for parents to improve their living conditions at older ages. This may be the case in settings where public wealth transfers are limited and children play a more prominent role in supporting older generations. Conclusion: Higher levels of schooling in offspring are associated with increased parental survival in rural South Africa, for mothers at risk of communicable disease mortality and fathers at risk of injury mortality. Offspring's human capital may be an important factor for health disparities, in lower-resource settings
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