Abstract
BackgroundAlthough the educational expansion is often seen as a mechanism that might reduce health inequalities, socioeconomic inequalities in health (SEIH) have persisted or increased over the past decades. Theories suggest that this persistence could be due to a changing role of education as a ‘gatekeeper’ to access other socioeconomic resources such as occupation and income that are also associated with health outcomes. To test this, we examine whether the mediating role of occupation and income in the education–health relationship differs between three cohorts of 55–64 year old adults.MethodsWe used cross-sectional data from three cohorts of 988, 1002, and 1023 adults born in 1928/37, 1938/47 and 1948/57 and observed in 1992/93, 2002/03, 2012/13 respectively, who participated in the Longitudinal Aging Study Amsterdam, the Netherlands. We used multigroup structural equation modelling to compare the strength of indirect effects of education via occupational skill level and income to functional limitations and depressive symptoms between cohorts.ResultsAbsolute educational inequalities in functional limitations increased for men and women in later cohorts, and in depressive symptoms only for men. Relative inequalities in functional limitations increased only for women and in depressive symptoms only for men. The indirect effect of education via income on both health outcomes was weaker in the most recent birth cohort compared to the earlier cohorts. In contrast, the indirect effect of education via occupation on functional limitations was stronger in the most recent cohort compared to the earlier cohorts. These differences were mainly due to a decreasing direct effect of education on income and an increasing direct effect of education on occupational skill level, rather than to changes in the direct effects of occupation and income on health.ConclusionsThe role of education in determining inequalities in health appears to have changed across cohorts. While education became a less important determinant of income, it became a more important determinant of occupational level. This changing role of education in producing health inequalities should be considered in research and policy.
Highlights
The educational expansion is often seen as a mechanism that might reduce health inequalities, socioeconomic inequalities in health (SEIH) have persisted or increased over the past decades
This study investigated differences between three birth cohorts of young-old adults born between 1928–1937, 1938–1947 and 1948–1957 in the mediating role of occupation and income in the education–health relationship
Following Fundamental cause theory (FCT), we argue that education, in our study, functions as a fundamental cause of disease as it remained stable across cohorts
Summary
The educational expansion is often seen as a mechanism that might reduce health inequalities, socioeconomic inequalities in health (SEIH) have persisted or increased over the past decades. The fact that relatively many people achieved a high educational level in recent birth cohorts may have changed the way in which lower and higher educated individuals compete for jobs and gain access to higher wages [4]. This raises the question whether these changes have implications for health inequalities; whether the direct effects and indirect effects of education (via occupation and income) on health have changed over time. We examine to what extent potential changes in these indirect effects are due to changes in the direct effects of education on occupation and income and to changes in the direct effects of the socioeconomic indicators on health
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