Abstract
BackgroundMaterial and behavioural factors play an important role in explaining educational inequalities in mortality, but gender differences in these contributions have received little attention thus far. We examined the contribution of a range of possible mediators to relative educational inequalities in mortality for men and women separately.MethodsBaseline data (1991) of men and women aged 25 to 74 years participating in the prospective Dutch GLOBE study were linked to almost 23 years of mortality follow-up from Dutch registry data (6099 men and 6935 women). Cox proportional hazard models were used to calculate hazard ratios with 95% confidence intervals, and to investigate the contribution of material (financial difficulties, housing tenure, health insurance), employment-related (type of employment, occupational class of the breadwinner), behavioural (alcohol consumption, smoking, leisure and sports physical activity, body mass index) and family-related factors (marital status, living arrangement, number of children) to educational inequalities in all-cause and cause-specific mortality, i.e. mortality from cancer, cardiovascular disease, other diseases and external causes.ResultsEducational gradients in mortality were found for both men and women. All factors together explained 62% of educational inequalities in mortality for lowest educated men, and 71% for lowest educated women. Yet, type of employment contributed substantially more to the explanation of educational inequalities in all-cause mortality for men (29%) than for women (− 7%), whereas the breadwinner’s occupational class contributed more for women (41%) than for men (7%). Material factors and employment-related factors contributed more to inequalities in mortality from cardiovascular disease for men than for women, but they explained more of the inequalities in cancer mortality for women than for men.ConclusionsGender differences in the contribution of employment-related factors to the explanation of educational inequalities in all-cause mortality were found, but not of material, behavioural or family-related factors. A full understanding of educational inequalities in mortality benefits from a gender perspective, particularly when considering employment-related factors.
Highlights
Material and behavioural factors play an important role in explaining educational inequalities in mortality, but gender differences in these contributions have received little attention far
Whereas an inverse educational gradient in mortality was found for men, reasonably similar hazard ratios were found at all three lower levels of education for women
Distribution of explanatory factors by educational level Inverse educational gradients were found for all material and employment-related factors, but noticeable differences were found in the size of these gradients between men and women (Table 1)
Summary
Material and behavioural factors play an important role in explaining educational inequalities in mortality, but gender differences in these contributions have received little attention far. Absolute mortality differences by education are generally larger for men than for women, but gender differences in relative mortality differences by education are less clear [13, 14]. These findings suggest that explanations for the educational gradient may differ for men and women, an issue that hardly received attention far. Two mechanisms may explain why material and behavioural factors contribute differently to the explanation of educational inequalities in mortality between men and women. Unemployment is more strongly related to mortality for men than for women, which may be the result of employment status being more central to men’s identities than to women’s [17]
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