Educational Differences In Health Research Articles

Education and health over the life cycle

There is little theoretical and empirical research on the effects of education on health over the life cycle. In this article, we extend the Grossman (1972) model of the demand for health and use the extended model to analyze the effect of education on health at different ages. The main conclusion from our model is that it is unlikely that the relationship between education and health will be constant over the life cycle and that education is likely to have little effect on health at younger ages when there is little depreciation of the health stock. We also present an extensive empirical analysis documenting the association between education and health over the life cycle. Results of our analysis suggest that in terms of mortality, education has little effect until age 60, but then lowers the hazard rate of death. For measures of morbidity, education has an effect at most ages between 45 and 60, but after age 60 has apparently little effect most likely due to selective mortality. In addition, most of the apparent beneficial effect of education stems from obtaining a high school degree or more. It is the health and mortality of lowest education group—those with less than a high school degree—that diverges from the health and mortality of other education groups. Finally, we find that the educational differences in health have become larger for more recent birth cohorts.

Macro-level determinants of post-retirement health and health inequalities: A multilevel analysis of 18 European countries

Poor health after retirement may have an important economic and societal impact and may be affected by macro-level factors. Our aim was to examine whether macro-level factors are associated with health and educational differences in health in recent retirees. We used data covering 18 European countries from the Survey on Health, Ageing and Retirement in Europe (SHARE) and the English Longitudinal Study of Ageing (ELSA) on 8867 respondents who had been retired less than 5 years. We performed multi-level linear regression analyses to examine whether social expenditure in nine policy areas, minimum pension replacement rates, and unemployment replacement rates explained cross-country differences in post-retirement self-rated health (SRH) and educational inequalities in SRH. In both men and women, a higher total expenditure as well as higher expenditures on health, old age, housing, and ‘other social policy areas’ (non-categorical cash benefits to low-income households and other social services) were associated with better SRH. Cross-level interactions showed that in the presence of a higher old age expenditure, a higher unemployment expenditure, and a higher total expenditure, the absolute educational inequalities in post-retirement SRH were smaller than with lower expenditures in these areas, in both men and women. We found the same effect in women only for a higher expenditure on health as well as a higher minimum pension replacement rate. A higher expenditure on survivors pensions, a lower expenditure on family, and a higher unemployment replacement rate had this effect in men only. This study showed that social expenditure and replacement rates were associated with post-retirement health and health inequalities.

Intergenerational Educational Pathways and Self-Rated Health in Adolescence and Young Adulthood: Results of the German KiGGS Cohort.

Health differences in social mobility are often analysed by income differences or different occupational positions. However, in early adulthood many young people still have very diffuse income situations and are not always fully integrated into the labour market despite many having finished school. This article focusses on the link between intergenerational educational pathways and self-rated health (SRH) among young adults considering their SRH in adolescence. The data source used is the German KiGGS cohort study. The analysis sample comprises 2175 young people at baseline (t0: 2003–2006 age 14–17) and first follow-up (t1: 2009–2012 age 19–24). Combining parent’s and young people’s highest school degree, the data can trace patterns of intergenerational educational pathways (constant high level of education, upward mobility, downward mobility, constant low level of education). Young people’s SRH was recorded at t0 and t1. During adolescence and young adulthood, participants were less likely to report poor SRH if they had a constant high intergenerational education or if they were upwardly mobile. The differences were particularly striking among young adults: average marginal effects (AME) for poor SRH showed much higher risk among downwardly mobile compared to peers with an intergenerational constant high education (AME: 0.175 [0.099; 0.251]), while the upwardly mobile had a significantly lower risk for less than good SRH than peers with an intergenerational constant low level of education (AME: −0.058 [−0.113; −0.004]). In the context of great societal demands and personal developmental needs, educational differences in health tend to increase in young adulthood. Public Health should pay more attention to educational and health inequalities in young adulthood.

Educational Differences in Health Among Middle-Aged and Older Adults in Brazil and Mexico.

This study examines educational differences in health conditions among middle-aged and older adults in Brazil and Mexico. Cross-sectional data from the 2013 Brazilian National Health Survey and the 2012 Mexican National Health and Nutrition Survey were used in the analyses. We used multivariate Poisson regressions to examine the relationship between educational level and prevalence of common health conditions (obesity, abdominal obesity, diabetes, hypertension, heart disease, and hearing and visual impairments). Socioeconomic and sex inequalities persist in both countries. In general, low levels of education were associated with higher risk for having health conditions. However, men of lower education had a smaller risk of abdominal obesity and hypertension. Brazil and Mexico have expanded public health actions aimed at improving health behaviors, diagnosis, and access to treatment of chronic conditions. However, important social disparities remain. Improving lifestyle behaviors, such as physical activity and dietary habits, could benefit both countries.

Decomposing the effect of social policies on population health and inequalities: an empirical example of unemployment benefits.

The purpose of this study is to discuss and empirically contrast different conceptualizations and operationalizations of social policies in analysing health and educational differences in health cross-nationally. Country-level institutional and expenditure data on unemployment benefit schemes and individual-level data from the EU-SILC for 23 countries were used to analyse the association between unemployment benefits and self-assessed health for individuals with different educational attainment. The analyses indicate that higher coverage rate (i.e. the proportion of the relevant population eligible for benefits) is associated with better self-related health among both low- and high-educated individuals, but is not linked to smaller educational differences in health. In contrast, replacement rate (i.e. the amount of benefits received) in isolation is not related to self-assessed health. However, in countries where coverage rates are high, higher replacement rates are associated with better health among both low- and high-educated individuals and smaller educational differences in health. Decomposing unemployment benefit programmes into two main dimensions--the proportion in the labour force covered by such programmes and the replacement rate received in case of unemployment--may present further insights into institutional mechanisms linking macro-level social policies to individual-level health outcomes.

Self-rated literacy level does not explain educational differences in health and disease.

BackgroundAlthough literacy is increasingly considered to play a role in socioeconomic inequalities in health, its contribution to the explanation of educational differences in health has remained unexplored. The aim of this study was to investigate the contribution of self-rated literacy to educational differences in health.MethodsData was collected from the Healthy Foundation and Lifestyle Segmentation Dataset (n = 4257). Self-rated literacy was estimated by individuals’ self-reported confidence in reading written English. We used logistic regression analyses to assess the association between educational level and health (long term conditions and self-rated health). Self-rated literacy and other potential explanatory variables were separately added to each model. For each added variable we calculated the percentage change in odds ratio to assess the contribution to the explanation of educational differences in health.ResultsPeople with lower educational attainment level were more likely to report a long term condition (OR 2.04, CI 1.80-2.32). These educational differences could mostly be explained by age (OR decreased by 27%) and could only minimally be explained by self-rated literacy, as measured by self-rated reading skills (OR decreased by 1%). Literacy could not explain differences in cardiovascular condition or diabetes, and only minimally contributed to mental health problems and depression (OR decreased by 5%). The odds of rating ones own health more negatively was higher for people with a low educational level compared to those with a higher educational level (OR 1.83, CI 1.59-2.010), self-rated literacy decreased the OR by 7%.ConclusionMeasuring self-rated reading skills does not contribute significantly to the explanation of educational differences in health and disease. Further research should aim for the development of objective generic and specific instruments to measure health literacy skills in the context of health care, disease prevention and health promotion. Such instruments are not only important in the explanation of educational differences in health and disease, but can also be used to identify a group at risk of poorer health through low basic skills, enabling health services and health information to be targeted at those with greater need.

The contribution of childhood circumstances, current circumstances and health behaviour to educational health differences in early adulthood.

BackgroundThe life course approach emphasises the contribution of circumstances in childhood and youth to adult health inequalities. However, there is still a lot to know of the contribution of living conditions in childhood and youth to adult health inequalities and how later environmental and behavioural factors are connected with the effects of earlier circumstances. This study aims to assess a) how much childhood circumstances, current circumstances and health behaviour contribute to educational health differences and b) to which extent the effect of childhood circumstances on educational health differences is shared with the effects of later living conditions and health behaviour in young adults.MethodsThe data derived from the Health 2000 Survey represent the Finnish young adults aged 18–29 in 2000. The analyses were carried out on 68% (n = 1282) of the sample (N = 1894). The cross-sectional data based on interviews and questionnaires include retrospective information on childhood circumstances. The outcome measure was poor self-rated health.ResultsPoor self-rated health was much more common among subjects with primary education only than among those in the highest educational category (OR 4.69, 95% CI 2.63 to 8.62). Childhood circumstances contributed substantially (24%) to the health differences between these educational groups. Nearly two thirds (63%) of this contribution was shared with behavioural factors adopted by early adulthood, and 17% with current circumstances. Health behaviours, smoking especially, were strongly contributed to educational health differences.ConclusionTo develop means for avoiding undesirable trajectories along which poor health and health differences develop, it is necessary to understand the pathways to health inequalities and know how to improve the living conditions of families with children.

Are Educational Differences in U.S. Self-Rated Health Increasing?: An Examination by Gender and Race

Recent literature has documented changes in educational differences in health over recent time periods, across the life course, and by gender and race. We unite previous literature regarding period, age, gender, and race variations in educational health differences by examining how trends in educational differences in self-rated health have unfolded from 1982 to 2003 and whether or not such trends vary across gender and race groups. We use 22 years of pooled repeated cross-sectional data from the National Health Interview Survey to examine these trends among U.S. adults aged 35–79. Consistent with recent literature, we find a trend toward widening gaps in self-rated health by educational level in recent years for middle-aged and older adults but relatively stable or even slightly narrowing gaps in recent years for younger adults. All of these changes are in the context of generally improving health across this time period, particularly for persons with a college education. Moreover, we find that these trends differ to some degree by race and gender, with young adult black women being the only group among whom educational differences in health are converging. Our findings point to the continued need to address educational health disparities in the United States, which are increasing for most demographic subgroups despite the national goal of their elimination.

Neuroticism, Education and Self-Assessed Health in the General Population of the United States. Can Smoking Behaviour Explain the Associations?

In this study we investigate the interrelation between neuroticism, education, smoking and health. Two lines of research are brought together: one studying the relationship between neuroticism and health and the other studying the association between education and health. As lower educated people more often score high on neuroticism, we study the relationships of education and neuroticism with health simultaneously. Moreover, we hypothesize that smoking behaviour is a common explanatory factor in these associations. A 1996 US general population sample is employed to test the hypotheses. The associations between education and neuroticism on the one hand and self-assessed health on the other hand proved to be substantially smaller when education and neuroticism are mutually controlled for. Yet, the hypothesis that smoking behaviour provides an explanation for educational differences in health was only supported for men.

Current and lifetime exposure to working conditions. Do they explain educational differences in subjective health?

Previous research has shown that the association between education and health is partly mediated by working conditions. So far, most studies fail to take into account working careers and instead focus on working conditions at one point in time. This study examines the extent to which current and lifetime exposure to working conditions differ between educational groups, and whether taking into account lifetime exposure rather than current exposure improves our understanding of educational differences in health. A representative sample of the Dutch population ( n = 1561 ) with retrospective information about working careers shows that lower educated men are significantly more exposed to adverse working conditions than higher educated men. These differences increase over the life course. Among women there are relatively small educational differences in exposure. Lifetime exposure to adverse working conditions explains a significant part (a third) of the health differences between the highest and lowest educated men. Moreover, measurements of lifetime exposure to working conditions offer a better explanation for educational differences in health than measurements of current exposure. Among women, only relative lifetime exposure to working conditions can explain a small part of the educational differences in health, while current and absolute lifetime exposure do not explain these differences.

Current or lifetime smoking? Consequences for explaining educational inequalities in self-reported health

Background. Studies explaining educational differences in health often employ current smoking as a mediator. To what extent does lifetime smoking mediate the association between education and self-reported health better than current smoking? Methods. Analysis of cross-sectional data from a representative general population sample of Dutch men and women ( n = 1,561) with complete retrospective smoking histories. Results. Educational differences in smoking over the life course are more pronounced than educational differences in current smoking, especially among men. The association between education and self-reported health is reduced when controlling for smoking for men. Among women, smoking is not such a mediator. The odds ratio for men with primary education to report less than good health is reduced from 2.94 (95% CI: 1.20–6.30) to 2.62 (95% CI: 1.13–6.05) when current smoking is taken into account and to 2.14 (95% CI: 0.90–5.04) when lifetime smoking is controlled for. This reduction in the difference between the highest and lowest educated is approximately 30% and statistically significant. For women, reductions are smaller and non-significant. Conclusions. Educational differences in smoking among men are underestimated if current instead of lifetime smoking is studied. Consequently, the contribution of smoking to bringing about social inequalities in health is underestimated if current smoking is measured.

Structural changes and social inequalities in health in Finland, 1986- 1994

This paper seeks to examine changes in health inequalities in Finland from the mid-1980s to the mid-1990s. To improve our understanding of the contribution of employment status changes to class and educational differences in health within the context of changing labour market conditions, we examined the differences in ill health among social classes, educational groups, and employment status groups. The data was derived from nation-wide Finnish Surveys on Living Conditions from 1986 and 1994. Analyses included the age range 25-64 years. Health was measured using limiting long-standing illness and perceived health as below good. Results are presented as age-standardized prevalence percentages and odds ratios from logistic regression analyses. The pattern and size of relative social inequalities in ill health have remained generally stable during the eight-year study period in Finland. Differences between social classes have changed only slightly. Differences between educational groups have declined somewhat among men, but have remained stable among women. Compared with the employed, health among the unemployed, housewives, and pensioners has improved for both men and women. Analysing social class differences within both the employed and the non-employed showed only negligible changes. Changes in social inequalities in health as indicated by class and educational differentials among Finnish men and women have mostly been negligible. The observed changes are likely to have been affected by the 1990s' labour market crisis in Finland. The rapidly increasing mass unemployment is unlikely to have been very individually selective in the short run. However, in the longer run, to the extent that unemployment remains high, this trend can be expected to change as re-entry to paid employment is likely to be more individually selective.

Educational differences in self-rated health during the Russian transition. Evidence from Taganrog 1993–1994

In the beginning of 1992, in order to do away with the ruins of the old communist system once and for all, radical economic reforms — ‘shock therapy’ — were introduced in Russia. However, there are winners and losers in the Russian transition from communism to market economy and democracy. The aim of the study is to investigate whether there are educational differences in self-rated health among the citizens of Taganrog in 1993–94. If there are indeed differences, the second aim is to investigate whether they can be explained by variations in specific social, economic and psychological circumstances, which are known to be affected by the present social and economic transformation in Russia. The analysed survey was carried out in a middle-sized Russian city, Taganrog, in late 1993 and early 1994. It was conducted by means of face-to-face interviews, with a sampling frame consisting of dwellings selected from an official register and stratified by type and size. The analysed sample consists of 2372 respondents, aged 25–54 years, in 1414 households. Data were analysed in logistic regressions with self-rated health as a dichotomised outcome variable. The results show that those with less than compulsory education reported poor health twice as often as the highest-educated group. Material prosperity and relations within the family were important for self-rated health and explained to a certain degree the educational health differences. Lower educational groups now live under conditions often characterised by economic hardship, family conflicts, etc., and consequently also poor health.

Health related lifestyle in adolescence predicts adult educational level: a longitudinal study from Finland.

OBJECTIVE: To assess the relative importance of perceived health and health related lifestyle in adolescence in the production of educational differences. DESIGN: A longitudinal study: survey data from 1981 and...