Educational Gradients In Mortality Research Articles

Educational inequality in cause-specific mortality among immigrants and their descendants in Sweden

Abstract Introduction Although immigrants in Western countries often face disadvantages and vulnerabilities such as lower socioeconomic status, they tend to exhibit weaker educational gradients in mortality compared to the native majority populations. However, it is unclear how these gradients vary across specific causes of death and whether they persist among second-generation immigrants. Therefore, this study aims to investigate educational inequalities in cause-specific mortality among first- and second-generation immigrants compared to the native ancestral population in Sweden. Data & Methods Individual-level analysis was conducted on Swedish register data from 2004 to 2016, including men and women aged 25 to 64. Poisson regression was used to examine the association between the highest educational degree attained and mortality due to circulatory diseases, neoplasms, external causes, self-harm, drug and alcohol use. Results The findings indicated that first-generation immigrants exhibited significantly lower educational inequality in all causes of death compared to native ancestral Swedes. In contrast, second-generation immigrants showed similar degrees of educational inequality in all-cause mortality and mortality due to neoplasms when compared to ancestral Swedes. However, they displayed more pronounced educational inequalities in mortality from external causes, self-harm, and drug use. Conclusions The results highlight that while first-generation immigrants experience lower educational inequality in the considered causes of death, second-generation immigrants show pronounced educational inequalities in avoidable causes of death. This study emphasizes the importance of considering heterogeneity in educational disparities in immigrant mortality and calls for policy interventions to address educational inequalities in second-generation immigrants. Key messages • When compared to the native majority population, first-generation immigrants in Sweden demonstrate lower educational inequality in mortality, regardless of the underlying cause. • Conversely, second-generation immigrants display larger educational inequalities, particularly for mortality caused by preventable factors.

Intergenerational educational trajectories and premature mortality from chronic diseases: A registry population-based study

The tracking of educational gradients in mortality across generations could create a long shadow of social inequality, but it remains understudied. We aimed to assess whether intergenerational educational trajectories shape inequalities in early premature mortality from chronic diseases. The study included 544 743 participants of the Swiss National Cohort, a registry population-based study. Individuals were born 1971–1980 and aged 10–19 at the start of the study (1990). Mortality follow-up was until 2018. Educational trajectories were High–High (reference), High–Low, Low–High, Low–Low, corresponding to the sequence of parental-individual attained education. Examined deaths were related to cardiovascular diseases (CVD), cancers, and substance use. Sex-specific inequalities in mortality were quantified via standardized cumulative risk differences/ratios between age 20 and 45. We triangulated findings with a negative outcome control. For women, inequalities were negligible. For men, while inequalities in cancers deaths were negligible, inequalities in CVD mortality were associated to low individual education regardless of parental education. Excess CVD deaths for Low–High were negligible while High–Low provided 234 (95% confidence intervals: 100 to 391) and Low–Low 185 (115 to 251) additional CVD deaths per 100 000 men compared to High–High. That corresponded to risk ratios of 2.7 (1.6 to 4.5) and 2.3 (1.6 to 3.4), respectively. Gradients in substance use mortality were observed only when education changed across parent-offspring. Excess substance use deaths for Low–Low were negligible while High–Low provided 225 (88 to 341) additional and Low–High 80 (23 to 151) fewer substance use deaths per 100 000 men compared to High–High. That corresponded to risk ratios of 1.8 (1.3 to 2.5) and 0.7 (0.5 to 0.9), respectively. Inequalities in premature mortality were driven by individual education and by parental education for some chronic diseases. This could justify the development of intergenerational prevention strategies.

Social Security reform with heterogeneous mortality

Using a heterogeneous agent, life-cycle model of Social Security claiming, labor supply and saving, we consider the implications of lifespan inequality for Social Security reform. Quantitative experiments show that welfare is maximized when baseline benefits are independent of lifetime earnings, the payroll tax cap is 50% larger than its current level, and claiming adjustments are reduced. The Social Security system that would maximize welfare in a “2050 demographics” scenario, characterized by longer lifespans and an increased education-mortality gradient, is similar to the one that would maximize welfare today.

Educational inequalities in epilepsy mortality in the Baltic countries and Finland in 2000\u20132015

Little is known about socioeconomic differences in epilepsy mortality. This study examined educational inequalities in epilepsy mortality in the general population in the Baltic countries and Finland in 2000–2015. Education-specific mortality estimates for individuals aged 30–74 in Estonia, Latvia and Lithuania were obtained from census-linked mortality datasets while data for Finland came from the register-based population and death data file of Statistics Finland. Trends and educational inequalities in epilepsy mortality were assessed using age-standardised mortality rates (ASMRs) per 100,000 person years and age-adjusted mortality rate ratios (RRs) calculated using Poisson regression. ASMRs were higher in men than women in all countries. ASMRs reduced in 2000–2015 among all men and women except for Finnish women. Among men, an inverse educational gradient in epilepsy mortality in 2000–2007 widened in 2008–2015 with ASMRs falling among high and mid educated men in all countries but increasing among low educated men in three countries. An inverse educational gradient in female mortality remained in all countries throughout 2000–2015. Although epilepsy mortality fell in the Baltic countries and Finland (men only) in 2000–2015, this masked a clear inverse educational gradient in mortality that became steeper across the period.

The Association Between Educational Attainment and Mortality: Examining Absolute and Relative Effects by Race/Ethnicity.

To determine whether the association between educational attainment and mortality varies by race/ethnicity on the absolute and relative scales, including among understudied races/ethnicities. Data were obtained from the US National Longitudinal Mortality Study (1983-1984). Hazard models for adults aged ≥25 years (n=725,756) with race/ethnicity by educational interaction terms were used to test relative interaction; linear binomial models were used to test for absolute interaction. For the most part, educational gradients in mortality did not differ across race/ethnicity on the multiplicative scale. Conversely, additive interactions appear to be significant. Blacks gained more in terms of reduced mortality rates for each additional year of schooling. The educational gradient in Whites is also notable as the lowest educated Whites have similar absolute numbers of expected deaths as Blacks similarly educated. At higher levels of education, Whites gain substantially in terms of longer longevity. The educational gradient in Asians, Hispanics, and Native Americans is narrower compared to both Whites and Blacks. The association between educational attainment and mortality does not function uniformly across race/ethnicity.

The Importance of Education for Middle- and Old-Age Mortality in Chile: Estimates From Panel Data Linked to Death Records.

To examine the association between education and mortality by age and gender in Chile. We drew data from 10,147 adults aged 40years and over from the Chilean Social Protection Survey linked to the national death records. We specify five Cox regression models to estimate the main and interaction effects for education levels, age, sex, and mortality. The hazard ratios reduce with increasing education. Secondary and tertiary education levels are associated, respectively, with 34% and 41% lower hazard rates than 0-4years of schooling. Also, the educational gradient in mortality is significantly weaker at older ages, and it does not differ by gender. Our findings endorse the negative association of formal education with adult mortality, uncovering Chile's structural problems despite the economic improvements underway. It also corroborates the importance of novel longitudinal data for mortality analyses in Latin America.

Comparing the educational gradients in three cardiovascular disease-specific health measures

Less-educated persons have worse cardiovascular health. We compare the educational gradients in three disease-specific health measures (biomarkers, self-reported doctors’ diagnoses and cause-specific mortality) in order to compare their relevance in different stages of the disease process. We study 14,102 people aged 50–89 from the US Health Retirement Study (HRS) in the period 2006–17. We use six CVD biomarkers (systolic/​diastolic blood pressure, ratio total/HDL cholesterol, C-reactive protein, body mass index, HbA1c) and two self-reported doctors’ diagnoses (stroke, heart attack). We estimate the gradient in biomarkers using log-binomial regression and the hazard of diagnoses and CVD mortality with Cox survival models. Among those without pre-diagnosed CVD conditions, the educational gradient in mortality is highest (RR 1.97), the gradient for those who receive a CVD diagnosis is in the middle (RR 1.46), and the gradient in biomarkers is lowest (RR 1.32). Among those with recent/​older diagnoses, the biomarker gradient is comparable to levels among the non-diagnosed, while the mortality gradient is much lower (RR 1.35). The gradients in diagnoses and mortality are only slightly explained by differences in biomarkers. The comparison of the three gradients and the mediation analysis suggest that in each of the steps to diagnosis and death there are social factors involved that increase the gradient and go beyond what biomarkers can predict. Having a CVD diagnosis leads to smaller mortality gradients, presumably because of the convergence of educational differences in behaviour and during treatment and monitoring. Our findings support prevention as a strategy against social inequalities in CVD.

The implications of changing education distributions for life expectancy gradients.

Recent research has proposed that shifting education distributions across cohorts are influencing estimates of educational gradients in mortality. We use data from the United States and Finland covering four decades to explore this assertion. We base our analysis around our new finding: a negative logarithmic relationship between relative education and relative mortality. This relationship holds across multiple age groups, both sexes, two very different countries, and time periods spanning four decades. The inequality parameters from this model indicate increasing relative mortality differentials over time. We use these findings to develop a method that allows us to compute life expectancy for any given segment of the education distribution (e.g., education quintiles). We apply this method to Finnish and American data to compute life expectancy gradients that are adjusted for changes in the education distribution. In Finland, these distribution-adjusted education differentials in life expectancy between the top and bottom education quintiles have increased by two years for men, and remained stable for women between 1971 and 2010. Similar distribution-adjusted estimates for the U.S. suggest that educational disparities in life expectancy increased by 3.3 years for non-Hispanic white men and 3.0 years for non-Hispanic white women between the 1980s and 2000s. For men and women, respectively, these differentials between the top and bottom education quintiles are smaller than the differentials between the top and bottom education categories by 18% and 39% in the U.S. and by 39% and 100% in Finland. Had the relative inequality parameters of mortality governing the Finnish and U.S. populations remained constant at their earliest period values, the difference in life expectancy between the top and bottom education quintiles would – because of overall mortality reductions – have declined moderately. The findings suggest that educational expansion may bias estimates of trends in educational differences in life expectancy upwards.

Educational Differences in Mortality and Hospitalisation for Cardiovascular Diseases for Males

High educated individuals are less frequently admitted to hospital for cardiovascular diseases and live longer than the lower educated. We address whether the educational gradient in the mortality rate can be explained by the educational difference in the timing of CVD hospitalisation. We account for possible selective hospitalisation, by using a correlated multistate hazard model (a 'Timing-of-events'- model) and, for selection into education, by using inverse propensity weighting based on the probability to attain higher education. We use Swedish Military Conscription Data (1951-1960), for males only, linked to administrative Swedish registers. Our empirical results indicate a clear educational gradient in mortality and in the impact of CVD hospitalisation on mortality. The implied educational gain in the number of months lost is, however, mainly due to other factors than CVD hospitalisation. Extending the analysis to cause specific mortality reveals that the largest educational differences exist in death due to external causes.

Educational Differences in Risk of All-Cause Mortality After Acute Cardiovascular Events: Examining Cohort and Gender Variations.

Acute cardiovascular events are prevalent in older adults. In this study, following a sample of respondents from the 1996-2016 Health and Retirement Study after diagnosis of myocardial infarction or stroke, we used discrete-time event history models to study mortality post diagnosis. We found an educational gradient in mortality following myocardial infarction or stroke with the better educated surviving longer, even as the gradient was weaker for stroke. Cohort variations existed with the educational gradients stronger for more recent cohorts (Silent and Boomer) as compared with the GI cohort. Gender interacted with cohort to shape mortality such that men from the Silent and Boomer cohorts benefited the most from high school and some college education. Mediation analysis showed that the educational differences in mortality are accounted for by spousal educational attainment, wealth, Medicaid coverage, change in health behaviors, and comorbidities.

Social Security Reform with Heterogeneous Mortality

Using a heterogeneous-agent, life-cycle model of Social Security claiming, labor supply and saving, we consider the implications of lifespan inequality for Social Security reform. Quantitative experiments show that welfare is maximized when baseline benefits are independent of lifetime earnings, the payroll tax cap is kept roughly unchanged, and claiming adjustments are reduced. Eliminating the earnings test and the income taxation of Social Security benefits provides additional gains. The Social Security system that would maximize welfare in a 2050 demographics scenario, characterized by longer lifespans and an increased education-mortality gradient, is similar to the one that would maximize welfare today.

Assessing the quality of education reporting in Brazilian censuses

Background: In developing countries, improving access to schooling has been and remains a priority. At the same time, a growing body of research relates education to demographic variables. It is therefore essential to measure the educational variable accurately. In Brazil, although the high degree of inaccuracy in age reporting is known, previous research has neglected that problems of misreporting may affect other variables such as education. Objective: To fill this gap, we calculate mortality levels by education as implied by intercensal survivorship ratios to investigate the quality of self-reported education among adults in Brazil between the 1991 and 2000 censuses. Results: Our findings show evidence of inaccurate educational data in the censuses. Analysis by single year of schooling weakly reflects the known educational gradient in mortality. After categorization of age and years of schooling into groups, a positive relationship between education and survival does appear, although some implausible patterns remain. Contribution: This study is an important step in demonstrating and assessing potential errors in census education data in Brazil. We highlight the importance of efforts to improve the quality of data on education, particularly in countries where an educational expansion is underway and where deficiencies in data quality are a potential issue of concern.

Status inconsistency and mortality in the immigrant population in the Turin and the Emilian Longitudinal Studies.

to compare the educational gradient in mortality between Italians and immigrants and to assess the hypothesis of status inconsistency in the immigrant population, evaluating the relationship between educational qualification and occupational class. multicentre longitudinal study. subjects aged 30-64 years, resident in Turin, Bologna, Modena, or Reggio Emilia who took part in the 2011 Census and followed up until 31.12.2018. all-cause mortality by educational qualification and occupational class was compared between Italians and immigrants from High Migratory Pressure countries; analyses were carried out using mortality rate ratios (MRR) and relative index of inequality (RII), applying Poisson models, adjusted for city, calendar period, age, and macroareas of origin, stratified by gender. occupational class among immigrants is evenly distributed across educational qualifications. Compared with Italians, immigrant men and women had a weaker and non-significant inverse educational gradient in mortality, which did not change substantially after the adjustment for occupational class. the results support the status inconsistency hypothesis, which may be partly responsible for the observed flattening of the educational gradients. The macroarea of origin appears to be a key determinant of mortality inequalities. Therefore, the use of educational qualification in exploring health inequalities among immigrants should be always complemented with other indicators of socioeconomic position and migratory history.

Which Aspects of Education Matter for Early Adult Mortality? Evidence from the High School and Beyond Cohort.

What dimensions of education matter for people's chances of surviving young adulthood? Do cognitive skills, non-cognitive skills, course taking patterns, and school social contexts matter for young adult mortality, even net of educational attainment? We analyze data from High School & Beyond-a nationally representative cohort of ~25,000 high school students first interviewed in 1980. Many dimensions of education are associated with young adult mortality, and high school students' math course taking retain their associations with mortality net of educational attainment. Our work draws on theories and measures from sociological and educational research and enriches public health, economic, and demographic research on educational gradients in mortality that has almost exclusively relied on ideas of human capital accumulation and measures of degree attainment. Our findings also call on social and education researchers to engage together in research on the life-long consequences of educational processes, school structures, and inequalities in opportunities to learn.

Supplemental Material for Job Complexity and Hazardous Working Conditions: How Do They Explain Educational Gradient in Mortality?

Supplemental Material for Job Complexity and Hazardous Working Conditions: How Do They Explain Educational Gradient in Mortality?

Rising educational gradients in mortality among U.S. whites: What are the roles of marital status and educational homogamy?

The educational gradient in U.S. mortality has been rising among non-Hispanic whites. A common intuition sees the growing educational divide in marital status and increases in educational homogamy as potential explanations. To empirically assess this possibility, we analyze mortality from 1986 to 2015 using the National Health Interview Survey Linked Mortality Files (562,584 persons; 204,756 deaths). At the individual level, being unmarried and spouse's lower educational attainment are associated with higher mortality. Counterfactual analyses, however, reveal that the growing educational divide in marital status and increases in educational homogamy contribute little (8%–15%) to the widening educational gradient in mortality. Our simulation analyses further show that extreme educational divide in marital status could substantially drive up mortality inequality, whereas educational homogamy, even when pushed to the maximum level, would play a limited role in increasing mortality inequality. Combined, the results suggest that changes in the educational divide in marital status have the potential to affect mortality inequality, but the actual changes over the past decades were not strong enough to have a major impact; increases in education homogamy, in contrast, barely affect mortality inequality by education. Along with other research showing small effects of educational homogamy on income inequality, our research suggests that the consequences of changing marriage patterns for social inequalities in general and health inequalities in particular may be more limited than commonly assumed.

Trends in Education-Specific Life Expectancy, Data Quality, and Shifting Education Distributions: A Note on Recent Research.

Several recent articles have reported conflicting conclusions about educational differences in life expectancy, and this is partly due to the use of unreliable data subject to a numerator-denominator bias previously reported as ranging from 20% to 40%. This article presents estimates of life expectancy and lifespan variation by education in the United States using more reliable data from the National Health Interview Survey. Contrary to prior conclusions in the literature, I find that life expectancy increased or stagnated since 1990 among all education-race-sex groups except for non-Hispanic white women with less than a high school education; there has been a robust increase in life expectancy among white high school graduates and a smaller increase among black female high school graduates; lifespan variation did not increase appreciably among high school graduates; and lifespan variation plays a very limited role in explaining educational gradients in mortality. I also discuss the key role that educational expansion may play in driving future changes in mortality gradients. Because of shifting education distributions, within an education-specific synthetic cohort, older age groups are less negatively selected than younger age groups. We could thus expect a greater concentration of mortality at younger ages among people with a high school education or less, which would be reflected in increasing lifespan variability for this group. Future studies of educational gradients in mortality should use more reliable data and should be mindful of the effects of shifting education distributions.

Educational inequalities in mortality of patients with atrial fibrillation in Norway

Objectives: We explored the educational gradient in mortality in atrial fibrillation (AF) patients.Design: We prospectively followed patients hospitalized with AF as primary discharge diagnosis in the Cardiovascular Disease in Norway 2008-2012 project. The average length of follow-up was 2.4 years. Mortality by educational level was assessed by Cox proportional hazard models. Population attributable fractions (PAF) were calculated. Analyses stratified by age (≤75 and >75 years of age), and adjusted for age, gender, medical intervention, and Charlson Comorbidity Index.Results: Of 42,138 AF patients, 16% died by end of 2012. Among younger patients, those with low education (≤10 years) had a HR of 2.3 (95% confidence interval 2.0, 2.6) for all-cause mortality relative to those with any college or university education. Similar results were observed for cardiovascular mortality. Disparities in mortality were greater among younger than older patients. A PAF of 35.9% (95% confidence interval 27.9, 43.1) was observed for an educational level of high school/vocational school or less versus higher education in younger patients.Conclusions: Increasing educational level associated with better prognosis suggesting underlying education-related behavioral and medical determinants of mortality. A considerable proportion of mortality within 5 years following hospital discharge could be prevented.

Education, Cognitive Ability and Cause-Specific Mortality: A Structural Approach

Education is negatively associated with mortality for most major causes of death. The literature ignores that cause-specific hazard rates are interdependent and that education and mortality both depend on cognitive ability. We analyze the education-mortality gradient at ages 18-63 using Swedish register data. We focus on months lost due to a specific cause of death which solves the interdependence problem, and use a structural model that derives cognitive ability from military conscription IQ scores. We derive the educational gains in months lost and the selection effects for each cause of death, and quantify the selection contribution of observed characteristics and unobserved cognitive ability. In a standard Cox model that controls for observed IQ, primary education was associated with 6 months lost when compared to secondary education. In a structural model that accounts for cognitive ability the difference was 43% larger. In addition, the largest educational gains were achieved for the lowest education group in the reduction of external cause mortality. The educational gains in cardiovascular mortality was small, mainly due to large selection effects. These results suggest that educational differences in cause specific mortality may be biased by conventional Cox regression analyses.

Four Decades of Educational Inequalities in Hospitalization and Mortality among Older Swedes.

BackgroundThe inverse association between education and mortality has grown stronger the last decades in many countries. During the same period, gains in life expectancy have been concentrated to older ages; still, old-age mortality is seldom the focus of attention when analyzing trends in the education-mortality gradient. It is further unknown if increased educational inequalities in mortality are preceded by increased inequalities in morbidity of which hospitalization may be a proxy.MethodsUsing administrative population registers from 1971 and onwards, education-specific annual changes in the risk of death and hospital admission were estimated with complimentary log-log models. These risk changes were supplemented by estimations of the ages at which 25, 50, and 75% of the population had been hospitalized or died (after age 60).ResultsThe mortality decline among older people increasingly benefitted the well-educated over the less well-educated. This inequality increase was larger for the younger old, and among men. Educational inequalities in the age of a first hospital admission generally followed the development of growing gaps, but at a slower pace than mortality and inequalities did not increase among the oldest individuals.ConclusionsEducation continues to be a significant predictor of health and longevity into old age. That the increase in educational inequalities is greater for mortality than for hospital admissions (our proxy of overall morbidity) may reflect that well-educated individuals gradually have obtained more possibilities or resources to survive a disease than less well-educated individuals have the last four decades.