Educational Gradient Research Articles

Gender and Education Differences in Mental Health in Belgium: a Bayesian Age-Period-Cohort Analysis

Abstract Background Mental illnesses (MI) constitute a growing public health problem, with reports of a higher prevalence among middle-aged adults (age effect), during specific periods such as economic crisis (period effect) and in recent birth cohorts (cohort effect). However, few studies have assessed whether these age-period-cohort (APC) effects were related to general population trends or if they are driven by changes in the mental health status of more vulnerable groups. Therefore, this study aimed to assess gender and educational differences underlying observed APC effects in the prevalence of MI in the Belgian adult population. Methods This study used data from six cross-sectional waves of the Belgian Health Interview Survey (1997-2018, ∼ 10,000 respondents per wave). Mental health was assessed using the 12-item General Health Questionnaire. Bayesian hierarchical APC models were applied on the prevalence of MI, taking into account gender and educational differences, as well as some potential confounding factors. Results Overall, this study confirmed the higher prevalence of MI in middle-aged adult, in 2013, and in more recent birth cohorts (1980-2000). Accounting for the interaction between gender and education, we found that the MI educational gradient was more pronounced for women than men. Finally, we found that APC trends were different between gender. The odds of having MI tended to be stable across age groups for women, while men showed an increased odds between 50-60 years and a decrease between 60-65 years. Regarding period and cohort effects, the increase odds in 2013 was mainly present in men, while the increase in recent birth cohorts was mainly present in women. Conclusions This study emphasizes that the age-period-cohort effects on mental health are different depending on gender and education, thus enriching our understanding on the underlying mechanisms to better guide future public (mental) health policies. Key messages • This study shows the importance of studying not only the overall trends in mental illness, but also the underlying differences in its distribution. • Insights into gender and educational differences in Age-Period-Cohort effects on mental health is crucial for the development of timely and efficient public health interventions.

Quality of Life among the Sámi Population

Abstract Introduction The Sámi, indigenous to Northern Europe, maintain rich traditions like reindeer herding and unique languages. Continuous efforts are made to preserve their cultural identity and practices. Systemic barriers, including cultural marginalization and environmental challenges, exacerbate these inequalities, impacting their ability to preserve traditional lifestyles. It is not known, until now, how this impacts Quality of Life (QoL). Aims Describe QoL in the Sámi population in Norway Methods In 2019/20, the three northernmost Counties in Norway took part in the Norwegian Counties Public Health Surveys (NCPHS), which also has a comprehensive QoL module (comprises subjective and objective measures, Cantril scale). NCPHS is an internet-based survey. On average 25 % of the adult population was invited to participate in the NCPHS. Results Being Sámi was through self-identification, n = 3312. Satisfaction with Life was 7,34 versus 7,41 for the general population. For Loneliness, 15,9 % percent of the Sámi were characterized as lonely (score 6-10) versus 13,3 %, and for positive emotions, there was no difference, with a score of 6,69 for both groups. Sex, age and educational gradients are similar to the general population, for all measures. Minor differences were found according to if one lived in a Sámi-majority municipality or not. Conclusions Overall, being Sámi is associated with slightly lower QoL on several measures, but effect sizes are general small to insignificant. Due to lack of data on the Southern Sámi population, findings cannot be generalized to all Sámi. Key messages • Overall, being Sámi is associated with slightly lower QoL on several measures, but effect sizes are general small to insignificant. • Due to lack of data on the Southern Sámi population, findings cannot be generalized to all Sámi.

Education gradients in parental time investment and subjective well-being

Education gradients in parental time investment and subjective well-being

State cigarette taxes, smoking cessation, and implications for the educational gradient in mortality

BackgroundRecent studies suggest that state policy, such as cigarette tax policy, is associated with variation in the educational gradient in mortality. However, it is unknown whether state cigarette taxes moderate the educational gradient in mortality directly by incentivizing smoking cessation. MethodsThis study uses 20 years of survey data from the Panel Study of Income Dynamics (N = 89,127 person-years; 751 deaths) merged with administrative data to examine the potential for a single state policy, cigarette taxes, to moderate the education-mortality association through influence on smoking cessation. ResultsIn mortality analyses, higher cigarette taxes are associated with a weaker educational gradient in mortality among smokers and overall. Smoking cessation analyses show higher state cigarette taxes increase the odds of quitting only for low-educated smokers, such that each $1 increase in taxes results in an additional 0.4 to 1 life years for low-educated smokers. For more educated subgroups, the association between state cigarette taxes and smoking cessation is confounded by broader temporal trends. DiscussionState cigarette taxes have potential to weaken the educational gradient in mortality by attenuating educational disparities in smoking cessation, however their direct effect is only on low-educated smokers. The findings help demonstrate how fundamental cause associations are contingent on state policy and vary over time.

Hidden patterns of inequality: The heterogeneity in parenting within educational groups

When sociology deals with differences within groups of similar socioeconomic status, research and theorizing tend to focus on the heterogeneity among the socioeconomically advantaged thus representing the socioeconomically disadvantaged as homogeneous. This study is a case of the opposite. For at set of high-stake cultural practices, parental strategies for social reproduction, I find most heterogeneity among socioeconomically disadvantaged mothers. Using data from the NLSY-CYA, I provide novel descriptive statistics of the variance in parenting by maternal education and analyze the determinants of these differences employing a variance function regression. I find an educational gradient in the heterogeneity of cognitively stimulating parenting: the variance is highest among mothers with no high school diploma and shrinks among mothers with more education. That is, mothers with the least amount of education show the most diversity in parenting. This educational gradient is associated with inequality in mothers’ family of origin, cognitive skills, and current economic situation. This result suggests that the systematic differences in heterogeneity stem from (1) selection into education based on family-of-origin characteristics and cognitive skills, where the non-deterministic sorting makes the least educated the most heterogeneous, and (2) the effect of education on mothers’ economic situation, where education decreases uncertainty and thereby makes the most educated the most homogeneous group. Moreover, the study calls for bringing attention to the potential larger heterogeneity in cultural practices among the socioeconomically disadvantaged and provides a theoretical framework for understanding this heterogeneity. This approach challenges stereotypes and deepens sociological understanding of inequality.

Educational differences in years lived with disability due to mental and substance use disorders: a cohort study using nationwide Norwegian and Danish registries

BackgroundFindings from the Global Burden of Disease (GBD) study have shown that the burden of mental and substance use disorders is considerable, and unevenly distributed across demographic groups in the population. However, there is a lack of knowledge on how this burden differs by socioeconomic position. The aim of this study was to examine educational differences in years lived with disability (YLDs) from mental and substance use disorders among males and females in two high-income countries, taking comorbidity with other diseases into account.MethodsThe study included all registered residents in Denmark and Norway from 2011 to 2021. Diagnostic information was retrieved from records in the Norwegian National Patient Registry (NPR) and the Danish Psychiatric Central Research Register (PCRR) and used as proxy measures for disorder prevalence. Demographical and educational information was taken from administrative registries. The YLD is a measure of the non-fatal health loss in the population and was calculated by multiplying the duration of a disorder with a disability weight (DW), scaled between 0 and 1. Information on remission and DWs were retrieved from the GBD study and other sources, and disorder specific DWs were averaged by severity levels and adjusted for comorbidity.ResultsEducational gradients in YLD rates were found for mental and substance disorders overall, and for most of the specific disorders. The educational gradient was more pronounced for schizophrenia, intellectual disability and substance use disorders than for eating, anxiety, and affective disorders. Both higher YLD rates, and a larger attributed proportion of the total YLDs, were found for schizophrenia, intellectual disability, and substance use disorders in the groups with low versus high education. YLD rates for eating, anxiety, and affective disorders were more equal across educational levels, but constituted a smaller proportion of the total YLDs among the groups with low versus the groups with high educational level.ConclusionMost of the disease burden related to mental and substance use disorders falls on those with the fewest years of education. This should be taken into consideration when public health targets aimed at improving mental health and reducing social inequalities in health are developed and implemented.

Pathways from education to mortality, mediated through income.

Lower levels of education are associated with higher mortality. Lower levels of education are also associated with lower income, which is also associated with higher mortality. We investigate the impact of education on mortality and the extent to which this is mediated through income over the life course. We account for both selective educational attainment and selective income over the life course, through inverse propensity weighting (IPW) of the mortality hazard. We decompose the educational gain, that is, the decrease in mortality from more education, in the hazard into an indirect effect of education, running through changes in income and a direct effect of education, running through other factors. We use Swedish conscription data (men only), linked to parental information and individual annual income for the period 1968 till 2012. Our empirical results indicate large educational gains in mortality. We also find that this educational gradient runs through changes in income, especially for the more educated, and does not run through other factors related to education. We conduct several robustness and sensitivity checks that indicate that the results are robust.

Socioeconomic inequalities in frailty distribution: A cross-national comparison of the United States and England.

To examine differences in socioeconomic gradients (i.e., education, income, and wealth) in frailty by gender in the US and England. We used harmonized data from the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA) in 2016. Frailty status was determined from measured and self-reported signs and symptoms in five domains: unintentional weight loss, exhaustion, low physical activity, slow walking speed, and weakness. Respondents were classified as robust (no signs or symptoms of frailty), pre-frail (signs or symptoms in 1-2 domains), or frail (signs or symptoms in 3 or more domains). Gender-stratified multinomial logistic regression models were used to assess the relationship between educational attainment, household income, and household wealth with the risk of frailty and pre-frailty, with and without covariates. We also calculated the slope index of inequalities on the predicted probabilities of frailty by income and wealth quintiles. We found socioeconomic gradients in pre-frailty and frailty by education, income, and wealth. Furthermore, the educational gradient in frailty was significantly steeper for US women compared to English women, and the income gradient was steeper for US men and women compared to English men and women. The between-country differences were not accounted for by adjusting for race/ethnicity and behavioral factors. Socioeconomic gradients in pre-frailty and frailty differ by country setting and gender, suggesting contextual factors such as cultural norms, healthcare access and quality, and economic policy may contribute to the effect of different measures of socioeconomic status on pre-frailty and frailty risk.

Assessing educational disparities in COVID-19 related excess mortality in Spain: a population register-linked mortality study.

Data on the increase in mortality during the COVID-19 pandemic based on individuals' socioeconomic positions are limited. This study examines this increase in mortality in Spain during the epidemic waves of 2020 and 2021. We calculated the overall and cause-specific mortality rates during the 2017-2019 pre-pandemic period and four epidemic periods in 2020 and 2021 (first, second, third-fourth, and fifth-sixth waves). Mortality rates were analyzed based on educational levels (low, medium, and high) and across various age groups (25-64, 65-74, and 75+). The increase in mortality during each epidemic period compared to the pre-pandemic period was estimated using mortality rate ratios (MRR) derived from Poisson regression models. An inverse educational gradient in overall mortality was observed across all periods; however, this pattern was not consistent for COVID-19 mortality in some age groups. Among those aged 75 years and older, highly educated individuals showed higher COVID-19 mortality during the first wave. In the 25-64 age group, individuals with low education experienced the highest overall mortality increase, while those with high education had the lowest increase. The MRRs were 1.21 and 1.06 during the first wave and 1.12 and 0.97 during the last epidemic period. In the 65-74 age group, highly educated individuals showed the highest overall mortality increase during the first wave, whereas medium-educated individuals had the highest increase during the subsequent epidemic periods. Among those aged 75 and older, highly educated individuals exhibited the highest overall mortality increase while the individuals with low education showed the lowest overall mortality increment, except during the last epidemic period. The varying educational patterns of COVID-19 mortality across different age groups contributed to the disparities of findings in increased overall mortality by education levels during the COVID-19 pandemic.

Temporal changes and educational disparities in the frequent consumption of sugar-sweetened beverages among Estonian adults during 2006–2022

ObjectivesExcessive consumption of sugar-sweetened beverages (SSBs) contributes to adverse health outcomes but is differentiated by socio-economic indicators. The study analyses the educational disparities in adults frequent consumption of sugar-sweetened beverages (SSBs) in Estonia and its temporal changes between 2006 and 2022. Study designRepeated cross-sectional survey. MethodsNationally representative data from 9 biennial cross-sectional surveys on 25–64-year-old Estonian residents (n = 20396) was used for the study. Changes in frequent (on 6–7 days per week) consumption of SSBs by study year, sex, age, and education is analysed using descriptive statistics and binomial logistic regression. Prevalence and odds ratios (OR) with 95 % confidence intervals (CIs) are presented focusing on temporal and educational patterns in frequent SSB consumption. ResultsThe prevalence of frequent SSB consumption among Estonian adults declined consistently from 2006 (14.0 %) to 2018 (5.2 %), followed by statistically non-significant increases in 2020 (6.8 %) and 2022 (7.1 %). Prevalence of frequent SSB consumption was significantly (p < 0.01) higher among adults with primary or lower education (12.4 %) compared to tertiary education group (4.8 %). The educational differences in SSB consumption (12.4 % in primary or lower vs. 4.8 % in tertiary education) were nearly three-fold after adjusting for sex, age, and period effects (OR 2.84, 95 % CI 1.71–4.74) and have been consistent since 2010. ConclusionsAlthough frequent consumption of SSBs has been generally decreasing among Estonian adults, the findings illustrate the persisting educational gradients in exposure that expectedly translates into socio-economic inequalities in adverse health outcomes resulting from excessive SSB consumption.

Examining the link: educational expansion and non-marital fertility in Croatia

This paper studies the macro-level relationship between education and non-marital fertility in Croatia. Using vital statistics on first births from 1984 to 2021, we explored non-marital fertility trends by mothers’ education and assessed the influence of women’s educational expansion. We observed a significant increase in the proportion of non-marital births, from under 10% in the mid-1980s to over 30% by 2021. Decomposition analysis showed that behavioural changes, particularly among medium-educated women, significantly influenced the increase in non-marital fertility. This group increasingly opted for childbearing outside of marriage. High-educated women also contributed to the trend, with the behavioural changes more modest in comparison to those of medium-educated women, but amplified by an increase in their group size. Direct standardization showed that higher educational attainment among first-time mothers moderated the proportion of non-marital births, suggesting that the proportion of non-marital births could have been even higher had the educational composition remained constant at 1984 levels. The study confirmed a persistent negative educational gradient, where lower educational attainment was associated with a higher likelihood of non-marital childbearing. The results have important implications for policymakers, as discussed in the paper.

Reconstructing Prospective Intergenerational Educational Mobility in 12 Countries

In this article, we reconstruct prospective intergenerational educational mobility and explore fertility's role in this process for women born between 1925 and 1950 in 12 European countries. We do so by combining high-quality retrospective data (Generations and Gender Survey) and low-requirement prospective datasets using an inferential method developed and advanced in prior research. Our analysis shows that the negative educational fertility gradient partly compensates for the inequality in prospective mobility rates between lower and higher educated women and is most pronounced in high-inequality contexts. However, fertility's role is small and declining and thus does not account for much of the differences in mobility rates between countries. We also explore the relative importance of sibship size effects in mediating the effect of fertility gradient, finding it negligible. Finally, we explore the correspondence between prospective and retrospective estimates in the reconstruction of prospective mobility rates and suggest why the former, when available, must be preferred.

Decomposition of life expectancy differentials with (and without) conditions by educational attainment for major groups of causes in contemporary Spain: where is the advantage?

IntroductionHealthy life expectancy is higher among individuals with higher socioeconomic standing. However, it is unclear whether such advantage is attributable to longer (i.e., mortality advantage) or to healthier (morbidity advantage) lifespans across different health conditions.ObjectiveEstimate the contribution of mortality and morbidity components in differences in condition-free life expectancies (CFLE) and life expectancy with conditions (LEWC) for five major groups of conditions by sex and educational attainment, instead of using a global indicator of morbidity.MethodsUsing the Sullivan Method, we computed remaining life expectancies at age 40 and 65, CFLE, and LEWC and applied a stepwise decomposition technique, using national health surveys along with mortality data, in a cross-sectional analysis.ResultsAn educational gradient was present in almost all conditions, with different intensities. For females, morbidity was the main contributor to educational differences in health expectancies, but mainly in the older age groups. For males, the drivers behind higher health expectancies for high-educated males were evenly distributed across mortality and morbidity between ages 40 and 65, but after that, the mortality gradient vanished between high-educated and middle-educated individuals.DiscussionThe changing contribution of the mortality and morbidity gradient for different conditions across age-groups brings evidence to adequately plan health policies to mitigate health gaps and improve quality of life of the populations in a lower social standing.

The changing educational and social class gradients in union dissolution: Evidence from a latecomer of the Second Demographic Transition

Most studies on the changing socioeconomic gradient of divorce have operationalized individuals’ socioeconomic status (SES) through education, often neglecting social class differences. Education may proxy cultural and cognitive skills, whereas social class could more accurately capture economic means. Additionally, existing research has predominantly focused on women and marital dissolutions. This study addresses these oversights by analyzing the educational and social class gradients of both marriage and cohabitation dissolutions among men and women in Italy—a latecomer to the Second Demographic Transition. We used non-proportional hazard models to estimate survival curves and union dissolution probabilities stratified by education, social class, and cohort. Our findings reveal a vanishing socioeconomic gradient of marital dissolution among women and a reversal from positive to negative among men across cohorts. These results challenge the conventional view that men’s higher SES always stabilizes unions and support Goode’s hypothesis on the reversal of the socioeconomic gradient of divorce for both genders. No clear SES gradient was found for cohabiting unions. Overall, the study demonstrates the significant predictive power of social class for marital dissolutions, even when controlling for education, emphasizing the need to consider both measures of SES to comprehensively account for different underlying mechanisms.

Educational gradient in hip fracture incidence in Norway. The Norwegian Epidemiologic Osteoporosis Studies (NOREPOS).

Socioeconomic gradients are seen for several health outcomes in high-income countries. We aimed to examine possible educational gradients in risk of hip fracture in Norway and to describe the cumulative incidence of hip fracture by educational level. In a population-wide cohort of Norwegians aged ≥ 50 years, information on attained education from Statistics Norway was linked to hospital-treated hip fractures and deaths during 2002-2019. We estimated relative fracture risk by educational level (primary, secondary or tertiary) in Cox proportional hazards regression. We also examined the cumulative incidence over attained age by gender and educational level in competing risk regression. The population included N = 1,389,858 individuals with 135,938 incident hip fractures. Compared with men who had attained tertiary education, hazard ratios (95% confidence intervals) for hip fracture were 1.44 (1.40, 1.49) in men with primary education only and 1.26 (1.22, 1.29) in men with secondary education. In women, the corresponding estimates were 1.28 (1.25, 1.31) and 1.16 (1.13, 1.19). In the age range 50 to 90 years, the highest cumulative incidence of hip fracture was seen in those with primary education. The gradient gradually diminished with advancing age and was reversed in the oldest (> 90 years) in both genders. There was a clear educational gradient in hip fracture incidence in both men and women in Norway, with a higher risk in people with lower education. Despite this, the cumulative incidence of hip fracture in old age was highest among people with higher education, due to their higher life expectancy.

Financial Asset Allocation and Fertility Intention: Evidence from Chinese Families Using CFPS Data

China faces a structural-demographic crisis characterized by low fertility rates, an aging population, and ecological imbalances. Despite policy interventions, fertility intentions remain a concern. This study explores the complex relationship between household financial asset allocation and fertility intentions using CFPS data. The findings reveal a significant negative association between investing in financial products, total financial assets, and fertility intentions. Urban-rural disparities, gender differences, and educational gradients further shape this relationship. Mechanism analysis suggests that while financial assets boost income, they also influence households towards smaller family sizes, reflecting changing societal values.

Gender and educational differences in work participation and working years lost in Norway.

This study aimed to quantify the duration of work participation and reasons for working years lost, according to gender and educational attainment, among a Norwegian population. Register data on labor market attachment between 2000-2015 were obtained from Statistics Norway. We included five cohorts: individuals turning 20 (N=323 333), 30 (N=386 006), 40 (N=388 962), 50 (N=358 745), and 60 years (N=284 425) between 1 January 2000 and 31 December 2005. Individuals were followed for ten years. Data completeness allowed calculation of the average time spent in work and years lost to health-related absences and non-employment states per cohort. Changes in state probabilities over time were also depicted. Mean differences between genders and educational levels, and corresponding 95% confidence intervals were based on 1000 bootstrap samples. Both genders spent most time in work; however, per cohort, women worked approximately one year less than men. As cohorts aged, main reasons for working years lost changed from education and economic inactivity to sickness absence and disability pensioning; this trend was stronger for women than men. Individuals with a low education spent fewer years in work and more years in sickness absence and disability pensioning than highly educated peers. This difference tended to be larger for women and older cohorts. Per cohort, women participated one year less in work than men and, depending on age, spent more time in education, economic inactivity, sickness absence, and disability pensioning. Stronger educational gradients were seen for work and health-related absences for older cohorts and women.

Educational gradients in the prevalence of medically assisted reproduction births in a comparative perspective

To study educational gradients in births after medically assisted reproduction across 5 countries with different institutional arrangements. We use logistic regression and compute predicted probabilities to estimate the association between education and giving birth after assisted reproduction, before and after adjustment for maternal age at delivery and marital/partnership status, using an overall sample of about 3.9 million live births in 5 countries. Not applicable. This study includes survey or register data containing information on births in 5 countries: N = 61,564 for Denmark, N=37,533 for France, N = 12,889 for Spain, N = 17,097 for the United Kingdom, and N = 3,700,442 for the United States. None. The probability of a child being born after medically assisted reproduction for mothers with a university degree relative to those having less than a university degree. University-educated mothers are more likely to give birth after assisted reproduction compared with mothers with lower levels of education. After adjustment for socio-demographic characteristics, educational differences disappear in the United Kingdom and to some extent Spain, whereas they attenuate but persist in the other countries. The United States seems to show a larger educational gradient. The results suggest that the institutional setting around assisted reproduction may moderate the gradient. A possible explanation may be access to treatments, as the United States - the context with the lowest subsidization - seems to show larger educational gradients than other contexts. In the context of global postponement of childbearing to older ages, mothers with lower levels of socioeconomic resources might find it more difficult to fully realize their fertility intentions in countries with less generous subsidization of treatments.

Research note: Gender and educational differences in childcare time: Evidence from the Czech Republic

Objective: This study explores the gender and educational differences in the time spent on childcare in the Czech Republic. In particular, we ask how gender and educational gradients in parenting time intersect and whether they vary by the child’s age. We consider the time parents spend in basic, interactive and focused childcare care as a way to address the intensive parenting model. Background: Prior research has documented an increase in parental time investment in childcare associated with changes in gender roles and the spread of norms of intensive parenting. However, it remains unclear whether educational and gender differences in parenting time are converging because of these changes and how they vary by the child’s age. Method: Using time-use data from the Czech Household Study Panel Study—a nationally representative sample from the Czech Republic (2015)—we applied mixed regression models to analyse time spent on three types of childcare activities. Results: The results indicate that highly educated parents allocate more time to basic and focused care, reflecting a commitment to intensive child-centred parenting. In addition, higher-educated fathers of preschoolers engage more in interactive care. Although gender disparities persist among higher-educated parents, the gap narrows for parents with children older than three years. Conclusion: The findings underscore the importance of analysing parenting time across different activities and child ages to understand family dynamics and child opportunities.

Microfoundations of the weakening educational gradient in fertility

The disappearance of the social gradient in fertility represents a paradigm shift that has called into question the validity of theories that predicted a decline in fertility with increased access to education and resources. Emerging theories have tried to explain this trend by highlighting a potential change in the fertility preferences of more educated couples. In this paper we add additional elements to this explanation. Using a computational modelling approach, we show that it is still possible to simulate the weakening social gradient in fertility, in the context of steady declines in family size preferences. Our results show that one of the key drivers of the change in the education–fertility relationship can be found in the transition to an increasingly regulated fertility regime. As the share of unplanned births decreases over time, the negative association between education and fertility weakens and the mechanisms that positively connect educational attainment with desired fertility become dominant.