Elsevier

Social Science & Medicine

Volume 66, Issue 3, February 2008, Pages 620-636
Social Science & Medicine

A broader perspective on education and mortality: Are we influenced by other people's education?

https://doi.org/10.1016/j.socscimed.2007.10.009Get rights and content

Abstract

The objective of this study was to find out whether the educational achievements of family members and people in the municipality have an impact on a person's mortality, net of the well-known strong influence of his or her own education. Using register data, discrete-time hazard models for all-cause mortality in 1980–2003 were estimated for all Norwegian men and women born between 1950 and 1973 (i.e. age 30–53). There were 23,692 deaths during the 19.1 million person-years of follow-up. The education of a former or current spouse had the clearest beneficial effect, although own education was more important. Mortality was also negatively associated with the education of the oldest sibling and to a lesser extent with that of the sibling-in-law and father-in-law. The average education in the municipality was not generally related to mortality, but a beneficial effect was seen among men with college education. In contrast to this, parents’ education affected mortality adversely, especially among women. The data did not allow causal pathways to be identified, but possible mechanisms were discussed. For example, it was argued that others’ education may affect mortality favourably through transmission of knowledge, imitation of behaviour, economic support, and the quality of health services. In some societies, childhood health might also be an issue. On the other hand, having better-educated family members or living in a community with many better-educated people, who typically also have higher incomes, may trigger psychosocial stress. However, one should be careful to interpret the observed relationships as reflecting purely causal effects. Various unobserved factors may influence the person's choice of spouse and place of residence as well as mortality, and having parents with higher (lower) education may signal that the person has had special problems (resources) during childhood or adolescence, which also may have implications for later health.

Introduction

Socio-economic differentials in health and mortality have attracted massive research interest over many years. Most of this work has taken an individual perspective, without necessarily being based on individual data: the focus has largely been on how a person's own socio-economic resources influence his or her own health and mortality. For example, it has been firmly established that people with high education have lower mortality than those with little education, and much is also known about the causal pathways (e.g., Kunst & Mackenbach, 1996; Ross & Mirowsky, 1999; Zajacova, 2006). In recent years, however, there has been a growing interest in finding out how the socio-economic resources of other people may affect a person's health, net of his or her own resources. Such studies help us build up a more complete picture of the social inequalities in health. The present study brings together three strands of this type of research, one that deals with the importance of the spouse's resources, one that deals with the importance of the parents’ resources, and one that deals with the importance of the resources in the community. The focus is on education, which is a readily available, often used, and theoretically meaningful indicator.

While it has been reported repeatedly that the married have lower mortality than the non-married, probably because of both selection (e.g. Goldman, 1993; Lillard & Panis, 1996) and truly causal effects of marriage and marital status changes (e.g. Lillard & Waite, 1995; Smith & Zick, 1996; Stolzenberg, 2001; Umberson (1992a), Umberson (1992b)), there is less certainty about the effects of the characteristics of the partner. Some studies of men's health and mortality have shown that wife's education has a beneficial effect (Bosma, Appels, Sturmans, Grabauskas, & Gostautas, 1995; Egeland, Tverdal, Meyer, & Selmer, 2002; Jaffe, Eisenbach, Neumark, & Manor, 2006; Monden, van Lenthe, de Graaf, & Kraaykamp, 2003; Strogatz, Siscovick, Weiss, & Rennert, 1988), although opinions differ about its strength compared to that of the man's own education (Jaffe et al., 2006; Monden, van Lenthe et al., 2003). Other studies, largely from earlier periods, have shown adverse effects of wife's education, at least for certain groups of men (Carmelli, Swan, & Rosenman, 1985; Eaker, Haynes, & Feinleib, 1983; Haynes, Eaker, & Feinleib, 1983; Suarez & Barrett-Connor, 1984). Low self-esteem among these men and a less supportive home environment because of the wives’ work were among the suggested explanations. The few investigations of this type that have addressed women's health and mortality have concluded that it is an advantage to have a husband with good education, though her own education may be more important (Monden, van Lenthe et al., 2003).

The impact of childhood socio-economic position has received far more attention, although the control for own resources has not always been very good, and there has been some concern about the quality of the parental resource indicators. Most of these studies have focused on men's health and shown beneficial effects of parental resources (Galobardes, Lynch, & Davey Smith, 2004; Hayward & Gorman, 2004), but such effects have been reported for women also (Beebe-Dimmer et al., 2004). However, there are also investigations pointing in the opposite direction: in a recent Norwegian analysis of relatively young people, adverse effects of parents’ education appeared (Strand & Kunst, 2007).

Over the last 10–15 years, there has been a rapidly increasing interest in multilevel analysis of socioeconomic health inequalities (Pickett & Pearl, 2001; Robert, 1999), also in Nordic countries (Blomgren, Martikainen, Mäkelä, & Valkonen, 2004; Chaix, Rosvall, & Merlo (2007a), Chaix, Rosvall, & Merlo (2007b); Gerdtham & Johannesson 2004; Martkainen, Kauppinen, & Valkonen, 2004; Osler et al., 2003; Sundquist, Malmström, & Johansson, 2004). These studies have largely dealt with the importance of aggregate income, poverty concentration and unemployment, and there has been large variation in the results. Much less attention has been devoted to average education, which of course is closely related to economic resources (Geronimus & Bound, 1998), but also may pick up other factors. It may be just as relevant to include in a multilevel analysis as various income indicators. In fact, two studies that included measures of both aggregate income and aggregate education showed that the effects of the latter were the strongest (Kravdal, 2006; Wen, Browning, & Cagney, 2003).

Because there is mixed evidence about these effects of other people's education, or quite few earlier studies on which to base conclusions, a new investigation based on a large data set with precise information on education should be valuable. It would be even more valuable if all the education variables could be considered in the same analysis. That would make it easier to compare the effects, which might provide some clues about the underlying mechanisms. Earlier studies have either included only the spouse's education, only the parents’ education, or only the average education in the community (in addition to the person's own education, of course).

The present analysis is based on data from Norway, which has a nation-wide population register, and where educational differentials in mortality have been reported to be no less pronounced than in other rich countries (Mackenbach, Kunst, Cavelaars, Groenhof, & Geurts, 1997). The population registration system allows identification of family members and includes highly reliable information about municipalities of residence, date of death, and education. More precisely, a discrete-time hazard regression model is estimated to describe how the average educational level in the municipality and the education of parents, sibling, spouse, former spouse, parents-in-law, and sibling-in-law is related to men's and women's all-cause mortality at the relatively low ages of 30–53, net of their own education. The educational levels of former spouse, sibling and in-laws have never been included in mortality models before, but may well have an influence, although not for all the same reasons as the other education variables. Unfortunately, the data do not allow statistical identification of the causal pathways that the different education variables may operate through, but it is discussed how various mechanisms may contribute to the education-mortality relationships. The consideration of a broad set of education variables should help to enrich this discussion.

Section snippets

Some reasons why others’ education may be important

A person's own education has been thought to affect his or her mortality through, for example, the specific health knowledge obtained at school, consciousness about being able to influence one's health and life situation, the ability to process new information of relevance for health, and the higher incomes resulting from the skills taught in school and the credentials (e.g. Ross & Mirowsky, 1999). A strong economy may in turn facilitate the engagement in activities that make life pleasant or

Data

The data cover the period up through 2003, and the main source is the Norwegian population register, which includes everyone living in Norway after 1960. In addition, information has been extracted from the 1970 census and Statistics Norway's education files. For each person, there is a unique anonymous identification code, as well as information on marital status 1 January each year from 1974 and spouse's identity, highest educational level achieved as of 1 October every year from 1980 and as

Results

Estimates from a model with categorical variables for own and family members’ education are shown in Table 1, while those from a corresponding model with continuous education variables are shown in Table 2. Because the latter model seems to reveal the main patterns well enough, continuous education variables are used in the remaining analysis for simplicity.

An interaction between own education and marital status is included. Preliminary model experimentation showed that it was strongly

The education of the oldest sibling and sibling-in-law

Earlier mortality studies have not checked the importance of siblings’ education. The effects that appear here are consistent with the ideas about learning and imitation: better-educated siblings may have health knowledge and behaviour (whether a result of their schooling itself or the individual resources behind their schooling) that are transmitted to the person under consideration. If there really is a stressful effect operating through low relative education (or beneficial effect of high

Conclusion

In addition to confirming the sharply protective effect of one's own education on mortality, this study based on a large, high-quality data material documents that the education of close family members also matters. Most importantly, mortality is lower among those who have or have had a well-educated spouse than among those with a less educated spouse, although one's own education is more important. This has not always been found in other studies. There are also effects of the education of the

Acknowledgement

This study was largely carried out while the author was at the Centre for Advanced Studies at the Norwegian Academy of Science. The support from the centre, the additional support from the Norwegian Research Council, and the helpful comments from Emily Grundy and four anonymous reviewers are greatly appreciated.

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