Overqualification and Risk of All-cause and Cardiovascular Mortality: Evidence From the Canadian Census Mortality Follow-up Study (1991–2001)

Abstract

here is strong evidence demonstrating an inverse association between socio-economic position (SEP) and mortality. 1 In epidemiologic studies, SEP is typically measured as education, occupation or income. 2 These indicators attempt to measure the underlying construct of SEP, and consequently a degree of overlap exists between them. However, these indicators often reflect a specific period in the life-course and measure different dimensions of SEP, and therefore should not be used interchangeably. [2][3][4] Studies have attempted to understand the relationship between different SEP measures and health. 5,6 Examining the effect of multiple SEP indicators in the same study, both independently and simultaneously, can provide insight into which SEP measures are the strongest predictors of mortality.There has been a longstanding interest in social epidemiology concerning the hypothesis that status inconsistency (i.e., having contradictory SEP measures) is associated with adverse health effects. A proposed pathway linking status inconsistency and poor health is via "goal-striving stress", where stress results from an individual's social class achievements (e.g., occupation) not meeting their aspirations (e.g., education). 7 This stress may result in neuroendocrine and immune system disruption and excess cortisol and sympathetic hormone release, which may elevate the risk of mortality, in particular from cardiovascular-related events. 8 Overqualification -where educational attainment is higher than occupational skill requirements -is a status inconsistency measure of increasing relevance. In 2008, 28% of Canadians in nonmanagement occupations were overqualified, with higher rates among immigrant 9 and younger workers. 10 While post-secondary educational attainment in Canada is increasing rapidly, the occupational skill level distribution of the labour market has not changed to the same extent. 10 These trends suggest that the prevalence of overqualification will likely continue to rise, underscoring the importance of understanding the relationship between overqualification and health.There are mixed results on the association between overqualification and health, with some studies finding an association with coronary heart disease (CHD), 11 all-cause and CHD mortality, 12 declines in self-rated health 13 and adverse emotional outcomes. 14 However, a more recent study found no association between overqualification and cardiovascular disease (CVD).

Gradients in Depressive Symptoms by Socioeconomic Position Among Men Who Have Sex With Men in the EXPLORE Study

“…These findings are consistent with studies in the general population documenting gradients in mental health by SEP (Frank et al, 2003; Krieger et al, 1997; Marmot & Wilkinson, 2005; Smith et al, 2012). The results of the current study also correspond with the results of a study of sexually active Australian gay men found that major depression was strongly associated with socioeconomic deprivation (Mao et al, 2009).…”

“…Based on examinations of health gradients in the general population (Frank et al, 2003; Krieger, 2001; Myers, 2009; Smith et al, 2012), the following SEP characteristics were selected as independent variables: household annual income, educational attainment, and employment status. Household annual income (<$11,999, $12,000 – $29,999, $30,000 – $59,999, $60,000+), educational attainment (High school or less [including GED], Some College, College Degree, Post-College), and current employment status (Employed full-time, part-time, unemployed, or other) were measured based on categorizations previously used in other studies using EXPLORE data (Salomon et al, 2009).…”

“…SEP is well known to be associated with inverse gradients across a wide range of health outcomes, including mental health (Adler et al, 1994; Frank, Cohen, Yen, Balfour, & Smith, 2003; Krieger, Williams, & Moss, 1997; Marmot & Wilkinson, 2005; Smith, Smith, Etches, & Mustard, 2012). The social gradient theory of health suggests that a person’s health status is a function of their SEP and, through the structured nature of social processes, is liable to selective accumulation of future advantage or disadvantage (Marmot & Wilkinson, 2005).…”

“…For men in particular, low income has been found to be associated with disproportionately higher rates of ill health, with income gradients more pronounced and non-linear than those for women (Frank et al, 2003). While there is evidence of a strong association between SEP and health gradients in studies of general populations (Adler et al, 1994; Frank et al, 2003; Krieger et al, 1997; Marmot & Wilkinson, 2005; Smith et al, 2012), there is a paucity of research on gradients among sexual minorities. The consideration of SEP to understand the health of sexual minority men has been largely limited to the field of sexual health (HIV in particular), where they are used as both correlates and moderators of studied relationships (Halkitis & Figueroa, 2013; Janssen, de Wit, Hospers, & van Griensven, 2001; LA McGarrity & Huebner, 2014; Raymond et al, 2014).…”

Educational mismatch and mortality among native‐born workers in Sweden. A 19‐year longitudinal study of 2.5 million over‐educated, matched and under‐educated individuals, 1990–2008

“…The later study (Smith et al . ) included a nationally representative Canadian 15% sample of individuals aged 25 to 64 years with a mortality follow up from 1991 to 2001. Cox proportional hazard regression was used.…”