Variations in the relation between education and cause-specific mortality in 19 European populations: A test of the “fundamental causes” theory of social inequalities in health

Mackenbach, Johan P.; Kulhánová, Ivana; Bopp, Matthias; Deboosere, Patrick; Eikemo, Terje Andreas; Hoffmann, Rasmus; Kulik, Margarete C.; Leinsalu, Mall; Martikainen, Pekka; Menvielle, Gwenn; Regidor, Enrique; Wojtyniak, Bogdan; Östergren, Olof; Lundberg, Olle

doi:10.1016/j.socscimed.2014.05.021

Cited by 181 publications

(192 citation statements)

References 48 publications

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“…An observation supporting this theory is that despite the major improvements in risk factors that have historically been the link between SES and health status, such as problems in sanitation or lack of medicine, the association between low SES and diseases continues to exist (Willson 2009). A recent study conducted in 16 European countries supports the theory by confirming that people with low education have higher mortality risk; however the risk differs across the causes of death and across populations (Mackenbach et al 2014).…”

Section: Theory Of Fundamental Causesmentioning

confidence: 84%

Barriers to outdoor physical activity and unmet physical activity need in older adults

Eronen

Bonsdorff

Törmäkangas

et al. 2014

Preventive Medicine

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Physical activity is a basic need, also in old age. However, many older people cannot fulfil this need, often due to walking limitations causing imbalance in person-environment fit. Decreased physical activity can lead to unmet physical activity need and restriction on life-space mobility. The opportunities to remain physically active depend on various factors, not all of which are equally achievable for all older adults. The aim was to investigate disparities in physical activity among older community-dwelling people, with a focus on functioning, environmental barriers and facilitators, and socioeconomic status (SES).The data were drawn from two studies conducted in Central Finland: Screening and Counseling for Physical Activity and Mobility (632 participants, 75% women, mean age 77.6) and Life-Space Mobility in Old Age (848 participants, 62% women, mean age 80.1). Walking limitations, SES, social support, environmental facilitators for outdoor walking and barriers to outdoor physical activity were self-reported. The outcome measures were unmet physical activity need, walking limitation and life-space mobility.Five outdoor physical activity barrier profiles were identified, in which people differed in health and functioning and vulnerability to the challenges of the environment. A higher number of environmental facilitators decreased the risk for walking limitation. The risk for unmet physical activity need increased along with the number of individual and environmental outdoor physical activity barriers, but was highest among people whose poor health and functioning hindered them from going outdoors. Low SES was associated with more restricted life-space mobility and unmet physical activity need, especially among persons with walking limitations.Disparities in physical activity can be traced back to various individual, social and environmental factors. The importance of the environment for physical activity is considerable especially among older people with walking limitations. Keywords ACKNOWLEDGEMENTSThis study was carried out at the Gerontology Research Center, Department of Health Sciences, University of Jyväskylä, Finland. My deepest gratitude goes to the supervisors of this thesis, Professor Taina Rantanen and Mikaela von Bonsdorff, PhD. Taina, I can't stop wondering how you always have solutions to the most complex problems and answers to even the trickiest questions. I highly value your knowledge and experience in the field of gerontology and feel proud that I have been able to conduct my PhD thesis under your supervision. Mikaela, thank you for always having time for me and my questions, especially during the first year of my PhD studies. I admire your enthusiasm towards research and appreciate the guidance and advice that you have given me. I feel that we have become friends during these years. I sincerely thank Professor Teppo Kröger for his interest and supportive comments on this work. I also want to thank Research Director Katja Kokko at the Gerontology Research Center, and Director of t...

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Section: Theory Of Fundamental Causesmentioning

confidence: 84%

Barriers to outdoor physical activity and unmet physical activity need in older adults

Eronen

Bonsdorff

Törmäkangas

et al. 2014

Preventive Medicine

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“…By the mid-2000s, the north-south gradient was even more notable, as relative mortality disparities continued to increase in the north but stayed fairly steady in the south (38). Relative disparities in mortality from preventable causes, which should be especially sensitive to income inequality if the rich and well-educated take the most advantage of prevention and treatment (15,45,48,49), follow the same north-south gradient (37).…”

Section: Cross-sectional Data: At a Single Point In Time Does The Lementioning

confidence: 99%

“…Such research will have to dig deeper into exactly who is affected by income inequality and how they are affected because these effects are unlikely to be uniform across time, place, or personal characteristics. In the literature we reviewed, for example, SES disparities in relative mortality are typically larger for men than for women, larger among younger than among older adults, and larger for preventable causes of death than for nonpreventable causes (37,48). Trends in disparities vary for different diseases and measures of health (23,45), by age, gender, and race/ethnicity, and for different measures of SES.…”

Section: Conclusion and Directions For Researchmentioning

confidence: 99%

The Health Effects of Income Inequality: Averages and Disparities

Truesdale¹,

Jencks

2016

Annu. Rev. Public Health

117

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Much research has investigated the association of income inequality with average life expectancy, usually finding negative correlations that are not very robust. A smaller body of work has investigated socioeconomic disparities in life expectancy, which have widened in many countries since 1980. These two lines of work should be seen as complementary because changes in average life expectancy are unlikely to affect all socioeconomic groups equally. Although most theories imply long and variable lags between changes in income inequality and changes in health, empirical evidence is confined largely to short-term effects. Rising income inequality can affect individuals in two ways. Direct effects change individuals' own income. Indirect effects change other people's income, which can then change a society's politics, customs, and ideals, altering the behavior even of those whose own income remains unchanged. Indirect effects can thus change both average health and the slope of the relationship between individual income and health.

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“…Accounting for this selection leads to a reduction of educational gains, especially for the low educated. This challenges the large educational impacts on cause specific hazards reported in the literature Kulhánová et al 2014;Mackenbach et al 2015). Our contribution to the literature is twofold.…”

Section: Conclusion and Discussionmentioning

confidence: 97%

“…Most of the studies on educational gains in cause-specific mortality ignore that education attainment depends on observed and unobserved factors, such as parental background and cognitive ability, that also influence mortality later in life (e.g. see Huisman et al 2005;Kulhánová et al 2014;Mackenbach et al 2015). Individuals with higher cognitive abilities may not only reach higher education levels but also better health outcomes.…”

Section: Introductionmentioning

confidence: 99%

Education, cognitive ability, and cause-specific mortality: A structural approach

2018

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Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. The Institute for the Study of Labor (IZA) in Bonn is a local and virtual international research center and a place of communication between science, politics and business. IZA is an independent nonprofit organization supported by Deutsche Post Foundation. The center is associated with the University of Bonn and offers a stimulating research environment through its international network, workshops and conferences, data service, project support, research visits and doctoral program. IZA engages in (i) original and internationally competitive research in all fields of labor economics, (ii) development of policy concepts, and (iii) dissemination of research results and concepts to the interested public. Terms of use: Documents in D I S C U S S I O N P A P E R S E R I E S Education, Cognitive Ability and Cause-SpecificIZA Discussion Papers often represent preliminary work and are circulated to encourage discussion. Citation of such a paper should account for its provisional character. A revised version may be available directly from the author. 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.JEL Classification: C41, C32, I14, I24

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Variations in the relation between education and cause-specific mortality in 19 European populations: A test of the “fundamental causes” theory of social inequalities in health

Cited by 181 publications

References 48 publications

Barriers to outdoor physical activity and unmet physical activity need in older adults

Barriers to outdoor physical activity and unmet physical activity need in older adults

The Health Effects of Income Inequality: Averages and Disparities

Education, cognitive ability, and cause-specific mortality: A structural approach

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