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Understanding the Educational Gradient in Mortality
Stockholm University, Faculty of Social Sciences, Department of Sociology.ORCID iD: 0000-0002-7156-3260
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

There is a positive association between education and longevity. Individuals with a university degree tend to live longer than high school graduates who, in turn, live longer than those with compulsory education. These differences are neither larger nor smaller in Sweden than in other European countries, despite its ambitious welfare-state policies. Furthermore, educational differences in longevity are growing, especially among women.

In this thesis I look at the structural, individual and behavioral processes which generate and maintain the educational gradient in mortality. This is done by compiling theoretical insights and empirical research from a range of scientific disciplines. In doing so, this thesis aims to contribute to a more comprehensive understanding of the educational gradient in mortality.

Several factors contribute to the association between education and health. Social and biological processes initiated in early life influence both educational achievement and adult health. Education helps individuals become more effective as agents by fostering generic skills such as information-gathering and decision-making. This aspect of education, learned effectiveness, promotes control and health regardless of available resources and prevailing conditions. Education thus has a direct influence on health. Education also indirectly influences health by giving access to better occupational positions and higher incomes, as well as by promoting social capital and healthy habits.

The empirical section of the thesis consists of four separate quantitative studies using register data. Three of the studies use Swedish national register data while one uses register data from 18 European populations. The results indicate that widening income inequalities in mortality have contributed to a widening of educational inequalities in mortality, since education is a determinant of income. Both alcohol and smoking contribute to educational inequalities in longevity, but smoking has played an especially pronounced role in the widening of inequalities among women. Smoking represents a significant part of the explanation as to why women with low education have experienced smaller gains in life expectancy than the rest of the population. The results also indicate that the general trend towards more well-educated populations has contributed to the widening educational inequalities in mortality in Europe and that education is a stronger predictor of mortality among low income-earners than among the rest of the population.

Place, publisher, year, edition, pages
Stockholm: Department of Sociology, Stockholm University , 2017.
Series
Health Equity Studies, ISSN 1651-5390 ; 23
Keyword [en]
social inequalites in health, education, mortality, register data, Sweden, smoking, alcohol
National Category
Sociology (excluding Social Work, Social Psychology and Social Anthropology)
Research subject
Sociology
Identifiers
URN: urn:nbn:se:su:diva-146655ISBN: 978-91-7649-889-7 (print)ISBN: 978-91-7649-890-3 (electronic)OAI: oai:DiVA.org:su-146655DiVA: diva2:1138281
Public defence
2017-10-27, hörsal 11, hus F, Universitetsvägen 10 F, Stockholm, 10:00 (English)
Opponent
Supervisors
Note

At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 4: Manuscript.

Available from: 2017-10-04 Created: 2017-09-04 Last updated: 2017-09-20Bibliographically approved
List of papers
1. Growing gaps: the importance of income and family for educational inequalities in mortality among Swedish men and women 1990–2009
Open this publication in new window or tab >>Growing gaps: the importance of income and family for educational inequalities in mortality among Swedish men and women 1990–2009
2015 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 6, 563-570 p.Article in journal (Refereed) Published
Abstract [en]

Aims: Although absolute levels of mortality have decreased among Swedish men and women in recent decades, educational inequalities in mortality have increased, especially among women. The aim of this study is to disentangle the role of income and family type in educational inequalities in mortality in Sweden during 1990-2009, focusing on gender differences. Methods: Data on individuals born in Sweden between the ages of 30 and 74 years were collected from total population registries, covering a total of 529,275 deaths and 729 million person-months. Temporary life expectancies (age 30-74 years) by education were calculated using life tables, and rate ratios were estimated with Poisson regression with robust standard errors. Results: Temporary life expectancy improved among all groups except low educated women. Relative educational inequalities in mortality (RRs) increased from 1.79 to 1.98 among men and from 1.78 to 2.10 among women. Variation in family type explained some of the inequalities among men, but not among women, and did not contribute to the trend. Variation in income explained a larger part of the educational inequalities among men compared to women and also explained the increase in educational inequalities in mortality among men and women. Conclusions: Increasing educational inequalities in mortality in Sweden may be attributed to the increase in income inequalities in mortality.

Keyword
Health inequalities, education, income, mortality, gender, register data
National Category
Public Health, Global Health, Social Medicine and Epidemiology Sociology
Research subject
Sociology
Identifiers
urn:nbn:se:su:diva-117200 (URN)10.1177/1403494815585401 (DOI)000360391600002 ()
Available from: 2015-05-13 Created: 2015-05-13 Last updated: 2017-09-07Bibliographically approved
2. The contribution of alcohol consumption and smoking to educational inequalities in life expectancy among Swedish men and women during 1991–2008
Open this publication in new window or tab >>The contribution of alcohol consumption and smoking to educational inequalities in life expectancy among Swedish men and women during 1991–2008
2017 (English)In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objectives

To assess the level and changes in contribution of smoking and alcohol-related mortality to educational differences in life expectancy in Sweden.

Methods

We used register data on the Swedish population at ages 30–74 during 1991–2008. Cause of death was used to identify alcohol-related deaths, while smoking-related mortality was estimated using lung cancer mortality to indirectly assess the impact of smoking on all-cause mortality.

Results

Alcohol consumption and smoking contributed to educational differences in life expectancy. Alcohol-related mortality was higher among men and contributed substantially to inequalities among men and made a small (but increasing) contribution to inequalities among women. Smoking-related mortality decreased among men but increased among women, primarily among the low educated. At the end of the follow-up, smoking-related mortality were at similar levels among men and women. The widening gap in life expectancy among women could largely be attributed to smoking.

Conclusions

Smoking and alcohol consumption contribute to educational differences in life expectancy among men and women. The majority of the widening in the educational gap in mortality among women can be attributed to alcohol and smoking-related mortality.

Keyword
Mortality, Health inequalities, Alcohol, Smoking, Registers
National Category
Public Health, Global Health, Social Medicine and Epidemiology Sociology
Research subject
Sociology
Identifiers
urn:nbn:se:su:diva-146139 (URN)10.1007/s00038-017-1029-7 (DOI)
Available from: 2017-08-23 Created: 2017-08-23 Last updated: 2017-11-06
3. Educational expansion and inequalities in mortality — A fixed-effects analysis using longitudinal data from 18 European populations
Open this publication in new window or tab >>Educational expansion and inequalities in mortality — A fixed-effects analysis using longitudinal data from 18 European populations
Show others...
2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 8, e0182526Article in journal (Refereed) Published
Abstract [en]

Objective

The aim of this paper is to empirically evaluate whether widening educational inequalities in mortality are related to the substantive shifts that have occurred in the educational distribution.

Materials and methods

Data on education and mortality from 18 European populations across several decades were collected and harmonized as part of the Demetriq project. Using a fixed-effects approach to account for time trends and national variation in mortality, we formally test whether the magnitude of relative inequalities in mortality by education is associated with the gender and age-group specific proportion of high and low educated respectively.

Results

The results suggest that in populations with larger proportions of high educated and smaller proportions of low educated, the excess mortality among intermediate and low educated is larger, all other things being equal.

Conclusion

We conclude that the widening educational inequalities in mortality being observed in recent decades may in part be attributed to educational expansion.

National Category
Public Health, Global Health, Social Medicine and Epidemiology Sociology
Research subject
Sociology
Identifiers
urn:nbn:se:su:diva-146158 (URN)10.1371/journal.pone.0182526 (DOI)000408355800027 ()
Available from: 2017-08-24 Created: 2017-08-24 Last updated: 2017-11-29Bibliographically approved
4. Educational inequalities in mortality are larger at low levels of income
Open this publication in new window or tab >>Educational inequalities in mortality are larger at low levels of income
(English)Manuscript (preprint) (Other academic)
National Category
Sociology (excluding Social Work, Social Psychology and Social Anthropology)
Research subject
Sociology
Identifiers
urn:nbn:se:su:diva-146653 (URN)
Available from: 2017-09-04 Created: 2017-09-04 Last updated: 2017-09-07Bibliographically approved

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