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Social Science & Medicine 66 (2008) 620–636 www.elsevier.com/locate/socscimed
A broader perspective on education and mortality: Are we inﬂuenced by other people’s education?
Department of Economics, University of Oslo, P.O. Box 1095, Blindern, 0317 Oslo, Norway Available online 19 November 2007
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 personyears 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. r 2007 Elsevier Ltd. All rights reserved.
Keywords: Education; Family; Municipality; Parents; Sibling; Spouse; Mortality; Norway
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
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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
E-mail address: firstname.lastname@example.org 0277-9536/$ - see front matter r 2007 Elsevier Ltd. All rights reserved. doi: 10.1016/j.socscimed.2007.10.009
2003. & Valkonen. also in Nordic countries (Blomgren. de Graaf. 1995. Makela. probably because of both selection (e. 1992b). there has been a rapidly increasing interest in multilevel analysis of socioeconomic health inequalities (Pickett & Pearl. & Cagney. Haynes. Because there is mixed evidence about these effects of other people’s education. at least for certain groups of men (Carmelli. & Johansson. Stolzenberg. which of course is closely related to economic resources (Geronimus & Bound. one that deals with the importance of the spouse’s resources. Some studies of men’s health and mortality have shown that wife’s education has a beneﬁcial effect (Bosma. Sundquist. Lillard & Waite. Haynes. & Feinleib. Robert. & Davey Smith. which has a nation-wide population register. 1993. In fact. Sturmans.. Martkainen. or quite few earlier studies on which to base conclusions. & Merlo. Hayward & Gorman. Wen. van Lenthe. Swan. While it has been reported repeatedly that the married have lower mortality than the non-married. 1999). Jaffe. 2004). Grabauskas. net of his or her own resources. Eisenbach. & Feinleib.g. Such studies help us build up a more complete picture of the social inequalities in health. The present analysis is based on data from Norway. a new investigation based on a large data set with precise information on education should be valuable. 1985. The focus is on education. 2004. Browning. ¨ ¨ Rosvall. but such effects have been reported for women also (Beebe-Dimmer et al. 1988). 2007a. often used. 2003). Much less attention has been devoted to average education. The impact of childhood socio-economic position has received far more attention. Kauppinen. 2004. Kravdal / Social Science & Medicine 66 (2008) 620–636 621 resources of other people may affect a person’s health. Weiss. Earlier studies have either included only the spouse’s education. & Kraaykamp. & Rennert. Martikainen. These studies ¨ have largely dealt with the importance of aggregate income. Kunst. 2003). there are also investigations pointing in the opposite direction: in a recent Norwegian analysis of relatively young people. Goldman.. It may be just as relevant to include in a multilevel analysis as various income indicators. Monden. though her own education may be more important (Monden. two studies that included measures of both aggregate income and aggregate education showed that the effects of the latter were the strongest (Kravdal. Low self-esteem among these men and a less supportive home environment because of the wives’ work were among the suggested explanations. 2006. and where educational differentials in mortality have been reported to be no less pronounced than in other rich countries (Mackenbach. 1995. Strogatz. Gerdtham & Johannesson 2004. van Lenthe et al. have shown adverse effects of wife’s education. & Selmer.. 1984). and theoretically meaningful indicator. & Valkonen. & Geurts. The population registration system allows identiﬁcation of family members and includes . Lillard & Panis. & Manor. The present study brings together three strands of this type of research. Chaix. Tverdal. 2004. poverty concentration and unemployment. and one that deals with the importance of the resources in the community. Suarez & Barrett-Connor. That would make it easier to compare the effects. Groenhof.. 2004). there is less certainty about the effects of the characteristics of the partner. which is a readily available. Appels. Most of these studies have focused on men’s health and shown beneﬁcial effects of parental resources (Galobardes. but also may pick up other factors. 2003). which might provide some clues about the underlying mechanisms. Monden. Eaker. and there has been large variation in the results. 2002. Eaker. only the parents’ education. and there has been some concern about the quality of the parental resource indicators. van Lenthe et al. 1983. 1997). Siscovick. Lynch. 1996) and truly causal effects of marriage and marital status changes (e. 1992a. 2004). 2007b. although the control for own resources has not always been very good.g. Over the last 10–15 years. It would be even more valuable if all the education variables could be considered in the same analysis. 1996. or only the average education in the community (in addition to the person’s own education. 2001. However. & Gostautas. Umberson. Malmstrom. 1983. Egeland. Smith & Zick. Neumark. largely from earlier periods. of course). Osler et al. 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. 2003. 2006. 1998). Meyer. 2007). although opinions differ about its strength compared to that of the man’s own education (Jaffe et al. adverse effects of parents’ education appeared (Strand & Kunst. Other studies.ARTICLE IN PRESS Ø. & Rosenman.. one that deals with the importance of the parents’ resources. 2006. 2001. Cavelaars.
. 1986) and other family members may send signals that are important. consciousness about being able to inﬂuence one’s health and life situation. 2003. colleagues. the ability to process new information of relevance for health. de Graff. and neighbours. which are linked with education. and there may also be a more passive imitation of health behaviour driven by a desire to gain others’ approval (Helleringer & Kohler. This is not because of transmission of fatal infections. sibling. 2006) and children. Gilpin. 1992). In particular. The consideration of a broad set of education variables should help to enrich this discussion. Wickrama. may be transmitted directly to other people through observation and communication. parents-inlaw. but for more social reasons.ARTICLE IN PRESS 622 Ø. former spouse. While it is especially spouses’ education that may operate through such a channel. Parizot. Montgomery & Casterline. The main pathways are reviewed below. date of death. and sibling-in-law is related to men’s and women’s all-cause mortality at the relatively low ages of 30–53. & Pierce. who may get very worried and stressed or ﬁnd too little time for their own needs. Learning and imitation Let us start with the possible ‘spill-over’ effect of other people’s education through social interaction: health knowledge and attitudes. Some reasons why others’ education may be important A person’s own education has been thought to affect his or her mortality through. but it is discussed how various mechanisms may contribute to the education-mortality relationships. Also the education of other people may operate through the person’s knowledge. 1992). siblings (Needle et al.. although not for all the same reasons as the other education variables. a better-educated spouse may contribute much to the family’s pool of economic resources (Smith & Zick. Much of this inﬂuence from parents may come at a low age. Adding to the pool of resources Sharing of resources is yet another channel that others’ education may operate through. which is inﬂuenced by their education. Distefan. & Chauvin. the speciﬁc health knowledge obtained at school. Ross & Mirowsky. Navaie-Waliser. a discrete-time hazard regression model is estimated to describe how the average educational level in the municipality and the education of parents. & Elder. for example. In particular. also the health of people outside the nearest family may be of some importance. those struggling with serious diseases may be a burden to their partners (Chaix. though the process is not easy to measure (Monden. Conger. there is typically an exchange of knowledge about prevention and treatment of illnesses. In addition. and many socially advantaged parents may provide economic assistance even when the child is an adult (Cooney & Uhlenberg. As elaborated on below. and the higher incomes resulting from the skills taught in school and the credentials (e. there may be direct economic beneﬁts from living in a community with a high average level of education. and education. Christiakis & Allison. so that the education in a wider community may have an impact. 1999). Viboud. attitudes and economic resources. In addition. net of their own education. and one typically interacts with friends. In marital relationships in particular. Choi. the data do not allow statistical identiﬁcation of the causal pathways that the different education variables may operate through. one may indeed learn from and imitate parents also (Farkas. 1999. 1996). Unfortunately. Effects of others’ health problems One may also be affected by family members’ actual health. This is further dealt with below.g. but with long-term consequences. More precisely. 1994). which is no longer a big issue in rich countries. 2006. but may well have an inﬂuence. and the partners may adopt each other’s life style and attitudes. & Kraaykamp. spouse. The educational levels of former spouse. Wallace. A strong economy may in turn facilitate the engagement in activities that make life pleasant or are more directly health-promoting. sibling and inlaws have never been included in mortality models before. 1999). but other mechanisms may be involved as well. and in many societies it increases the chance of receiving highquality health services. who in turn interact with others. Tambs & Moum. 2005. Kravdal / Social Science & Medicine 66 (2008) 620–636 highly reliable information about municipalities of residence.
Quality of health services and other structural factors The education of people in the community is potentially important because it may inﬂuence society in ways that affect everyone. 2004. For example. the individual under consideration may receive better help. a larger proportion of them may have got inadequate nutrition through childhood. may create harmful stress (Vernon & Bufﬂer. Hill. 2006. people make comparisons with single individuals (Buckingham & Alicke. 1975). with ﬁnancing from national sources. After all. most hospitals and health centres in Norway are public. though the evidence is not very solid (Elstad. Besides. 2004. Further. but when many local people are well educated. in addition to operating through the social interaction mechanism just mentioned. 2004). but one may well question the relevance of any hypothesis of this nature. We do not know much about the effect of that. and thus present less competing demand for health services. and high individual incomes may trigger the establishing of some smaller private health services. which signals some acceptance of a discrepancy. Perhaps a low education compared to others has a similar impact. Kawachi. Whether there is an effect beyond that depends partly on how visible the education of other people in the community is. On the other hand. 1998). which in turn reﬂect socio-economic resources even further back in time. 2001. whether related to income or other status indicators. and are subjected to national quality regulations. however. 1998)) insufﬁcient measures to prevent illness may have been taken. Subramanian. and if such issues were important. Besides. is on the current level of education in the municipality where the person currently lives. Hayward. but it has been argued that a low income compared to others in the community may produce a psychosocial stress that increases mortality. 1997). & Crimmins. Doyle. it was pointed out in some of the studies reporting adverse effects of wife’s education that men with well-educated wives may have lower self-esteem than other men at the same educational level. 2002. The focus in this paper.. & Almeida-Filho. These and other factors may have led to childhood infections and other diseases. which may be linked with certain potentially fatal diseases at adult age (Blackwell. one has chosen to marry and remain married. Harmful effects of low relative education All the mechanisms suggested so far would contribute to a low mortality among those who have well-educated family members or live in a community with many well-educated people. In line with this idea. which in principle may affect the person’s mortality through childhood health. Another possibility is that a higher level of education may increase the chance that the individual has a wellpaid job in the advanced service sector. Alper. and it has ` been suggested that a ‘status discrepancy’ vis-a-vis a spouse. For example. Kravdal / Social Science & Medicine 66 (2008) 620–636 623 Childhood health The socio-economic resources in the family of origin. & Drevenstedt. Galobardes et al. Wilkinson. are determined or signalled especially by the parents’ education. Such effects may not be immediate. The factors discussed in the literature are that people who have parents with little resources on average may have been weaker already at the time of birth because of the mother’s health and life style during pregnancy. For example. Dahl. or (unless outweighed by a beneﬁcial impact of lesseducated mothers’ lower rate of employment (Coreil. a person’s health is inﬂuenced by the quality of both current and earlier health services in the community. A low relative education is at least linked with a low relative income. one . but harmful effects are also possible. education is a major determinant of income. Lynch et al. 1988). 2000. which may offer some health advantages. there is a possibility of an opposite effect (in societies with high child mortality): survivors of poor conditions at low age may be selected for good health or have acquired immunity (Preston..ARTICLE IN PRESS Ø. 2002). when other people have better health because of better education. Wagstaff & van Doorslaer. Wood. it is perhaps easier to recruit qualiﬁed health personnel. Wilson. gender-neutral versions of such hypotheses would seem most plausible. In countries where women generally have almost as high education as men. if not higher. & Hofoss. Cohen. those who are surrounded by well-educated people have a lower relative education than others. Others have suggested that it may be problematic to have a partner with lower education (Pearlin. Turner. they may more often have been exposed to secondhand smoke or other environmental hazards. & Liller. A strong public economy resulting from a high average education may allow more generosity with respect to social support (which is the municipalities’ responsibility). & Skoner. given one’s own education.
For some of these malignancies and the cardiovascular diseases. coming from poorly educated families may be an indication of a strong personal drive. it is also possible that there is a special group of people with certain characteristics linked to good health that have migrated to or remained in a municipality with high average education. smoking. 2007. little physical activity and various other lifestyle factors may be involved in the aetiology. It is indeed documented that parental expectations can be an important source of stress (Wang & Heppner. For similar reasons. according to Statistics Norway. political and environmental characteristics of municipalities that may contribute to a high average education (in addition These mechanisms should be of importance for mortality also at the quite low ages considered here. so that the spouse has been in a position to ‘pick and choose’ (Becker. All these risk factors may in turn be affected by other people’s education through some of the channels discussed above. The same types of arguments may be applied with respect to parents’ and other family members’ education. such characteristics may also be picked up by sibling’s education. among those with little education. 1991). or whether the associations are partly or fully a result of certain characteristics of these people (or places) affecting both their education and the individual’s mortality. 2007a) and other violent deaths (16%. In . there are a number of economic. involving the absolute level of parents’ education rather than the relative. it is by no means obvious that well-educated parents are particularly critical and demanding of their adult children (Umberson. 1998. Conversely. colorectal. an association between individual mortality and other people’s education may not only reﬂect causal mechanisms such as those discussed above. Some of these deaths may be traced back to psychosocial stress or lifestyle factors such as alcohol and drug abuse (Brismar & Bergman. as opposed to 5%). For example. which may have harmful consequences regardless of the children’s own education. However. high fat intake. cultural. Similarly. For example. Leistikow. having well-educated parents. 2000). Relevance for both young and older adults Unfortunately. In this study. Martin. Under-achievement compared to parents may perhaps be perceived as particularly problematic. when various lifestyle factors have had more time to make themselves felt. might be that well-educated parents tend to expect much from their children. Jacobs. only a control for the population size of the municipality is included (see below). as opposed to 1% for the total population. Another issue is that we do not know whether it is other people’s education itself that is potentially important. breast. Giner et al. assuming that a high education is highly valued by potential partners. Potential confounders to perhaps being inﬂuenced by it) and also affect individual mortality. compared to 25% in the total population). and may have an impact on the health of the person in focus. given own education. A related problem is that own education is determined by unobserved factors that are associated with parents’ education. although perhaps not as much as at the higher ages. Kravdal / Social Science & Medicine 66 (2008) 620–636 might expect to see sharper links between heterogamy and divorce (Lyngstad. through for example the skills or attitudes developed at school or the credentials earned. may be a signal that the person has had health or behavioural problems in adolescence. A somewhat different hypothesis. Marriage and (lack of) migration reﬂect choices that are inﬂuenced by the person’s own characteristics. sibling’s or parents’ intellectual resources and interests have been key factors behind their education. A relatively large proportion of the deaths at age 30–53 are a result of suicides (9% at age 35–54 in 2004. & Noderer. Rocke. though not as common as in the total population (38%).. lymphatic/haemapoietic and pancreatic cancers are the most common types (in descending order).ARTICLE IN PRESS 624 Ø. spouse’s. which could have implications for mortality at adult ages. In principle. given parents’ special position as role models and educators (while there possibly may be a corresponding pleasure to be derived from overachievement). 1992b). which typically is linked with high education for the child. 2004). but to a lesser extent. One trivial reason is that people are not assigned randomly to places of residence and spouses. Cancer is responsible for the largest number of deaths (34% at age 35–54. having a well-educated spouse may be a result of own resources beyond education and even a good health. Lung. 2002). among those with high education. Also cardiovascular diseases are a quite common cause of death among these relatively young adults (16% at age 35–54). For example.
These parent–child links were used to ﬁnd siblings. Parents are identiﬁed for almost everyone born in Norway after 1965. and there are deﬁnitely sex differences in the causes of death. some authors have suggested that boys and girls respond differently to signals from parents (Flay et al. a large proportion of the non-married live in consensual unions and their partners are not identiﬁed. Most importantly. if there is a similar advantage to be drawn from having a superior position. The education of various family members was added through a series of record linkages. beneﬁts from own. show that about 40% of the non-married at age 30–54 were cohabiting (Statistics Norway. who grew up when children’s health was generally good even among the least advantaged. On the one hand. 1994).e. the chance of dying at young adult age depends on whether people seek and get good professional help for their diseases or lifestyle problems. if any. Smith and Waitzman (1994) showed more harmful effect of own poverty among the non-married than among the married. there are 15. 2007b). they are identiﬁed largely on the basis of co-residence in the 1970 census. and the main source is the Norwegian population register. and others have pointed to differences in the concern about relative economic deprivation (Yngwe. it would seem likely that men and women with little education are those who beneﬁt most from economic contributions from others and from the various types of community support. For example. Dideriksen. and date of death. Unfortunately. To shed light on these issues. which may also be linked to others’ education. For each person. there are typically differences between the wife’s and husband’s economic contributions. few studies have addressed this and theoretical predictions can point in either direction. & Burstrom.ARTICLE IN PRESS Ø. which is in the middle of the period under analysis. those born 1973 or earlier. Kravdal / Social Science & Medicine 66 (2008) 620–636 625 addition. and perhaps the strength of their voices when it comes to health issues in the family. Moreover.8 million person-years of follow-up (from 1980 to 2003). an adverse effect (beneﬁcial effect of low education among others) would also show up among the better educated. It is impossible to predict what all this should add up to. one would expect to see the most adverse effect of others’ education among the least educated.. For example. the mechanism involving childhood health may be of particularly little relevance for the youngest cohorts.and outmigration. highest educational level achieved as of 1 October every year from 1980 and as of 1970. However. Among men. The analysis is restricted to ages above 30. Material and methods Some of the effects that are reviewed above may depend on the person’s own educational level.3 million person-years. as well as information on marital status 1 January each year from 1974 and spouse’s identity. because of the very low mortality at lower ages. ﬁgures from 1993–1995. we do not know the composition of the person’s household. while. the spouse may also buffer any discomfort stemming from high education among other people. while the corresponding numbers among women are 7928 deaths and 9. . the possibility of marital status differentials is taken into account. Interactions with own education dance with that. for those born earlier. there is a unique anonymous identiﬁcation code. dates of any in. i. Variations across sex and marital status The effects of others’ education may depend on the person’s sex as well. it is possible that education effects vary across marital status. but they do not receive much attention. To the extent that the argument about low relative education is relevant. However. because of the limitations on identiﬁcation of parents. In this analysis. The 1950 cohort is chosen as the oldest. which includes everyone living in Norway after 1960. parents’ or other people’s resources may be less important for a person who is married and may enjoy some of these advantages anyway through the spouse’s support. municipality of residence every month since 1964. Unfortunately. Lundberg. models are estimated separately for four different levels of own education in this analysis. Fritzell. In accorData The data cover the period up through 2003. information has been extracted from the 1970 census and Statistics Norway’s education ﬁles. 2003). On the other hand. In addition.764 deaths during the 9. ¨ Besides. For example.
One-year observations starting at a time when the person under consideration is temporarily abroad or before ﬁrst immigration are ignored. where pijt is the probability that person i in municipality j dies within the year t. When constructing the latter. However.) Experimentation showed that one year was a sufﬁciently short observation length. 1995. perhaps because the person does not exist) or not relevant (as for a spouse when the person is not married).administrative units in the country and the lowest aggregate level deﬁned in the data. As part of the present analysis. and ending in 2003 or the time of death or last emigration. Marital-status indicators are also included. (ii) lower-secondary (11–12 years). 1996). 13. were added in preliminary models. but any number would do. the education is set to 10. the model is logðpijt =ð1 À pijt ÞÞ ¼ b1 X ijt þ b2 Z jt . A dummy (0/1 variable) for ‘own education unknown’ is therefore included. (This choice is not critical. Oslo. beginning in January the year the person turns 30. When a model was estimated in NLMIXED/SAS for the sub-group of bettereducated men (see motivation for that limitation below). Without such a term. and 18. Some authors have shown that such a missingindicator approach may give biased estimates even when the missing values appear ‘completely at random’. but are not important for the results. a very simple model including only age. Norway includes 433 municipalities. two dummies are included for each of the relatives. Kravdal / Social Science & Medicine 66 (2008) 620–636 Estimation of discrete-time hazard models For each person. without affecting other estimates. and there are four other large urban . Variables The education variables refer to the number of years of schooling normally needed for the educational level recorded as the highest attained as of the year in focus. using 16 and 19 instead of 15 and 18 gave almost the same results. it was experimented with the exclusions of persons with missing values for the education of family members that were identiﬁed (existing). a series of one-year observations is created. The other signals unknown education. whatever comes ﬁrst. one runs into space constraints with MLwiN and numerical underﬂow with aML. Unfortunately. For example. and Zjt is a vector of characteristics of the municipality. (iv) some college (14–17). Five educational levels are deﬁned. Xijt is a vector of characteristics of person i in municipality j at the start of t. Dummies indicating whether the relative was dead or emigrated. average education and a dummy for large city could be estimated. That gave almost the same results.ARTICLE IN PRESS 626 Ø. respectively. has about half a million inhabitants. Mathematically. using the SAS software. the standard error of the municipality-level effects will be biased downwards. and whether 1970 information was used. period. and argued that it would be better to leave out all observations with at least one missing variable (Greenland & Finkle. These oneyear observations include various independent variables referring to the situation at the start of the year. In addition. according to Statistics Norway’s standard: (i) compulsory (10 years). Both categorical and continuous education variables are used in the models. the last year alive in the country before that (if that year was in the 1980s).) There is missing information on education both in 1970 and the 1980s for about 2% of the relevant persons. b1 and b2 are the corresponding effect vectors. For example. and the outcome variable is whether the person died within the year. 15. (iii) higher-secondary (13 years). convergence was still not attained after 200 h with a well-equipped PC and reasonable starting values. 2003). and a logistic model is estimated from the resulting sample. Jones. so that one gets an exaggerated impression of their importance (Goldstein. One signals whether the relative is unidentiﬁed (identiﬁcation number not found. which are the lowest political. and (v) higher education (18 years or more). The size of the municipalities differs greatly. In either case. In this model. Ideally. the standard error of the effect of average education was 19% larger than it was without inclusion of the municipality-level error term. it is difﬁcult to handle multilevel models with so many observations and variables as in this study with the commercially available software. the capital. one should include a random term at the municipality level to account for unobserved characteristics at that level. individual education. 11. (About 2% are censored because of emigration. or 1970 (if last year alive in the country was 1970–1979). years of education in the ﬁve categories are set to 10. All observations for all persons are pooled together.
the average population size is about 7000. which in the Norwegian context should also reﬂect density quite well.722**** 0.310–0.712) 14–17 years 0. Additional effect for the never marriedc 10 yearsb 0 0 11–12 years 0. the correlations are actually not very strong (between 0.505**** 0.433**** 0.993 (0.778) 0 1.352–0.505–0.649**** 0.165**** (1.092–1.998 (0. One might perhaps hesitate to include so many potentially correlated education variables in one model.909–1. but very modestly—except when own education was added—and the standard errors did not increase much.848–1.218*** (1. Effects for the married 0 10 yearsb 11–12 years 0.354) Own education.958 (0.833) (0. Age and year are additional continuous control variables.. Several model speciﬁcations were tried and the effect of one education variable did of course change when others were added. and controlling for differences in age composition did not matter either.530) Women 0 0.042 (0.265) 1.847) (0. with a variation from 200 to 75 000.071–1.933 0.456**** (0. while those from a corresponding model with continuous education variables are shown in Table 2.922) 14–17 years 0.023–1.044–1.626) 18+ years 0. which may also affect health through different mechanisms (Chaix et al.657–0.484–0.5.2 and 0.073–1. and because the data set is also very large.647) (0.733–0.155** (1.054) 0. A ﬁne categorization of both variables was tried and gave the same results.454–0.107**** (1. correlation table can be obtained from the author). Among the other municipalities.825) 18+ years 0.543–0.335) 1.572**** (0. Kravdal / Social Science & Medicine 66 (2008) 620–636 627 municipalities with a population of 100 000–250 000.314) 1.579**** 0.039) 0.781) 14–17 years 0.041–1.667) 0.515–0. The latter variable is included because high average education may be partly a result of an urban environment (see earlier discussion about confounders). continuous education variables are used in the remaining analysis for simplicity.083) 0.984–1.964 (0.068*** (1.872) (0.615–0.075) 1.813) Education of mother 10 yearsb 11–12 years 13 years 14–17 years 18+ years Education of father 10 yearsb 11–12 years 13 years 14–17 years 18+ years 0 0.207**** (1. Taking averages over 30–49 or 30–89 instead gave similar results.237**** (0.843–1.019 0. and the population size of that municipality (grouped into 10 categories).856) 13 years 0.949–1.720) Own education.104) 1.278) 0 1.142) (0.114) 1.224 (0.015–1.392–0.832) 0.634) 0.566**** (0.572) (0. would have Table 1 Effects of various education variables on mortality at age 30–53 among Norwegian women and men born 1950–1973 (odds ratios with 95% conﬁdence intervals)a Men Own education.ARTICLE IN PRESS Ø. of course.121*** (1.652**** (0.010 (0.569–0.798–1.651**** (0.470) 1.630–0.685**** (0.052–1.502**** (0.208) 1.159–0.590**** (0. and that the effect of spouse’s education. Two municipality-level variables are considered: average education among women and men aged 30–69 in the municipality in which the person lived at the beginning of the one-year observation.794**** (0.614–0.701–0.170–1.911 (0.533) (0. identiﬁcation of separate effects does not seem to be a problem.910–1.174) 1.753**** (0. An interaction between own education and marital status is included.727–1.860) 13 years 0.523–0.750**** (0.339) 0 1.959–1.519–0.411) 0 Education of oldest sibling 10 yearsb 0 .446–0. Preliminary model experimentation showed that it was strongly signiﬁcant.197*** (1.040) 13 years 0.871–1.311**** (1.503**** (0.597–0. Because the latter model seems to reveal the main patterns well enough.593) 18+ years 0.025) (0.724**** 0. 2006).568**** (0. which is only relevant for the married. Results Estimates from a model with categorical variables for own and family members’ education are shown in Table 1. Leaving out the person in focus when calculating the average has no impact on the results.426–0. Other potentials confounders were not available in the data. However. Additional effect for the previously marriedc 10 yearsb 0 0 11–12 years 1.764**** (0.
864*** (0.830–1.490–0. the dividing line between ‘effect’ and ‘no effect’ is set at a signiﬁcance level of 5%.893** (0.577–0.786–1.343) 1.891–0. (For example.667–0.940) 13 years 0. ***po0.992) 0.855–1.872–1.907Ã0.646) 0 0.894 for the never-married and 0.943) 0. c To be multiplied with the effect for the married: to get the effects for this group.829–1.803–0.893**** (0.813) 0.939 (0.725–0.910–1.864*** (0.816–1.726** (0.949) 0.844–1.064) 18+ years 0.902**** (0.012) 0 0.071) 0.918) 0.062) 0.788–1.077) 1.873*** (0. a In addition to including all these education variables.921 (0.074) 14–17 years 0.550–1.905–1.783 among the never-married.882–1.756–1.708–0.01. See text for further details.180) Education of oldest sibling-in-law 10 yearsb 0 11–12 years 0. Besides. the models include age (continuous).) Moreover.050) 1.10.824–1.852–0.750**** (0.945 (0. A very similar interaction pattern appeared if only the education variables that are relevant for all marital status groups were included.349) *po0.857–1.919–1.971) 0.803–1.552–0.999) 0. while the effect of own education for married men is 0. interactions between marital status and some other education variables.032) 0 0.825*** (0.943 (0.542–0–974) Education of mother-in-law 0 10 yearsb 11–12 years 0.932 (0. (Throughout this presentation of results. b Reference category.915* (0.097) 13 years 14–17 years 18+ years Ø.807–1.858–1.840 (0.009) 0.656–0. Kravdal / Social Science & Medicine 66 (2008) 620–636 Table 1 (continued ) Men 0.854–0. These are described below.891–1.874) 0.839) 18+ years 0.001 two-tailed test.935 for the previously married.918.706*** (0.031 (0.681–0.965 (0. they include indicators for each family member of whether he or she is identiﬁed or relevant and whether an educational code is found. The corresponding interaction effect for the previously married is 0.929 (0.051) been much weaker if this interaction had not been included.798*** (0. The conﬁdence intervals for the municipality-level effects are somewhat too small because it was impossible to add a municipalitylevel random term to the intercept.943 (0.612–0.804**** (0.983 (0. and not the education of spouse and inlaws: 0.734–0.779) Women 0.808–1. though less than own education.013) 0.822–0.924** (0. This was the case for women also).960 (0. This is because having no such interaction in the model means that one assumes the same effect of own education for all marital status groups.749**** (0.030) 0.961) 0.809) 0 0.051) 0.618**** (0.ARTICLE IN PRESS 628 Table 1 (continued ) Men 11–12 years 13 years 14–17 years 18+ years Average education in municipality Education of spouse 10 yearsb 11–12 years 13 years 14–17 years 18+ years 0.818–0. The same results appeared when the youngest sibling was considered .778** (0.907.862–0.053) 0.043) 14–17 years 0.107) 0.838–0. Education of former spouse 10 yearsb 0 11–12 years 0.777–0.863 and 0. but weaker.730**** (0.102 (0.778–1.004) 13 years 0. and does not allow the effect for the married to be weaker.970) 0.884–1.964 (0.891) 0.935* (0. rather than 0. while only father’s education has such an effect on men’s mortality.786**** (0.788*** (0.989) 0 0.863 ¼ 0.111) Women 0.683**** (0. widowed.05. There are also signiﬁcant.981) 0.576) Education of father-in-law 10 yearsb 0 11–12 years 0.940 (0. the spouse and the former spouse reduces mortality for both sexes. Both mother’s and father’s education are positively associated with women’s mortality. ****po0. divorced and separated. **po0.935*** (0.931 (0.985 (0.959 (0.927) 0.244) 0.918.841) 14–17 years 0.670–0.889**** (0.693–0.114 (0.901 (0.798–0.428–1.997) 13 years 0.955) 0.869–1. the education of the oldest sibling.892* (0.912) 0.954 (0. it is 0.891*** (0.845–1.940 (0.903) 0 0.942 (0. period (continuous). size of the population (in 10 categories) and dummies for never-married.103) 18+ years 0.794–0.923** (0.
000) 0.984–1.920) 0. instead of the oldest. There are indications of an opposite pattern for women.987) 0.937–0.961**** (0.967–1. **po0.895–0. which supports the idea of such variations. there is also a signiﬁcantly reduced mortality among those who have a father-in-law with some secondary education compared to those whose father-in-law has only compulsory education. primarily for men.051**** (1.942) 0. there are indications of a sharper effect of spouse’s education at low than at high levels of own education. but the effect would have remained signiﬁcance even with a 37% increase of the standard error.953**** (0.896–0.030–1.935–0.914**** (0.037**** (1.036) 0.97.847–0. Inclusion of interactions with marital status or stratiﬁed estimation reveals that there are some variations in the education effects across marital status. To learn more about them. one gets an exaggerated impression of signiﬁcance.871**** (0. With respect to the average education in the municipality.09 for men and p ¼ 0. a signiﬁcantly reduced mortality is seen for those with a father-in-law who has a higher education.001 two-tailed test.959–1.014) 1.980–1. while for women. a beneﬁcial effect is only rather weakly indicated (p ¼ 0.041) 0.93–0. (iii) the effect of former spouse’s education is strongly signiﬁcant according to a model estimated separately for the previously married (about 0. The education of the in-laws appears to be of little importance. Kravdal / Social Science & Medicine 66 (2008) 620–636 Table 2 Effects of various education variables on mortality at age 30–53 among Norwegian women and men born 1950–73 (odds ratios with 95% conﬁdence intervals)a Men Own education For the married Additional effect for the never married Additional effect for the previously married Education of mother Education of father Education of oldest sibling Average education in municipality Education of spouse Education of former spouse Education of mother-in-law Education of father-in-law Education of oldest siblingin-law Women 629 0.02).820–0. (ii) the effect of average education on men’s mortality is sharpest among the married (signiﬁcant only in a model estimated for married men exclusively.014) 0.943**** (0.988) 0. for example because a feeling of inferiority has a harmful inﬂuence while there is no advantage to be drawn from superiority.05.15 for women in these model where standard errors are biased downwards and we therefore get an exaggerated impression of signiﬁcance).98).969–0.918**** (0.942) 1.947 (0.011) 0.999 (0.01.973–1.986 (0. with CI 0. The conﬁdence intervals for the municipality-level effects are somewhat too small because it was impossible to add a municipality-level random term to the intercept.018) *po0.003) 0. ***po0.983** (0. 0.958**** (0.052) 0. ****po0.932) 0. Model experimentation revealed that some cross-level interactions were signiﬁcant.974–1.957–1. and a signiﬁcant negative relationship appears only in the highest educational category (Table 3).963–0.907**** (0. For men.912**** (0.863**** (0.92–1. a The model are the same as those shown in Table 1.992 (0. but let us brieﬂy note the main patterns: (i) the effect of father’s education is somewhat sharper among the never-married than among the other groups. but no clear trend appears in the coefﬁcient across educational levels.897) 0. In addition. As explained above.945–0.927–0.95 for both sexes. while it is insigniﬁcant when the model is restricted to the currently married (about 0.960) 0.008) 0.015-1.025**** (1. A particularly interesting result is that the effects of mother’s and father’s education do not vary systematically with own education. In these models without a municipality-level random term. but the interaction between own education and average education is not signiﬁcant. These variations are not central to the analysis.880–1.893–0. The clearest variation is seen for the effect of average education on men’s mortality: the point estimate declines from higher than 1 to below 1 with increasing level of own education.978) 0.956* (0. it is possible that the effects of others’ education vary with the person’s own education.847–0.900 with CI 0.980* (0. models are estimated separately for the three lowest educational levels and the two highest combined.022–1. except that the education variables are continuous.10.019) 0. There is some evidence for a negative relationship between the education of the oldestsibling-in-law and men’s mortality. See text for further details.007 (0.880) 0.988).073) 1. .882–0.975**** (0.972) 0.978**** (0. which is more than the 19% seen in experiments with a corresponding multilevel model with fewer variables (see above). with CI 0.907–1.979) 1.999 (0.ARTICLE IN PRESS Ø.
whose education is controlled for.993–1.739–0.034) 1.070) 0.957) 0.944 (0.025) 1. ****po0.058) *po0.912–1.980 (0.044**** (1.966* (0. as that person is more distant.022) 1.179) 0.019) 0.953–1. Kravdal / Social Science & Medicine 66 (2008) 620–636 Table 3 Effects of various education variables on mortality at age 30–53 among Norwegian women and men born 1950–73 (odds ratios with 95% conﬁdence intervals).945–0.017) 1.982) 0.999–1. by level of own educationa 10 years of education Men Education of mother Education of father Education of oldest sibling Average education in municipality Education of spouse Education of former spouse Education of mother-in-law Education of father-in-law Education of oldest sibling-in-law Women Education of mother Education of father Education of oldest sibling Average education in municipality Education of spouse Education of former spouse Education of mother-in-law Education of father-in-law Education of oldest sibling-in-law 11–12 years of education 13 years of education 14+ years of education 0.092) 0.997–1.026) 0.061) 0. Discussion The education of the oldest sibling and sibling-in-law Earlier mortality studies have not checked the importance of siblings’ education.885 CI 0.961–1.053) 0.982) 0.916–1.014 (0. while the corresponding numbers for women are 1870.958–0.702–0.952*** (0.968 (0.946–1.068** (1.070) 0. Because the effect of average education on men’s mortality was found to differ between the married and the non-married when men in all educational categories were considered together.007 (0.809–1.039) 1.985–1.922–1.062) 0.007 (0.104) 1.172) 0.904–0. The very modest evidence for an effect of the education of the sibling-in-law is hardly surprising.067) 1. a The models are the same as those shown in Table 2.992–1.059) 0.030) 1.021) 1.021–1.040) 0.984 (0.967–1.951–1.996 (0.977** (0.828** (0.001 (0.020) 0.990) 1.981** (0.941*** (0.002) 0.003) 0.996 (0.740–1.014 (0.959–1.892–0.887–0.01.107) 1. but such variations are not explored in this analysis.947–1.958**** (0.029) 1.136) 0.970 (0.007) 1.934–0.972–1.023 (0. which in this study reﬂects the importance of the education of other people than the spouse (and other close family members perhaps living in the municipality).659–0.997) 0. The number of deaths in the four education categories for men are 3960.959* (0.933–1.995 (0.983) 0. except that own education is left out for those with 10–13 years of education. it is at least more than outweighed by effects contributing in the opposite direction.931–1.977 (0.057 among the non-married).947**** (0.004 (0.018) 1.920–0.988) 0.053) 0.003 (0.015) 1.948 (0.005) 0.946–1.961**** (0. 900. given the negative estimates for betterand less-educated alike. The conﬁdence intervals for the municipality-level effects are somewhat too small because it was impossible to add a municipality-level random term to the intercept.960) 1.929–1.921–1.004 (0.882–1.001 two-tailed test.983–1.015) 1.032* (0.042) 0.ARTICLE IN PRESS 630 Ø.903–1.958–1.950** (0. The estimates generally pointed towards more beneﬁcial effects of average education for the married than the nonmarried.013 (0.918–1.949 among the married.024* (0.975–1.900–0.042) 0.930–1.041**** (1. **po0.839*** (0.976–1.037*** (1. 5724.119) 1.972 (0.949) 1. 2729 and 2551.969 (0.061** (1.069 (0.950–1.007–1. as opposed to 0. Average education in the community There are several reasons why one should expect a beneﬁcial effect of average education.974–1.985 (0.803–1.993 (0. the models shown in Table 3 were also estimated for the married and non-married separately.007 (0.047) 0.064) 0.930–0.980 (0.10.031 (0.974 (0.021 (0.034) 0. ***po0.917–1.913 (0.994 (0. and the difference was most pronounced for those with high education (0.982 (0. 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.944–1.979–1.866–1.085) 0.988 (0.022** (1.018–1.962* (0.017) 1.002 (0.953) 0. Just as one apparently . Effects of siblings’ and sibling-in-law’s education might depend on age differences and distances between places of residence.066) 1.924**** (0.042) 1.930–1. 1536.920 (0.025–1.931–1.047) 1.991 (0.014 (0.970*** (0.928–1.923–0.070) 0.000–1.917**** (0. If there really is a stressful effect operating through low relative education (or beneﬁcial effect of high relative education).961–1. 3194.975) 0.021) 1.019 (0.929–1.980–1.945–1.950–0.955** (0.974–1.045) 0.052 (0.071) 0.030 (0.064**** (1.030) 0.05.910**** (0.791 CI 0.983–1.031) 0.046) 1.235) 1.976) 0.959*** (0.014) 1.989 (0.958–1.978) 0.991) 1.052) 0.921–0.996) 0.863–0. See text for further details.969–1.999 (0.779–1.010) 1.012–1.003–1.034) 0.961–1.001 (0.
but this effect seems at least not to be strong enough to outweigh all the advantages of having a welleducated spouse. because of the clear positive association between the own and parents’ education. even after a marital disruption. would help for a better-educated man to move to a municipality with many well-educated people. In addition. In contrast to what has been reported by some authors. colleagues or neighbours in the municipality (while this causal channel would have appeared less likely if there were no effect of sibling’s education). As an illustration of that. however. Anyway. for example. Thus. Once again. which have typically also considered older age groups and often used other indicators of socio-economic status and poorer control for own position. beyond his or her education. Such adverse education effects were estimated also in another Norwegian study (Strand & Kunst. have pointed in the opposite direction. One might argue that a high education of a spouse also could be problematic because the person under consideration might feel inferior (perhaps depending on whether the situation was foreseen when the couple decided to marry). for the previously married. as reported also by others. It is more difﬁcult to understand why a beneﬁcial effect should be restricted to men. See Appendix Table A1 for results from a simple analysis. it should be kept in mind that selective migration and common community factors behind average education and mortality in principle may have biased the estimates in any direction. Bentley.) Other investigations. however (2%). a beneﬁcial effect is seen only among men who themselves have high education or are married. one year of additional education for a spouse is associated with a 6% reduction of a man’s mortality. Turrell. 2006). selection may be involved as well: having a well-educated spouse may to some extent be a result of the person’s own resources. Education of parents The adverse effects of mother’s or father’s education stand in contrast to the beneﬁcial effects of spouse’s and sibling’s education and average education (for some groups). one may beneﬁt from social interaction with friends. very similar effects of parents’ education appeared. but this is because it tends to get high Education of spouse The education of the spouse or. the average education may. the newborn child of a well-educated couple has a particularly good chance of a long life. for example. Bromm. and especially married men. while the corresponding effect of his own education is 9%. there were beneﬁcial effects of parents’ education in the Norwegian data when own education was left out (see Appendix Table A1). Kravdal / Social Science & Medicine 66 (2008) 620–636 631 learns from and imitates siblings. or that health could be improved by encouraging the spouse to return to school to ﬁnish a degree. This is in line with other recent studies. based on almost the same young cohorts and the same type of data. we cannot be really sure that any given person can add years to life by choosing a spouse with much rather than with little education. Earlier studies provide no clues. Marital status differentials in the effect of community socioeconomic resources have never been addressed before. 2007). In other words. Such a stress component among the less educated may outbalance the beneﬁcial effect stemming from other factors. one should be careful to give the estimates a causal interpretation and conclude that it. For example. but if these variables were left out of the present analysis. but have not been reported from other countries. However.ARTICLE IN PRESS Ø. Thus. and it is of course possible that the characteristics that have stimulated a spouse to take high education may be responsible for much of the lower mortality. This interaction with own education would be consistent with an idea that those with little education may feel stressed by being surrounded by people with higher education. As pointed out above. who probably also have higher incomes (which may be a more visible characteristic). there are several plausible reasons why partner’s education may contribute positively to a person’s health. while there is no corresponding advantage of high relative education among the better-educated. and no clear conclusions can be drawn from the few investigations that have considered sex differentials in such effects (Kavanagh. Sibling’s education has weaker impact. affect the quality of health services and some other structural factors. the former spouse is negatively associated with mortality according to the Norwegian data. spouse’s education has less importance than own education. both for women and men. . however. (That study did not include the education of other family members or people in the municipality. & Subramanian. A good control for own position is indeed important.
such as cancer. and there is not a correspondingly pronounced link between father’s and son’s education. that the overall mortality of a couple with high education is even lower compared to that of a lesseducated couple than one might assume from estimated effects of own education. Moreover. less clearly. However.. Conclusion In addition to conﬁrming the sharply protective effect of one’s own education on mortality. Similarly. There are also effects of the education of the oldest sibling and. of the siblingin-law. that parental resources improve childhood health. as few signiﬁcant effects of parents-in-laws’ education appear. one may be more directly affected by the parents-in-law. Net of that. the parents’ education is adversely linked with mortality. the results might reﬂect that the harmful effects of parents’ education tend to be most dominant for the causes of death that are most relevant for women. if mother’s education tends to be a particularly strong determinant of a daughter’s education. but a beneﬁcial effect appears among men with college education. 1994). there is some evidence that girls are more inﬂuenced by parents’ health behaviour than boys (Flay et al. which in turn may have implications for the partner’s mortality. for better or worse. First. The average education in the municipality is not generally associated with mortality.. the effects of parents’ education were not particularly sharp among the least educated. although one’s own education is more important. In principle. mortality is lower among those who have or have had a welleducated spouse than among those with a less educated spouse. Such knowledge may be valuable both for health personnel directly involved in support and treatment. If that also means that they feel more stressed by parental demands. this study based on a large. Alternatively. Education of parents-in-law With respect to parents-in-law’s education. 2007). for example. which are seen especially with respect to mother’s education.ARTICLE IN PRESS 632 Ø. Most importantly. parents’ education may be correlated with the person’s own endowments. The sex differences in the effects of parents’ education. One implication of these ﬁndings is. though probably less than by parents. by how they have achieved relative to their parents. Finally. as seen also in another Norwegian study (Strand & Kunst. A more adverse effect for women might also reﬂect that they are more inﬂuenced. 2003). through for example learning about health behaviour or comparison. are hard to understand. though. and for politicians and planners who are . but this would be inconsistent with some recent ﬁndings about sex-speciﬁc responses to economic deprivation (Yngwe et al. For example. Documentation of such a pattern is lacking. although not necessarily with exactly the same strength. On the other hand. the subgroup with better-educated parents may have had serious problems with implications both for their educational careers and their mortality as adults. Second. Parents’ education should operate through the same mortality-depressing factors as spouse’s education. upward educational mobility may signal special resources. behaviour and interests in adolescence. though probably not very likely in these Norwegian cohorts. Kravdal / Social Science & Medicine 66 (2008) 620–636 education. among those who themselves have low education. Another possibility. rather than that of a son. It is also possible. the spouse’s health and health behaviour may be affected adversely through the same channels as just described. the effect is partly or fully a result of selection: as explained earlier. with possibly beneﬁcial long-term consequences. parents’ education affects mortality adversely. the observed differences might be due to selection. because both partners beneﬁt for the other’s education. Why then do we see these adverse effects? One might perhaps suspect that those who attain a low level of education compared to their parents suffer from a feeling of inferiority. which is also supported by the data. It would seem reasonable that such effects are weak. This has not always been found in other studies. two types of mechanisms might be relevant. the prediction could go in either direction. high-quality data material documents that the education of close family members also matters. Unfortunately. which suggests that there either is no such relative-education effect or that there is also a corresponding beneﬁt of a high relative education among the better-educated. though without substantiation in the literature. the literature provides a weak basis for further speculation about these possibilities. may be that well-educated parents are more demanding and have high expectations that are perceived as burdening for the children regardless of their own achievements.
932**** 0. Table A1 Effects of own and parents’ education on mortality at age 30–53 among Norwegian women and men born 1950–1973.799**** 0. and in common with most other studies of the education-mortality relationship.036**** 0.10.032**** 0. .015* 0.048**** *po0. rather than the entire population. ***po0.05. The patterns may be quite similar in other countries. given the possibility of confounding. as many of the mechanisms suggested here as potentially responsible for the links between others’ education and mortality seem broadly relevant.01.970**** 0.976** 0.844**** 1. a person should not necessarily expect that ﬁnding a well-educated partner or moving to a community with a high average education will be beneﬁcial to his or her health. mother’s or father’s education are missing are excluded.995 1. Appendix A Effects of own and parents’ education on mortality at age 30–53 among Norwegian women and men are shown in Table A1. the strength of the various relationships may well differ.991 0. In particular. The models only include age and period in addition to the education variables for which estimates are shown in the column of estimates. ****po0. However.805**** 1. the additional support from the Norwegian Research Council. It is certainly possible that those who get a good education themselves may beneﬁt from that. differences in educational levels between communities may have a particularly modest effect in Norway because of national regulation of social and health services and intra-national economic transfers. and that there are advantageous ‘spill-over’ effects on other as well.001 two-tailed test. Other effects might have been seen in the older population.985** 0.799**** 1. **po0. education may have less impact on people’s economic resources in a Nordic egalitarian welfare country with generally low income inequality (United Nations. and not cohabitants.ARTICLE IN PRESS Ø.807**** 0. The educational level among people in a smaller community might have had another effect than the municipality-level average. and the helpful comments from Emily Grundy and four anonymous reviewers are greatly appreciated. and the childhood-health argument may be even less relevant for young Norwegians than for their contemporaries in other countries. Fourthly.983 0. 2006) than elsewhere.838**** 1. Kravdal / Social Science & Medicine 66 (2008) 620–636 633 concerned about social inequalities in health and mortality and need as complete picture as possible about these inequalities.845**** 1. An additional complicating factor in such a prediction would be that a higher education for some people would increase the chance of others taking more education. Unfortunately.912**** 0. and the estimates should not be used to predict how a further expansion of education in Norway will affect the level of mortality. The support from the centre. but there is uncertainty even about the ﬁrst of these causal effects. as discussed above.859**** 0.949**** 0. Another is that the data only allowed relatively young adults to be considered.067**** 0. and economic resources may be less important for health. according to different models (odds ratios without conﬁdence intervals)a Men Own education Education of mother Education of father Women Own education Education of mother Education of father 0. the study has four major limitations. the municipality is the lowest possible level of aggregation. Thirdly. Acknowledgement This study was largely carried out while the author was at the Centre for Advanced Studies at the Norwegian Academy of Science.033**** 0. In this case. one cannot know whether the estimates reﬂect only causal effects. One is that only spouses could be identiﬁed. three main types of confounders seem plausible. a Persons for whom own. Moreover. Moreover.045**** 1. One of them is linked in particular to parents’ education and may explain why the estimated effect of that education variable is different from those of all others.
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