Educational expansion and inequalities in mortality-A fixed-effects analysis using longitudinal data from 18 European populations

Olof Östergren; Olle Lundberg; Barbara Artnik; Matthias Bopp; Carme Borrell; Ramune Kalediene; Mall Leinsalu; Pekka Martikainen; Enrique Regidor; Maica Rodríguez-Sanz; Rianne de Gelder; Johan P Mackenbach

doi:10.1371/journal.pone.0182526

Educational expansion and inequalities in mortality-A fixed-effects analysis using longitudinal data from 18 European populations

PLoS One. 2017 Aug 23;12(8):e0182526. doi: 10.1371/journal.pone.0182526. eCollection 2017.

Authors

Affiliations

¹ Centre for Health Equity Studies (CHESS), Stockholm University / Karolinska Institutet, Stockholm, Sweden.
² Department of Public Health, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
³ Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland.
⁴ Agència de Salut Pública de Barcelona, Barcelona, Spain.
⁵ Lithuanian University of Health Sciences, Kaunas, Lithuania.
⁶ Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden.
⁷ Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia.
⁸ Department of Sociology, University of Helsinki, Helsinki, Finland.
⁹ Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain.
¹⁰ Department of Public Health, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands.

Abstract

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.

MeSH terms

Adult
Europe / epidemiology
Female
Health Status Disparities*
Humans
Longitudinal Studies
Male
Middle Aged
Mortality*

Grants and funding

This work was supported by a grant (FP7-CP-FP grant no. 278511) from the European Commission Research and Innovation Directorate General, as part of the “Developing methodologies to reduce inequalities in the determinants of health” (DEMETRIQ) project. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.