1
|
Guo Y, Yang F. Spousal education and frailty levels among Chinese older adults: A national longitudinal study. SSM Popul Health 2024; 26:101607. [PMID: 38516527 PMCID: PMC10955636 DOI: 10.1016/j.ssmph.2024.101607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/11/2024] [Indexed: 03/23/2024] Open
Abstract
Background Prior research has identified one's own education level as a risk factor for frailty. However, the association between spousal education and frailty in later life is uncertain. We aim to examine the longitudinal association between spousal education and frailty levels among Chinese older populations. Methods 3856 participants aged 60 and older from the 2011-2018 China Health and Retirement Longitudinal Study were analyzed. A 54-item deficit cumulative frailty index was developed to evaluate frailty levels at each follow-up. Linear mixed-effects models were used to examine the longitudinal association of spousal education with frailty levels, and whether this association varied by sex and own education level. Results Higher spouse education was associated with lower frailty levels, and this association decreased with age. Compared with older adults whose spouses had no formal education, older adults whose spouses had less than middle school education had an 8.82 lower level of frailty (95% CI: 15.05 to -2.58, P < 0.01); those with spouses with middle school education and above had a 23.44 lower level (95% CI: 31.43 to -15.44, P < 0.001). Stratified analysis showed that every additional year of spouse education was also associated with lower frailty levels in non-frail participants at baseline, but stronger among those already frail. The association between high spousal education and lower frailty did not vary by sex or own education. Conclusion This study reveals a significant association between having a more educated spouse and lower later-life frailty levels for both older men and women, regardless of one's own educational background. It emphasizes the importance of leveraging educated spouses to prevent and manage frailty.
Collapse
Affiliation(s)
- Yujia Guo
- School of Health Policy & Management, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, Jiangsu Province, China
| | - Fan Yang
- School of Public Health, NHC Key Lab of Health Technology Assessment (Fudan University), Fudan University, 130 Dong-An Road, Shanghai, 200032, China
- NHC Key Lab of Health Technology Assessment (Fudan University), Fudan University, 130 Dong-An Road, Shanghai, 200032, China
| |
Collapse
|
2
|
Fletcher J, Noghanibehambari H. The effects of education on mortality: Evidence using college expansions. HEALTH ECONOMICS 2024; 33:541-575. [PMID: 38093403 PMCID: PMC10900482 DOI: 10.1002/hec.4787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 02/03/2024]
Abstract
This paper explores the long-run health benefits of education for longevity. Using mortality data from the Social Security Administration (1988-2005) linked to geographic locations in the 1940-census data, we exploit changes in college availability across cohorts in local areas. Our treatment on the treated calculations suggest increases in longevity between 1.3 and 2.7 years. Some further analyses suggest the results are not driven by pre-tends, endogenous migration, and other time-varying local confounders. This paper adds to the literature on the health and social benefits of education.
Collapse
Affiliation(s)
- Jason Fletcher
- La Follette School of Public Affairs, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | |
Collapse
|
3
|
Liu H, Chopik WJ, Shrout MR, Wang J. A national longitudinal dyadic analysis of spousal education and cognitive decline in the United States. Soc Sci Med 2024; 343:116603. [PMID: 38281387 PMCID: PMC10923139 DOI: 10.1016/j.socscimed.2024.116603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 01/30/2024]
Abstract
Education plays a significant role in shaping cognitive functioning throughout an individual's life. However, existing research has not adequately explored how the educational attainment of the spouse can impact cognitive functioning over time. This study presents one of the first longitudinal analyses of how spousal education is linked to cognitive trajectories of each member within couples during their later life in the United States. Guided by the linked lives perspective, we analyze data from 8370 couples in the Health and Retirement Study spanning from 2000 to 2018. Results from the Actor-Partner Interdependence Model (APIM) integrated with latent growth curve models reveal that cognitive trajectories exhibit a correlation between spouses over time. Moreover, our analysis uncovers gender-specific effects of spousal education on cognition, shedding light on the underlying mechanisms driving this connection. Notably, the lower educational attainment of husbands is associated with a faster cognitive decline in both themselves and their wives. This association is partially explained by economic resources, but not by health and social behaviors. The lower educational attainment of wives is linked to their own faster cognitive decline as well as lower initial cognitive levels of their husbands, in part via economic resources. However, wives' educational attainment is largely unrelated to their husbands' cognitive decline. Intriguingly, wives' education has a more pronounced impact on the health and social behaviors of their husbands than vice versa, although these health and social behaviors do not appear to influence husbands' cognitive decline. In conclusion, these results underscore the importance of considering spousal education in comprehending the complexities of cognitive decline within dyadic relationships.
Collapse
Affiliation(s)
- Hui Liu
- Department of Sociology, Purdue University, USA; Center on Aging and the Life Course, Purdue University, USA.
| | | | - M Rosie Shrout
- Center on Aging and the Life Course, Purdue University, USA; Department of Human Development and Family Science, Purdue University, USA
| | - Juwen Wang
- Department of Sociology, Purdue University, USA; Center on Aging and the Life Course, Purdue University, USA
| |
Collapse
|
4
|
Mustafa A, Jungari S, Shekhar C. Relationship between children’s educational attainment and parental depression among Indian elderly parents. ASIAN POPULATION STUDIES 2023. [DOI: 10.1080/17441730.2023.2193515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
|
5
|
Lamu AN, Chen G, Olsen JA. Amplified disparities: The association between spousal education and own health. Soc Sci Med 2023; 323:115832. [PMID: 36947992 DOI: 10.1016/j.socscimed.2023.115832] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Abstract
Positive associations between own educational attainment and own health have been extensively documented. Studies have also shown spousal educational attainment to be associated with own health. This paper investigates the extent to which spousal education contributes to the social gradient in health, net of own education; and whether parts of a seeming spousal education effect are attributable to differences in early-life human capital, as measured by respondents' height and childhood living standard. Furthermore, we investigate the relative contribution of predictors in the regression analysis by use of Shapley value decomposition. We use data from a comprehensive health survey from Northern Norway (conducted in 2015/16, N = 21,083, aged 40 and above). We apply three alternative health outcome measures: the EQ-5D-5L index, a visual analogue scale (EQ-VAS) and self-rated health. In all models considered, spousal education is generally positively significant for both men and women. The results also suggest that spousal education is generally more important for men than women. In the sub-sample of individuals having a spouse, decomposition analyses showed that the relative contribution of spousal education to the goodness-of-fit in men's (women's) health was 13% (14%) with the EQ-5D-5L; 25% (20%) with the EQ-VAS and; 30% (21%) with self-rated health. Heterogeneity analyses showed stronger spousal education effects in younger age groups. In conclusion, we have provided empirical evidence that spousal education may contribute to explaining the amplified health gradient in an egalitarian country like Norway.
Collapse
Affiliation(s)
- Admassu N Lamu
- NORCE - Norwegian Research Center, Bergen, Norway; Department of Community Medicine, UiT - the Arctic University of Norway, Tromsø, Norway
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Jan Abel Olsen
- Department of Community Medicine, UiT - the Arctic University of Norway, Tromsø, Norway; Centre for Health Economics, Monash University, Melbourne, Australia; Norwegian Institute of Public Health, Oslo, Norway.
| |
Collapse
|
6
|
Halpern-Manners A, Hernandez EM, Wilbur TG. Crossover Effects of Education on Health within Married Couples. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2022; 63:301-318. [PMID: 35001695 DOI: 10.1177/00221465211063879] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Although empirical work has shown that personal and spousal education are both related to health, the nature of these associations has been harder to establish. People select into marriages on the basis of observed and hard-to-observe characteristics, complicating the job of the researcher who wishes to make causal inferences. In this article, we implement a within-sibling-pair design that exploits variation within pairs in spousal education to generate estimates of spousal crossover effects. Results-based on a long-term study of siblings and their spouses-suggest that spousal education is positively related to health, but to a greater degree for women than men. Sensitivity analyses show that these patterns are unlikely to derive from measured differences between individuals or unmeasured characteristics that sort them into unions. These results are consistent with network-based theories of social capital, which view education as a resource that can be mobilized by network ties to enhance health.
Collapse
Affiliation(s)
| | | | - Tabitha G Wilbur
- Department of Sociology, Indiana University, Bloomington, IN, USA
| |
Collapse
|
7
|
Östergren O, Fors S, Rehnberg J. Excess Mortality by Individual and Spousal Education for Recent and Long-Term Widowed. J Gerontol B Psychol Sci Soc Sci 2022; 77:946-955. [PMID: 34878543 PMCID: PMC9071383 DOI: 10.1093/geronb/gbab227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES The loss of a spouse is followed by a dramatic but short-lived increase in the mortality risk of the survivor. Contrary to expectations, several studies have found this increase to be larger among those with high education. Having a spouse with high education is associated with lower mortality, which suggests that losing a spouse with high education means the loss of a stronger protective factor than losing a spouse with low education. This may disproportionately affect the high educated because of educational homogamy. METHODS We use Swedish total population registers to construct an open cohort of 1,842,487 married individuals aged 60-89 during 2007-2016, observing 239,276 transitions into widowhood and 277,946 deaths. We use Poisson regression to estimate relative and absolute mortality risks by own and spousal education among the married and recent and long-term widows. RESULTS We find an absolute increase in mortality risk, concentrated to the first 6 months of widowhood across all educational strata. The relative increase in mortality risk is larger in higher educational strata. Losing a spouse with high education is associated with higher excess mortality, which attenuates this difference. DISCUSSION When considering the timing and the absolute level of excess mortality, we find that the overall patterns of excess mortality are similar across educational strata. We argue that widowhood has a dramatic impact on health, regardless of education.
Collapse
Affiliation(s)
- Olof Östergren
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Stefan Fors
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Johan Rehnberg
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| |
Collapse
|
8
|
Sum KK, Tint MT, Aguilera R, Dickens BSL, Choo S, Ang LT, Phua D, Law EC, Ng S, Tan KML, Benmarhnia T, Karnani N, Eriksson JG, Chong YS, Yap F, Tan KH, Lee YS, Chan SY, Chong MFF, Huang J. The socioeconomic landscape of the exposome during pregnancy. ENVIRONMENT INTERNATIONAL 2022; 163:107205. [PMID: 35349911 DOI: 10.1016/j.envint.2022.107205] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/08/2022] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND While socioeconomic position (SEP) is consistently related to pregnancy and birth outcome disparities, relevant biological mechanisms are manifold, thus necessitating more comprehensive characterization of SEP-exposome associations during pregnancy. OBJECTIVES We implemented an exposomic approach to systematically characterize the socioeconomic landscape of prenatal exposures in a setting where social segregation was less distinct in a hypotheses-generating manner. METHODS We described the correlation structure of 134 prenatal exogenous and endogenous sources (e.g., micronutrients, hormones, immunomodulatory metabolites, environmental pollutants) collected in a diverse, population-representative, urban, high-income longitudinal mother-offspring cohort (N = 1341; 2009-2011). We examined the associations between maternal, paternal, household, and areal level SEP indicators and 134 exposures using multiple regressions adjusted for precision variables, as well as potential effect measure modification by ethnicity and nativity. Finally, we generated summary SEP indices using Multiple Correspondence Analysis to further explore possible curved relationships. RESULTS Individual and household SEP were associated with anthropometric/adiposity measures, folate, omega-3 fatty acids, insulin-like growth factor-II, fasting glucose, and neopterin, an inflammatory marker. We observed paternal education was more strongly and consistently related to maternal exposures than maternal education. This was most apparent amongst couples discordant on education. Analyses revealed additional non-linear associations between areal composite SEP and particulate matter. Environmental contaminants (e.g., per- and polyfluoroalkyl substances) and micronutrients (e.g., folate and copper) showed opposing associations by ethnicity and nativity, respectively. DISCUSSION SEP-exposome relationships are complex, non-linear, and context specific. Our findings reinforce the potential role of paternal contributions and context-specific modifiers of associations, such as between ethnicity and maternal diet-related exposures. Despite weak presumed areal clustering of individual exposures in our context, our approach reinforces subtle non-linearities in areal-level exposures.
Collapse
Affiliation(s)
- Ka Kei Sum
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore.
| | - Mya Thway Tint
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Rosana Aguilera
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA
| | - Borame Sue Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sue Choo
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Li Ting Ang
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Desiree Phua
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Evelyn C Law
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Sharon Ng
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Karen Mei-Ling Tan
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Neerja Karnani
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Bioinformatics Institute, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Johan G Eriksson
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Yap-Seng Chong
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Fabian Yap
- Duke-NUS Medical School, Singapore, Singapore; Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore, Singapore; Department of Maternal-Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Mary F F Chong
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jonathan Huang
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Centre for Quantitative Medicine (CQM), Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
9
|
Youssim I, Israel S, Shapiro I, Calderon-Margalit R, Manor O, Paltiel O, Friedlander Y, Hochner H. Independent associations of inter-spousal gaps in age and education with long-term mortality and cancer survival: the Jerusalem Perinatal Study 1964 – 2016. Ann Epidemiol 2022; 70:32-36. [DOI: 10.1016/j.annepidem.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022]
|
10
|
Gilsanz P, Mayeda ER, Eng CW, Meyer OL, Glymour MM, Quesenberry CP, Whitmer RA. Participant education, spousal education and dementia risk in a diverse cohort of members of an integrated health care delivery system in Northern California. BMJ Open 2021; 11:e040233. [PMID: 34145004 PMCID: PMC8215232 DOI: 10.1136/bmjopen-2020-040233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The role of spousal education on dementia risk and how it may differ by gender or race/ethnicity is unknown. This study examines the association between one's own education separate from and in conjunction with spousal education and risk of dementia. DESIGN Cohort. SETTING Kaiser Permanente Northern California (KPNC), an integrated health care delivery system. PARTICIPANTS 8835 members of KPNC who were aged 40-55, married and reported own and spousal education in 1964-1973. PRIMARY OUTCOME MEASURE Dementia cases were identified through medical records from 1 January 1996 to 30 September 2017. METHODS Own and spousal education was self-reported in 1964-1973 and each was classified as four indicator variables (≤high school, trade school/some college, college degree and postgraduate) and as ≥college degree versus <college degree. Age as timescale weighted Cox proportional hazard models adjusted for demographics and health indicators evaluated associations between participant education, spousal education and dementia risk overall and by gender and race/ethnicity. RESULTS The cohort was 37% non-white, 46% men and 30% were diagnosed with dementia during follow-up from 1996 to 2017 (mean follow-up=12.7 years). Greater participant education was associated with lower dementia risk independent of spousal education, demographics and health indicators. Greater spousal education was associated with lower dementia adjusting for demographics but became non-significant after further adjustment for participant education. The same pattern was seen for spousal education ≥college degree (not adjusting for participant education HRspousal education≥college degree=0.83 (95% CI: 0.76 to 0.90); adjusting for participant education HRspousal education≥college degree=0.92 (95% CI: 0.83 to 1.01)). These associations did not vary by gender or race/ethnicity. CONCLUSION In a large diverse cohort, we found that higher levels of participant's own education were associated with lower dementia risk regardless of spousal education. An inverse association between spousal education and dementia risk was also present, however, the effects became non-significant after adjusting for participant education.
Collapse
Affiliation(s)
- Paola Gilsanz
- Behavioral Health and Aging, Kaiser Permanente Division of Research, Oakland, California, USA
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Los Angeles, California, USA
| | - Chloe W Eng
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Oanh L Meyer
- Department of Neurology, University of California Davis, Davis, California, USA
| | - M Maria Glymour
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Charles P Quesenberry
- Biostatistics Core, Kaiser Permanente Division of Research, Oakland, California, USA
| | - Rachel A Whitmer
- Behavioral Health and Aging, Kaiser Permanente Division of Research, Oakland, California, USA
- Department of Public Health Sciences, University of California Davis, Davis, California, USA
| |
Collapse
|
11
|
Saenz JL, Beam CR, Zelinski EM. The Association Between Spousal Education and Cognitive Ability Among Older Mexican Adults. J Gerontol B Psychol Sci Soc Sci 2020; 75:e129-e140. [PMID: 31974544 PMCID: PMC7424282 DOI: 10.1093/geronb/gbaa002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Education and cognition are closely associated, yet the role of spousal education is not well understood. We estimate the independent effects of own and spousal education on cognitive ability in late-life in Mexico, a developing country experiencing rapid aging. METHOD We analyzed 4,017 married dyads (age 50+) from the 2012 Mexican Health and Aging Study. Cognitive ability for married adults was a factor score from a single factor model. Using seemingly unrelated regression, we test whether spousal education influences older adults' cognitive ability, whether associations are explained by couple-level socioeconomic position, health and health behaviors, and social support, and whether associations differed by gender. RESULTS Education and cognitive ability were correlated within couples. Higher spousal education was associated with better cognitive ability. Associations between spousal education and cognitive ability were independent of own education, did not differ by gender, and remained significant even after adjustment for couple-level socioeconomic position, health and health behaviors, and perceived social support. DISCUSSION In addition to own education, spousal education was associated with better cognitive ability, even at relatively low levels of education. We discuss the possibility that spousal education may improve cognition via transmission of knowledge and mutually reinforcing cognitively stimulating environments.
Collapse
Affiliation(s)
- Joseph L Saenz
- Davis School of Gerontology, University of Southern California, Los Angeles
| | - Christopher R Beam
- Davis School of Gerontology, University of Southern California, Los Angeles
- Department of Psychology, University of Southern California, Los Angeles
| | | |
Collapse
|
12
|
Until Death Do Us Part. The Influence of Own and Partner's Socioeconomic Status on the Health of Spanish Middle-Aged Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134644. [PMID: 32605200 PMCID: PMC7370088 DOI: 10.3390/ijerph17134644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 11/21/2022]
Abstract
Objectives: To explore whether the influence of a partner’s socioeconomic status (SES) on health has an additive or a combined effect with the ego’s SES. Methods: With data on 4533 middle-aged (30–59) different-sex couples from the 2012 Spanish sample of the European Union Statistics on Income and Living Conditions (EU-SILC) survey, we apply separate sex-specific logistic regression models to calculate predicted probabilities of having less than good self-perceived health according to individual and partner’s characteristics separately and combined. Results: Both approaches led to similar results: Having a partner with better SES reduces the probabilities of not having good health. However, the combined approach is more precise in disentangling SES effects. For instance, having a higher educated partner only benefits health among Spanish low-educated men, while men’s health is worse if they have a working spouse. Conversely, women’s health is positively influenced if at least one couple member is economically active. Conclusions: There are significant health differences between individuals according to their own and their partner’s SES in an apparently advantageous population group (i.e., individuals living with a partner). The combinative approach permits obtaining more precise couple-specific SES profiles.
Collapse
|
13
|
Fan W, Qian Y. Rising educational gradients in mortality among U.S. whites: What are the roles of marital status and educational homogamy? Soc Sci Med 2019; 235:112365. [PMID: 31229359 DOI: 10.1016/j.socscimed.2019.112365] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/11/2019] [Accepted: 06/11/2019] [Indexed: 12/16/2022]
Abstract
The educational gradient in U.S. mortality has been rising among non-Hispanic whites. A common intuition sees the growing educational divide in marital status and increases in educational homogamy as potential explanations. To empirically assess this possibility, we analyze mortality from 1986 to 2015 using the National Health Interview Survey Linked Mortality Files (562,584 persons; 204,756 deaths). At the individual level, being unmarried and spouse's lower educational attainment are associated with higher mortality. Counterfactual analyses, however, reveal that the growing educational divide in marital status and increases in educational homogamy contribute little (8%-15%) to the widening educational gradient in mortality. Our simulation analyses further show that extreme educational divide in marital status could substantially drive up mortality inequality, whereas educational homogamy, even when pushed to the maximum level, would play a limited role in increasing mortality inequality. Combined, the results suggest that changes in the educational divide in marital status have the potential to affect mortality inequality, but the actual changes over the past decades were not strong enough to have a major impact; increases in education homogamy, in contrast, barely affect mortality inequality by education. Along with other research showing small effects of educational homogamy on income inequality, our research suggests that the consequences of changing marriage patterns for social inequalities in general and health inequalities in particular may be more limited than commonly assumed.
Collapse
Affiliation(s)
- Wen Fan
- Department of Sociology, Boston College, United States.
| | - Yue Qian
- Department of Sociology, University of British Columbia, Canada
| |
Collapse
|
14
|
Utilization and Associated Factors of Insecticide Treated Bed Net among Pregnant Women Attending Antenatal Clinic of Addis Zemen Hospital, North-Western Ethiopia: An Institutional Based Study. Malar Res Treat 2018; 2018:3647184. [PMID: 30675334 PMCID: PMC6323465 DOI: 10.1155/2018/3647184] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/14/2018] [Accepted: 11/26/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Insecticide treated bed net (ITN) is one type of cost-effective vector control approach for the prevention of malaria. It has to be treated with insecticide and needs ongoing treatment with chemicals. Malaria infcetion during pregnancy is a amajor health problem in Ethiopia. Little is known about the utilization of ITN by pregnant women in the study area. This study was aimed to assess utilization and associated factors of insecticide-treated nets among pregnant women in Adis Zemen Hospital. Methods This hospital based cross-sectional study was conducted in Adis Zemen from May 1 to 30, 2018, among 226 pregnant mothers. After obtaining informed consent, data were collected using a pretested structured questionnaire via face to face interview. To reach the study unit, a systematic random sampling technique was used. The collected data were entered, cleaned, checked using Epi data version 3.1, and finally analyzed using SPSS version 20. Binary and multivariable logistic regressions were computed to identify significantly associated variables at 95% confidence interval. Result A total of 226 pregnant mothers attending antenatal clinics participated in making the response rate 100%. Among a total 226 subjects, 160(70.8%) of mothers had good utilization of insecticide bet net. Mothers who had an educational status of college and above were 2.8 times more likely to utilize insecticide-treated bed net than mothers who could not read and write (AOR; 2. 8: CI; 1.9, 6.5). Mothers whose age was >30 were 70% times less likely utilized insecticide-treated bed net than mothers whose age was 30 and less (AOR;.3: CI;.2,.6). Conclusion and Recommendation Utilization of insecticide-treated bed net by pregnant women is low in the study area. The participants' age, educational status, household monthly income, and husband educational status were significantly associated with utilization of insecticide-treated bed net. Different stakeholders shall give a special attention to awareness creation on advantageous of insecticide bed net.
Collapse
|
15
|
Murakami K, Ohkubo T, Hashimoto H. Socioeconomic Inequalities in Oral Health Among Unmarried and Married Women: Evidence From a Population-Based Study in Japan. J Epidemiol 2018; 28:341-346. [PMID: 29576603 PMCID: PMC6048301 DOI: 10.2188/jea.je20170088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Socioeconomic inequalities in oral health have been reported in developed countries, but the influence of marital status has rarely been considered. Our aim was to examine marital status differentials in the association between socioeconomic status (SES) and oral health among community-dwelling Japanese women. Methods From 2010 to 2011, a questionnaire survey was conducted among residents aged 25–50 years in Japanese metropolitan areas. Valid responses were received from 626 unmarried women and 1,620 married women. Women’s own and husbands’ educational attainment and equivalent income were used to assess SES. Self-rated “fair” or “poor” oral health was defined as poor oral health. Multiple logistic regression analysis was conducted to examine which SES indicators were associated with oral health. Results The prevalence of poor oral health was 21.1% among unmarried women and 23.8% among married women. Among unmarried women, equivalent income was not associated with oral health, but women’s own education was significantly associated with oral health; the multivariate-adjusted odds ratio of poor oral health among those with high school education or lower compared to those with university education or higher was 2.14 (95% confidence interval, 1.19–3.87). Among married women, neither women’s own nor husbands’ education was associated with oral health, but equivalent income was significantly associated with oral health, particularly among housewives; the multivariate-adjusted odds ratio of poor oral health among those in the lowest compared with highest income quartile was 1.57 (95% confidence interval, 1.08–2.27). Conclusions These findings indicate that marital status should be considered when examining associations between SES and oral health among Japanese women.
Collapse
Affiliation(s)
- Keiko Murakami
- Department of Hygiene and Public Health, Teikyo University School of Medicine.,Department of Health and Social Behavior, School of Public Health, The University of Tokyo
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine
| | - Hideki Hashimoto
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo
| |
Collapse
|
16
|
Zang E, Zheng H. Does the sex ratio at sexual maturity affect men's later-life mortality risks? Evidence from historical China. Soc Sci Med 2018; 202:61-69. [PMID: 29510303 PMCID: PMC6458052 DOI: 10.1016/j.socscimed.2018.02.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/12/2018] [Accepted: 02/23/2018] [Indexed: 11/22/2022]
Abstract
This study examines the relationship between the male-to-female sex ratio (measured as the proportion male) at sexual maturity and later-life mortality risks in the context of pre-industrial northeast China, using registration data from the Qing Dynasty. We find that a higher male-to-female sex ratio at sexual maturity is associated with a higher later-life mortality risk among men. This association is likely due to the long-term adverse consequences of stress caused by low mate availability at sexual maturity. We further find that a high sex ratio at sexual maturity mitigates the health benefits of marriage and exacerbates the health disadvantages of holding an official position in Qing China.
Collapse
Affiliation(s)
| | - Hui Zheng
- The Ohio State University, United States
| |
Collapse
|
17
|
Jang SN, Kawachi I. Contrasting Effects of Spousal Education on Depressive Symptoms Among Korean Middle-Aged and Older Adults. Ann Geriatr Med Res 2018; 22:33-39. [PMID: 32743241 PMCID: PMC7387632 DOI: 10.4235/agmr.2018.22.1.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/02/2018] [Accepted: 03/10/2018] [Indexed: 11/06/2022] Open
Abstract
Background Within marital dyads, we focused on the so-called positive spillover effects of one spousal partner’s educational attainment on the health of the other partner. This study examined the relationship between spousal educational attainment and depressive symptoms in Korean older adults. Methods Data were obtained from a sample of marital dyads aged 45 or older (total 6,824 husbands and wives) from the baseline survey of the Korean Longitudinal Study of Ageing. Depressive symptoms were measured by the 10-item Center for Epidemiological Studies Depression scale (CES-D 10). A stepwise actor-partner interdependence model was used to examine the association between own and spousal educational attainment and depressive symptoms, conditioning for covariates. Results Among men, we found that their wives’ educational attainment did not influence their mental health, whereas, among women, their depressive symptoms were inversely related to their husbands’ level of schooling. With regard to own education, more-educated men reported lower psychological distress, whereas, among women, there was no overall association. However, in a subset of Korean women with the highest level of household income, higher educational attainment was associated with more depressive symptoms. Conclusion Our findings underscore the need to incorporate the cultural context in examining the spillover effects of education on health within marriage.
Collapse
Affiliation(s)
- Soong-Nang Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Ichiro Kawachi
- Department of Social Behavioral Sciences, Harvard T.H. CHAN School of Public Health, Boston, MA, USA
| |
Collapse
|
18
|
The effect of partners' education on women's reproductive and maternal health in developing countries. Soc Sci Med 2017; 197:104-115. [PMID: 29223685 DOI: 10.1016/j.socscimed.2017.11.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/25/2017] [Accepted: 11/29/2017] [Indexed: 11/23/2022]
Abstract
The effect of partners' education on women's and children's health in developing countries has received relatively little attention to date. This study uses couple data from 37 recent Demographic and Health Surveys fielded in sub-Saharan African and Asian countries to assess the effect of partners' schooling on women's modern contraceptive use, frequency of antenatal care visits, and skilled birth attendance. Using multilevel logistic regressions, the study shows that partners' schooling has strong effects on their spouses' maternal healthcare utilization; especially when partners had secondary or higher levels of schooling. Overall, women whose partners had an above secondary level of education were 32% more likely to use modern contraceptives, 43% more likely to attend at least four antenatal care visits, and 55% more likely to deliver their most recent baby with a health professional, compared to women whose partner had no education, after controlling for individual and community-level covariates. Finally, interacting the partners' years of schooling, we found that an additional year of partners' schooling was 1) positively associated with modern contraceptive use when the women had low educational attainment (substitution effect), but negatively associated when women were better educated, 2) positively and increasingly associated with the frequency of antenatal care visits as women's education increased (multiplicative effect), and 3) positively and significantly associated with skilled birth attendance for less educated women (substitution effect). This study highlights the importance of male education in shaping their wife's health behaviours in developing countries and provides strong impetus for male education beyond primary level (as well as for women), something that has been neglected in past policy discourse.
Collapse
|
19
|
Murakami K, Ohkubo T, Hashimoto H. Distinct association between educational attainment and overweight/obesity in unmarried and married women: evidence from a population-based study in Japan. BMC Public Health 2017; 17:903. [PMID: 29178902 PMCID: PMC5702137 DOI: 10.1186/s12889-017-4912-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 11/14/2017] [Indexed: 12/12/2022] Open
Abstract
Background Associations between education and obesity have been consistently reported among women in developed countries, but few studies have considered the influence of marital status and husbands’ education. This study aimed to examine differences in the association between education and overweight/obesity by marital status and to determine the contribution of husbands’ education to overweight/obesity among community-dwelling Japanese women. Methods A questionnaire survey was conducted from 2010 to 2011 among residents aged 25–50 years in Japanese metropolitan areas. Of 2145 women who agreed to participate and completed the survey, 582 were unmarried and 1563 were married. Overweight/obesity was defined as body mass index ≥25 kg/m2. Multiple logistic regression analysis was conducted to determine whether women’s or their husbands’ education was associated with overweight/obesity after adjusting for age, work status, and equivalent income. Results The prevalence of overweight/obesity was 11.9% among unmarried women and 10.3% among married women. Women’s own education was significantly associated with overweight/obesity among unmarried women but not among married women. The multivariate-adjusted odds ratio of high school education or lower compared with university education or higher was 3.21 (95% confidence interval: 1.59–6.51) among unmarried women. Among married women, husbands’ education was significantly associated with overweight/obesity: women whose husbands’ educational attainment was high school or lower had significantly higher odds of overweight/obesity than did those whose husbands had a university education or higher (1.67, 95% confidence interval: 1.10–2.55). Among married women whose educational attainment was college or higher, women whose husbands’ educational attainment was high school or lower had a significantly higher risk for overweight/obesity when compared with women whose husbands’ educational attainment was college or higher. Conclusions Associations between women’s own education and overweight/obesity varied by marital status, and husbands’ educational level was important for married women’s overweight/obesity. These findings indicate that the social influences bound to educational background affect women’s overweight/obesity.
Collapse
Affiliation(s)
- Keiko Murakami
- Department of Hygiene and Public Health, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan. .,Department of Health and Social Behavior, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Hideki Hashimoto
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| |
Collapse
|
20
|
Kilpi F, Martikainen P, Konttinen H, Silventoinen K, Torssander J, Kawachi I. The Spillover Influence of Partner's Education on Myocardial Infarction Incidence and Survival. Epidemiology 2017; 29:237-245. [PMID: 29135570 DOI: 10.1097/ede.0000000000000785] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Education is believed to have positive spillover effects across network connections. Partner's education may be an important resource preventing the incidence of disease and helping patients cope with illness. We examined how partner's education predicted myocardial infarction (MI) incidence and survival net of own education and other socioeconomic resources in Finland. METHODS A sample of adults aged 40-69 years at baseline in Finland in 1990 was followed up for MI incidence and mortality during the period 1991-2007 (n = 354,100). RESULTS Lower own and spousal education both contributed independently to a higher risk of MI incidence and fatality when mutually adjusted. Having a partner with basic education was particularly strongly associated with long-term fatality in women with a hazard ratio of 1.53 (95% confidence interval, 1.22-1.92) compared with women with tertiary level educated partners. There was some evidence that the incidence risk associated with basic spousal education was weaker in those with own basic education. The highest risks of MI incidence and fatality were consistently found in those without a partner, whereas the most favorable outcomes were in households where both partners had a tertiary level of education. CONCLUSIONS Accounting for spousal education demonstrates how health-enhancing resources accumulate to some households. Marriage between people of similar educational levels may therefore contribute to the widening of educational differences in MI incidence and survival.
Collapse
|
21
|
De Neve JW, Kawachi I. Spillovers between siblings and from offspring to parents are understudied: A review and future directions for research. Soc Sci Med 2017; 183:56-61. [PMID: 28478353 DOI: 10.1016/j.socscimed.2017.04.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 03/24/2017] [Accepted: 04/07/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND While a large literature has highlighted the protective effects of human capital on an individual's health and to some extent their offspring's health, little evidence is available on the positive spillover benefits of human capital for other family members. We conducted a scoping review of the evidence and identify future directions for research. METHODS We systematically searched the public health and economics literature on spillover effects from human capital, as indicated by educational attainment, to the health and/or survival of family members. We assessed (i) downward spillover effects (from parents and/or grandparents to offspring), (ii) horizontal spillover effects (from partners, spouses, and/or siblings), and (iii) upward spillover effects (from offspring to their parents and/or grandparents). We assessed the frequency of studies, their study designs, findings, and identified priority areas to inform future research on spillover effects of human capital. FINDINGS A total of 567 studies met our selection criteria. 286 studies assessed downward spillovers, 22 studies assessed horizontal spillovers, and five studies assessed upward spillovers. Studies on horizontal and upward spillovers found universally positive associations between additional education and better health in family members. The majority of studies used cross-sectional and longitudinal study designs as opposed to (quasi-)experimental designs. Further research is needed on horizontal and upward spillovers and research in low-resource settings, in addition to understanding what level of education matters the most, as well as mechanisms. CONCLUSIONS Although positive spillovers of human capital between siblings and from offspring to parents are likely, they have been understudied. Estimates of the returns to human capital that exclude these benefits may be too low.
Collapse
Affiliation(s)
- Jan-Walter De Neve
- Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg 69120, Germany; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston MA 02115, United States.
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston MA 02115, United States.
| |
Collapse
|
22
|
Brooke HL, Ringbäck Weitoft G, Talbäck M, Feychting M, Ljung R. Adult children's socioeconomic resources and mothers' survival after a breast cancer diagnosis: a Swedish population-based cohort study. BMJ Open 2017; 7:e014968. [PMID: 28363931 PMCID: PMC5387936 DOI: 10.1136/bmjopen-2016-014968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Socioeconomic inequalities in survival after breast cancer persist worldwide. We aim to determine whether adult offspring's socioeconomic resources contribute to inequalities in mothers' survival after breast cancer. METHODS 14 231 women, aged 65-79 years, with a child aged ≥30 years and a first primary diagnosis of breast cancer in the National Cancer Register between 2001 and 2010 were followed until death, 10 years after diagnosis, or end of study (December 2015). Relative survival proportions and excess mortality within 10 years of diagnosis by strata of offspring's education level and disposable income were estimated using flexible parametric models accounting for measures of mothers' socioeconomic position and expected mortality in the general population. RESULTS 4292 women died during 102 236 person-years of follow-up. Crude 10-year relative survival proportions for mothers of children with >14, 12-14 and <12 years of education were 0.89 (0.87 to 0.91), 0.87 (0.85 to 0.89) and 0.79 (0.76 to 0.81), respectively. Compared with mothers of children with >14 years of education, mothers of children with <12 or 12-14 years of education had substantially higher excess mortality (excess HR 1.69 (1.38 to 2.07) and 1.22 (1.00 to 1.48), respectively). Higher mortality did not differ between tertiles of offspring's disposable income. CONCLUSIONS Adult offspring's education level may contribute to inequalities in mothers' survival after breast cancer. Clinicians should be aware of the educational context beyond the individual and women with less educated offsprings may require extra support. This should be considered in future research, policy frameworks and interventions aimed at reducing survival inequalities.
Collapse
Affiliation(s)
- Hannah L Brooke
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Rickard Ljung
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
23
|
Lee C, Glei DA, Goldman N, Weinstein M. Children's Education and Parents' Trajectories of Depressive Symptoms. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2017; 58:86-101. [PMID: 28661765 PMCID: PMC5579841 DOI: 10.1177/0022146517690200] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Using five waves of the Taiwanese Longitudinal Study of Aging (1996-2011), we investigate (1) the association between family members' education and the age trajectories of individuals' depressive symptoms and (2) gender differences in those relationships. Our examination is guided by several theoretical frameworks, including social capital, social control, age as leveler, and resource substitution. Nested models show that having a more educated father is associated with lower depressive symptoms, but the relationship disappears after controlling for respondent's education. Including spouse's education attenuates the coefficient for respondent's education. A similar pattern appears when children's education is added to the model. Among all the family members, children's education has the strongest association with depressive symptoms, with a similar magnitude for both genders, although its strength gradually weakens as respondents age. Our findings suggest the importance of the transfer of resources from children to parents and how it may affect mental health at older ages.
Collapse
Affiliation(s)
- Chioun Lee
- 1 University of Wisconsin-Madison, Madison, WI, USA
| | - Dana A Glei
- 2 Georgetown University, Washington, DC, USA
| | | | | |
Collapse
|
24
|
Syse A, Lyngstad TH. In sickness and in health: The role of marital partners in cancer survival. SSM Popul Health 2016; 3:99-110. [PMID: 29349208 PMCID: PMC5769016 DOI: 10.1016/j.ssmph.2016.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/02/2016] [Accepted: 12/12/2016] [Indexed: 11/23/2022] Open
Abstract
Married cancer patients enjoy a survival advantage, potentially attributable to better health at diagnosis, earlier contact with health personnel, and/or access to resources to ensure more optimal treatment. These mechanisms only invoke the mere presence of a partner, but partners bring varying amounts of resources into the household. It is likely that also spousal resources contribute to differentials in survival net of own resources, as gradients in survival by the latter are well documented. Our aim is to examine the combined roles of own and spouses’ socioeconomic characteristics (SES) and age for cancer survival. Almost 268,000 married patients diagnosed with a first cancer after age 50 during 1975–2007 were identified from the Norwegian Cancer Registry and other national registers. In a sequence of hazard models, differences in survival by patients' own education, income and age and the role of spouses' characteristics were assessed. Furthermore, we also assessed the importance of homogamy/heterogamy along the same dimensions. Partners’ characteristics clearly matter for survival. The relative survival of patients with highly educated partners, net of their own education, is significantly higher than that of patients with lesser-educated partners. Somewhat similar effects are observed for income, net of education. A less consistent pattern is observed for age, although non-normative heterogamy patterns in age and income appear to be associated with a survival disadvantage. The naïve perspective of only considering the presence of partners may thus conceal important differences in cancer survival. Health personnel may take advantage of such knowledge in interactions with patients and their families, and gather information on resources in immediate networks that may impact prognosis favorable and/or unfavorable and help patients utilize these resources to improve prognosis. For married cancer patients, survival is influenced by the resources of spouses. As such, who you marry play a role for your survival. Having a highly educated and/or a high earning spouse appears to be beneficial. But, non-normative spousal patterns in age and SES appear to be disadvantageous. Married patients’ spousal resources may help shed light on inequalities in survival.
Collapse
Affiliation(s)
- Astri Syse
- Statistics Norway, Dep. of Research, P.O. Box 8131 Dep., N-0033 Oslo, Norway
| | - Torkild Hovde Lyngstad
- University of Oslo, Department of Sociology and Human Geography, P.O. Box 1096 Blindern, N-0317 Oslo, Norway
| |
Collapse
|
25
|
Savitsky B, Manor O, Friedlander Y, Burger A, Lawrence G, Calderon-Margalit R, Siscovick DS, Enquobahrie DA, Williams MA, Hochner H. Associations of socioeconomic position in childhood and young adulthood with cardiometabolic risk factors: the Jerusalem Perinatal Family Follow-Up Study. J Epidemiol Community Health 2016; 71:43-51. [PMID: 27417428 DOI: 10.1136/jech-2014-204323] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 11/30/2015] [Accepted: 06/29/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Several stages in the life course have been identified as important to the development of cardiovascular disease. This study aimed to assess the associations of childhood and adulthood socioeconomic position (SEP) and social mobility with cardiometabolic risk factors (CMRs) later in life. METHODS We conducted follow-up examinations of 1132 offspring, aged 32, within a population-based cohort of all births in Jerusalem from 1974 to 1976. SEP was indicated by parents' occupation and education, and adulthood SEP was based on offspring's occupation and education recorded at age 32. Linear regression models were used to investigate the associations of SEP and social mobility with CMRs. RESULTS Childhood-occupational SEP was negatively associated with body mass index (BMI; β=-0.29, p=0.031), fat percentage (fat%; β=-0.58, p=0.005), insulin (β=-0.01, p=0.031), triglycerides (β=-0.02, p=0.024) and low-density lipoprotein cholesterol (LDL-C; β=-1.91, p=0.015), independent of adulthood SEP. Adulthood-occupational SEP was negatively associated with waist-to-hip ratio (WHR; β=-0.01, p=0.002), and positively with high-density lipoprotein cholesterol (HDL-C; β=0.87, p=0.030). Results remained similar after adjustment for smoking and inactivity. Childhood-educational SEP was associated with decreased WHR and LDL-C level (p=0.0002), and adulthood-educational SEP was inversely associated with BMI (p=0.001), waist circumference (p=0.008), WHR (p=0.001) and fat% (p=0.0002) and positively associated with HDL-C (p=0.030). Additionally, social mobility (mainly upward) was shown to have adverse cardiometabolic outcomes. CONCLUSIONS Both childhood and adulthood SEP contribute independently to CMR. The match-mismatch hypothesis may explain the elevated CMRs among participants experiencing social mobility. Identification of life-course SEP-related aspects that translate into social inequality in cardiovascular risk may facilitate efforts for improving health and for reducing disparities in cardiovascular disease.
Collapse
Affiliation(s)
- B Savitsky
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - O Manor
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Y Friedlander
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - A Burger
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - G Lawrence
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - R Calderon-Margalit
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - D S Siscovick
- Cardiovascular Health Research Unit, Department of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
| | - D A Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - M A Williams
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - H Hochner
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| |
Collapse
|
26
|
Vanthomme K, Vandenheede H, Hagedoorn P, Gadeyne S. Socioeconomic disparities in lung cancer mortality in Belgian men and women (2001-2011): does it matter who you live with? BMC Public Health 2016; 16:493. [PMID: 27287541 PMCID: PMC4901481 DOI: 10.1186/s12889-016-3139-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 05/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ample studies have observed an adverse association between individual socioeconomic position (SEP) and lung cancer mortality. Moreover, the presence of a partner has shown to be a crucial determinant of health. Yet, few studies have assessed whether partner's SEP affects health in addition to individual SEP. This paper will study whether own SEP (education), partner's SEP (partner's education) and own and partner's SEP combined (housing conditions), are associated with lung cancer mortality in Belgium. METHODS Data consist of the Belgian 2001 census linked to register data on cause-specific mortality for 2001-2011. The study population includes all married or cohabiting Belgian inhabitants aged 40-84 years. Age-standardized lung cancer mortality rates (direct standardization) and mortality rate ratios (Poisson regression) were computed for the different SEP groups. RESULTS In men, we observed a clear inverse association between all SEP indicators (own and partner's education, and housing conditions) and lung cancer mortality. Men benefit from having a higher educated partner in terms of lower lung cancer mortality rates. These observations hold for both middle-aged and older men. For women, the picture is less uniform. In middle-aged and older women, housing conditions is inversely associated with lung cancer mortality. As for partner's education, for middle-aged women, the association is rather weak whereas for older women, there is no such association. Whereas the educational level of middle-aged women is inversely associated with lung cancer mortality, in older women this association disappears in the fully adjusted model. CONCLUSIONS Both men and women benefit from being in a relationship with a high-educated partner. It seems that for men, the educational level of their partner is of great importance while for women the housing conditions is more substantial. Both research and policy interventions should allow for the family level as well.
Collapse
Affiliation(s)
- Katrien Vanthomme
- Interface Demography, Department of Social Research, Faculty of Economic and Social Sciences and Solvay Business School, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Hadewijch Vandenheede
- Interface Demography, Department of Social Research, Faculty of Economic and Social Sciences and Solvay Business School, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Paulien Hagedoorn
- Interface Demography, Department of Social Research, Faculty of Economic and Social Sciences and Solvay Business School, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Sylvie Gadeyne
- Interface Demography, Department of Social Research, Faculty of Economic and Social Sciences and Solvay Business School, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| |
Collapse
|
27
|
Yang L, Martikainen P, Silventoinen K. Effects of Individual, Spousal, and Offspring Socioeconomic Status on Mortality Among Elderly People in China. J Epidemiol 2016; 26:602-609. [PMID: 27150012 PMCID: PMC5083324 DOI: 10.2188/jea.je20150252] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The relationship between socio-economic status and health among elderly people has been well studied, but less is known about how spousal or offspring's education affects mortality, especially in non-Western countries. We investigated these associations using a large sample of Chinese elderly. METHODS The data came from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from the years 2005 to 2011 (n = 15 355, aged 65-105 years at baseline; 5046 died in 2008, and 2224 died in 2011). Educational attainment, occupational status, and household income per capita were used as indicators of socio-economic status. Spousal and offspring's education were added into the final models. The Cox proportional hazards model was used to study mortality risk by gender. RESULTS Adjusted for age, highly educated males and females had, on average, 29% and 37% lower mortality risk, respectively, than those with a lower education. Particularly among men, this effect was observed among those whose children had intermediate education only. A higher household income was also associated with lower mortality risk among the elderly. Male elderly living with a well-educated spouse (HR 0.79; 95% CI, 0.64-0.99) had a lower mortality risk than those living with a low-educated spouse. CONCLUSIONS Both the socio-economic status of the individual and the educational level of a co-resident spouse or child are associated with mortality risk in elderly people. The socio-economic position of family members plays an important role in producing health inequality among elderly people.
Collapse
Affiliation(s)
- Lei Yang
- Population Research Unit, Department of Social Research, University of Helsinki
| | | | | |
Collapse
|
28
|
Abstract
BACKGROUND There has been a growing interest in understanding relationships between educational attainment of an individual and his or her spouse's health. However, the issue has not been extensively studied, particularly in East Asian nations. PURPOSE We investigated the relation between individuals' specific dietary behaviors and their spouses' educational attainment in China. METHOD A total of 2071 individuals were surveyed in the 2012 Zhuzhou Healthy City Project, in China. Multivariate logistic regressions were used to model two specific individual dietary behaviors (i.e., oil intake and salt intake) as a function of own and their spouses' educational attainment. The models were also constructed by gender. RESULTS Spouses' education was positively associated both with individuals' oil intake and salt intake after adjusting for the demographic characteristics, socioeconomic status, and health knowledge. Also, females (i.e., wives) were more likely to benefit from her spouse's education in terms of healthy dietary behaviors. When his or her spouse's level of education were greater, an individual was more likely to meet the dietary guidelines of salt and oil intakes. This Chinese study supports the male dominance hypothesis (i.e., males are more influential on female's health behavior) and the highest status dominance hypothesis (i.e., individuals with higher socioeconomic status are more influential on those with lower status). In terms of the social cognitive theory, married couples exchange health knowledge and share health behaviors. CONCLUSION Spouses' educational attainment and health knowledge should be incorporated into the design of health promotion programs targeting married couples in China. Finally, additional theoretical explanations and implications are evaluated in this article.
Collapse
|
29
|
Harling G, Bärnighausen T. The role of partners' educational attainment in the association between HIV and education amongst women in seven sub-Saharan African countries. J Int AIDS Soc 2016; 19:20038. [PMID: 26902392 PMCID: PMC4762222 DOI: 10.7448/ias.19.1.20038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 12/08/2015] [Accepted: 12/22/2015] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Individuals' educational attainment has long been considered as a risk factor for HIV. However, little attention has been paid to the association between partner educational attainment and HIV infection. METHODS We conducted cross-sectional analysis of young women (aged 15-34) in 14 Demographic and Health Surveys from seven sub-Saharan Africa (SSA) countries with generalized HIV epidemics. We measured the degree of similarity in educational attainment (partner homophily) in 75,373 partnerships and evaluated the correlation between homophily and female HIV prevalence at the survey cluster level. We then used logistic regression to assess whether own and partner educational attainment was associated with HIV serostatus amongst 38,791 women. RESULTS Educational attainment was positively correlated within partnerships in both urban and rural areas of every survey (Newman assortativity coefficients between 0.09 and 0.44), but this correlation was not ecologically associated with HIV prevalence. At the individual level, larger absolute differences between own and partner educational attainment were associated with significantly higher HIV prevalence amongst women. This association was heterogeneous across countries, but not between survey waves. In contrast to other women, for those aged 25-34 who had secondary or higher education, a more-educated partner was associated with lower HIV prevalence. CONCLUSIONS HIV prevalence amongst women in SSA is associated not only with one's own education but also with that of one's partner. These findings highlight the importance of understanding how partners place individuals at risk of infection and suggest that HIV prevention efforts may benefit from considering partner characteristics.
Collapse
Affiliation(s)
- Guy Harling
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health Boston, MA, USA;
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health Boston, MA, USA
- Africa Centre for Population Health, Mtubatuba, KwaZulu-Natal, South Africa
| |
Collapse
|
30
|
Spoerri A, Schmidlin K, Richter M, Egger M, Clough-Gorr KM. Individual and spousal education, mortality and life expectancy in Switzerland: a national cohort study. J Epidemiol Community Health 2014; 68:804-10. [PMID: 24764353 DOI: 10.1136/jech-2013-203714] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Household measures of socioeconomic position may better account for the shared nature of material resources, lifestyle, and social position of cohabiting persons, but household measures of education are rarely used. We aimed to evaluate the association of combined educational attainment of married couples on mortality and life expectancy in Switzerland. METHODS The study included 3,496,163 ever-married persons aged ≥30 years. The 2000 census was linked to mortality records through 2008. Mortality by combined educational attainment was assessed by gender-age-specific HRs, with 95% CIs from adjusted models, life expectancy was derived using abridged life tables. RESULTS Having a less educated partner was associated with increased mortality. For example, the HR comparing men aged 50-64 years with tertiary education married to women with tertiary education to men with compulsory education married to women with compulsory education was 2.05 (1.92-2.18). The estimated remaining life expectancy in tertiary educated men aged 30 years married to women with tertiary education was 4.6 years longer than in men with compulsory education married to women with compulsory education. The gradient based on individual education was less steep: the HR comparing men aged 50-64 years with tertiary education with men with compulsory education was 1.74 (1.67-1.81). CONCLUSIONS Using individual educational attainment of married persons is common in epidemiological research, but may underestimate the combined effect of education on mortality and life expectancy. These findings are relevant to epidemiologic studies examining socio-demographic characteristics or aiming to adjust results for these characteristics.
Collapse
Affiliation(s)
- Adrian Spoerri
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Kurt Schmidlin
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Matthias Richter
- Institute of Medical Sociology (IMS), Martin-Luther University, Halle, Germany
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Kerri M Clough-Gorr
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland Section of Geriatrics, Boston University School of Medicine, Boston Medical Center, Boston, USA
| | | |
Collapse
|
31
|
Jasilionis D, Shkolnikov VM, Andreev EM, Jdanov DA, Vågerö D, Meslé F, Vallin J. L’avant-garde en matière d’espérance de vie montre-t-elle la voie au reste de la population ? POPULATION 2014. [DOI: 10.3917/popu.1404.0589] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
32
|
Brown DC, Hummer RA, Hayward MD. The Importance of Spousal Education for the Self-Rated Health of Married Adults in the United States. POPULATION RESEARCH AND POLICY REVIEW 2013; 33:127-151. [PMID: 24511172 DOI: 10.1007/s11113-013-9305-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Education's benefits for individuals' health are well documented, but it is unclear whether health benefits also accrue from the education of others in important social relationships. We assess the extent to which individuals' own education combines with their spouse's education to influence self-rated health among married persons ages 25 and older in the United States (N = 337,846) with pooled data from the 1997-2010 National Health Interview Survey. Results from age and gender-specific models revealed that own education and spouse's education each share an inverse association with fair/poor self-rated health among married men and women. Controlling for spousal education substantially attenuated the association between individuals' own education and fair/poor self-rated health and the reduction in this association was greater for married women than married men. The results also suggest that husbands' education is more important for wives' self-rated health than vice versa. Spousal education particularly was important for married women ages 45-64. Overall, the results imply that individuals' own education and spousal education combine to influence self-rated health within marriage. The results highlight the importance of shared resources in marriage for producing health.
Collapse
Affiliation(s)
| | - Robert A Hummer
- Department of Sociology and Population Research Center, University of Texas at Austin
| | - Mark D Hayward
- Department of Sociology and Population Research Center, University of Texas at Austin
| |
Collapse
|
33
|
Vandenheede H, Vanroelen C, Gadeyne S, De Grande H, Deboosere P. Household-based socioeconomic position and diabetes-related mortality among married and cohabiting persons: findings from a census-based cohort study (Flanders, 2001–2010). J Epidemiol Community Health 2013; 67:765-71. [PMID: 23761411 DOI: 10.1136/jech-2012-202290] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
34
|
Nilsen SM, Bjørngaard JH, Ernstsen L, Krokstad S, Westin S. Education-based health inequalities in 18,000 Norwegian couples: the Nord-Trøndelag Health Study (HUNT). BMC Public Health 2012; 12:998. [PMID: 23157803 PMCID: PMC3533525 DOI: 10.1186/1471-2458-12-998] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 11/14/2012] [Indexed: 12/04/2022] Open
Abstract
Background Education-based inequalities in health are well established, but they are usually studied from an individual perspective. However, many individuals are part of a couple. We studied education-based health inequalities from the perspective of couples where indicators of health were measured by subjective health, anxiety and depression. Methods A sample of 35,980 women and men (17,990 couples) was derived from the Norwegian Nord-Trøndelag Health Study 1995–97 (HUNT 2). Educational data and family identification numbers were obtained from Statistics Norway. The dependent variables were subjective health (four-integer scale), anxiety (21-integer scale) and depression (21-integer scale), which were captured using the Hospital Anxiety and Depression Scale. The dependent variables were rescaled from 0 to 100 where 100 was the worst score. Cross-sectional analyses were performed using two-level linear random effect regression models. Results The variance attributable to the couple level was 42% for education, 16% for subjective health, 19% for anxiety and 25% for depression. A one-year increase in education relative to that of one’s partner was associated with an improvement of 0.6 scale points (95% confidence interval = 0.5–0.8) in the subjective health score (within-couple coefficient). A one-year increase in a couple’s average education was associated with an improvement of 1.7 scale points (95% confidence interval = 1.6–1.8) in the subjective health score (between-couple coefficient). There were no education-based differences in the anxiety or depression scores when partners were compared, whereas there were substantial education-based differences between couples in all three outcome measures. Conclusions We found considerable clustering of education and health within couples, which highlighted the importance of the family environment. Our results support previous studies that report the mutual effects of spouses on education-based inequalities in health, suggesting that couples develop their socioeconomic position together.
Collapse
Affiliation(s)
- Sara Marie Nilsen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | | | | | | | | |
Collapse
|
35
|
Lower treatment intensity and poorer survival in metastatic colorectal cancer patients who live alone. Br J Cancer 2012; 107:189-94. [PMID: 22576591 PMCID: PMC3389401 DOI: 10.1038/bjc.2012.186] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Socioeconomic status (SES) and social support influences cancer survival. If SES and social support affects cancer treatment has not been thoroughly explored. Methods: A cohort consisting of all patients who were initially diagnosed with or who developed metastatic colorectal cancer (mCRC, n=781) in three Scandinavian university hospitals from October 2003 to August 2006 was set up. Clinical and socioeconomic data were registered prospectively. Results: Patients living alone more often had synchronous metastases at presentation and were less often treated with combination chemotherapy than those cohabitating (HR 0.19, 95% CI 0.04–0.85, P=0.03). Surgical removal of metastases was less common in patients living alone (HR 0.29, 95% CI 0.10–0.86, P=0.02) but more common among university-educated patients (HR 2.22, 95% CI 1.10–4.49, P=0.02). Smoking, being married and having children did not influence treatment or survival. Median survival was 7.7 months in patients living alone and 11.7 months in patients living with someone (P<0.001). Living alone remained a prognostic factor for survival after correction for age and comorbidity. Conclusion: Patients living alone received less combination chemotherapy and less secondary surgery. Living alone is a strong independent risk factor for poor survival in mCRC.
Collapse
|
36
|
Li Y, Fu H, Zhao F, Luo J, Kawachi I. Influence of spousal education on partner's self-rated health: cross-sectional study among 1382 married couples in Shanghai, China. Asia Pac J Public Health 2011; 25:398-408. [PMID: 22087039 DOI: 10.1177/1010539511420417] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The effect of individual educational attainment on health has been extensively documented in western countries, whereas empirical evidence of education spillover effects in marital dyads is scarce and inconsistent. A total of 2764 individuals (or 1382 marital dyads) were surveyed in the Shanghai Healthy City Project 2008. Logistic regression models were used for analysis, and all analyses were stratified by gender. Significant protective associations were observed in univariate models linking general health status to the individual's own educational attainment and to their partner's educational level. After controlling for presence of chronic conditions, lifestyle factors, and social support, these associations were attenuated. The authors found a gender difference in the association of spouse's educational attainment with self-rated health. The influence of education on health may be partly mediated by lifestyle and other factors.
Collapse
Affiliation(s)
- Yang Li
- 1School of Public Health, Fudan University, Shanghai, China
| | | | | | | | | |
Collapse
|
37
|
Differences according to educational level in the management and survival of colorectal cancer in Sweden. Eur J Cancer 2011; 47:1398-406. [DOI: 10.1016/j.ejca.2010.12.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 12/07/2010] [Accepted: 12/14/2010] [Indexed: 01/19/2023]
|
38
|
Lipowicz A, Szklarska A. Social mobility by marriage and risk of cardiovascular disease among adults in Southwestern Poland. Ann Hum Biol 2011; 38:307-12. [PMID: 21231899 DOI: 10.3109/03014460.2010.541160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The social position of a husband or wife can influence the health status of the individual and his/her partner. Also, social position can change over time as a result of education, job, income, marriage and/or divorce. AIM To examine the association of mobility by marriage based on educational discrepancy between spouses and risk of cardiovascular disease (CVD) among Polish men and women of 40-50 years of age. SUBJECTS AND METHODS The sample included 394 married men and 453 married women of 40-50 years of age. All were residents of Wrocław located in southwestern Poland. Risk of CVD was assessed with the Framingham Risk Score (FRS). The sex-specific effect of social mobility on CVD risk (FRS) was tested by multiple regression analyses. RESULTS Among Polish married men and women, social mobility by marriage had a significant association with risk of CVD. Downwardly mobile men and women had a higher risk of CVD, while upwardly mobile men and women had a lower risk of CVD compared with individuals from homogamous marriages. The sole exception to this trend was poorly educated men among whom marriage with a better educated wife did not affect CVD risk. CONCLUSION Social mobility by marriage influences CVD risk. The results provide additional insights for studies examining socioeconomic differentials in CVD risk.
Collapse
Affiliation(s)
- Anna Lipowicz
- Institute of Anthropology, Polish Academy of Sciences, Kuznicza 3550-951, Wroclaw, PO Box 1180, Poland.
| | | |
Collapse
|
39
|
Jin L, Elwert F, Freese J, Christakis NA. Preliminary evidence regarding the hypothesis that the sex ratio at sexual maturity may affect longevity in men. Demography 2010; 47:579-86. [PMID: 20879678 PMCID: PMC3000064 DOI: 10.1353/dem.0.0121] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In human populations, variation in mate availability has been linked to various biological and social outcomes, but the possible effect of mate availability on health or survival has not been studied. Unbalanced sex ratios are a concern in many parts of the world, and their implications for the health and survival of the constituent individuals warrant careful investigation. We indexed mate availability with contextual sex ratios and investigated the hypothesis that the sex ratio at sexual maturity might be associated with long-term survival for men. Using two unique data sets of 7,683,462 and 4,183 men who were followed for more than 50 years, we found that men who reached their sexual maturity in an environment with higher sex ratios (i.e., higher proportions of reproductively ready men) appeared to suffer higher long-term mortality risks than those in an environment with lower sex ratios. Mate availability at sexual maturity may be linked via several biological and social mechanisms to long-term survival in men.
Collapse
Affiliation(s)
- Lei Jin
- Department of Sociology, RM 431, Sino Building, Chung Chi College Campus, Chinese University of Hong Kong, Shatin, Hong Kong SAR.
| | | | | | | |
Collapse
|
40
|
Guilley E, Bopp M, Faeh D, Paccaud F. Socioeconomic gradients in mortality in the oldest old: a review. Arch Gerontol Geriatr 2010; 51:e37-40. [PMID: 20071040 DOI: 10.1016/j.archger.2009.12.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 12/08/2009] [Accepted: 12/22/2009] [Indexed: 11/17/2022]
Abstract
This review aims at identifying gaps in knowledge on socioeconomic gradients in mortality in the oldest old. The authors review literature on oldest old population with a focus on unanswered questions: do socioeconomic status (SES) gradients in mortality persist after 80; does the magnitude of the gradient change as compared with younger populations; which socioeconomic/socio-demographic determinants should be used in this population with specific characteristics (e.g., with respect to sex ratio and household type)? Results are often inconsistent while conclusions drawn by selected studies are generally limited by the difficulty of disentangling the effects of age and cohort, and of generalizing results observed in preponderantly small, selected samples (which typically exclude institutionalized persons). Future research should explore the effects of socio-demographic indicators other than education and social class (e.g., marital status, loss of the partner) and adequately differentiate the social position of oldest old women. The authors recommend that research applies a life-course perspective combined with an interdisciplinary perspective to improve our understanding of the SES gradients in later life. Research is needed to elucidate which causal pathways depending on SES in younger age impact on mortality in higher ages up to oldest old.
Collapse
Affiliation(s)
- Edith Guilley
- Institute of Social and Preventive Medicine, University Hospital and Faculty of Biology and Medicine, rue du Bugnon 17, 1005 Lausanne, Switzerland.
| | | | | | | |
Collapse
|
41
|
Effects of spouses' socioeconomic characteristics on mortality among men and women in a Norwegian longitudinal study. Soc Sci Med 2008; 66:2035-47. [DOI: 10.1016/j.socscimed.2008.01.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Indexed: 11/23/2022]
|
42
|
Kravdal Ø. A broader perspective on education and mortality: are we influenced by other people's education? Soc Sci Med 2007; 66:620-36. [PMID: 18023954 DOI: 10.1016/j.socscimed.2007.10.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Indexed: 10/22/2022]
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 person-years 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.
Collapse
Affiliation(s)
- Øystein Kravdal
- Department of Economics, University of Oslo, Blindern, 0317 Oslo, Norway.
| |
Collapse
|
43
|
Jaffe DH, Manor O, Eisenbach Z, Neumark YD. The Protective Effect of Marriage on Mortality in a Dynamic Society. Ann Epidemiol 2007; 17:540-7. [PMID: 17434751 DOI: 10.1016/j.annepidem.2006.12.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 12/27/2006] [Accepted: 12/27/2006] [Indexed: 11/19/2022]
Abstract
PURPOSE We sought to assess whether the protective effect of marriage on overall and cause-specific mortality has changed over time in a dynamic society. METHODS Data from the census-based Israel Longitudinal Studies (ILMS) I (1983-1992) and II (1995-2004) were analyzed. Cox proportional hazard modeling adjusting for sociodemographic factors was applied to 152,150 and 209,125 individuals, ages 45-89 years from the ILMS I and II, respectively. During each study period 31,749 (ILMS I) and 37,656 (ILMS II) deaths were reported. RESULTS Mortality inequalities by marital status remained significant and widened over time for middle-aged and elderly men and women. Changes in cause-specific mortality indicated a widening of cardiovascular disease mortality inequalities by marital status. An increasing trend was also noted for deaths from cancer (+25%) and other causes (+38%, p < 0.05) in middle-aged men, but not women (cancer = 0%; other causes = -3%). CONCLUSIONS The stronger beneficial effect of marriage over time may reflect societal changes that have differentially affected men and women.
Collapse
Affiliation(s)
- Dena H Jaffe
- Braun School of Public Health and Community Medicine, Hebrew University - Hadassah, Jerusalem, Israel.
| | | | | | | |
Collapse
|
44
|
Jaffe DH, Eisenbach Z, Neumark YD, Manor O. Does one's own and one's spouse's education affect overall and cause-specific mortality in the elderly? Int J Epidemiol 2005; 34:1409-16. [PMID: 16144860 DOI: 10.1093/ije/dyi185] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To examine educational gradients in overall and cause-specific mortality among elderly married men and women and their spouses. METHODS Using the census-based Israel Longitudinal Mortality Study (1983-92), 13 573 married men and 6563 married women were identified who were aged 70-89 years at baseline. Cox proportional hazard models were used to assess the strength of the association between education and overall and cause-specific mortality. RESULTS Educational gradients for own and spouse's mortality varied by gender and cause of death. In particular, in relation to cardiovascular disease, men married to uneducated wives experienced elevated mortality risks [hazard ratio (HR) = 1.30; 95% confidence interval (95% CI) 1.11-1.52]. Women were generally unaffected by their husband's education, except for those who died from non-breast cancer, for whom husband's low education had a harmful effect (HR = 1.98; 95% CI 1.26-3.11). CONCLUSIONS Mortality among elderly married persons is associated with one's own and one's spouse's educational achievement. Research using partner's education as a proxy for one's own attainment may be omitting valuable information regarding these and other health risks.
Collapse
Affiliation(s)
- D H Jaffe
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel.
| | | | | | | |
Collapse
|