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Romero KRF, Yang Y, Green SH, Gutierrez S, Meza E, Torres JM. Adult child educational attainment and older parents' psychosocial outcomes during the COVID-19 pandemic. BMC Public Health 2024; 24:2056. [PMID: 39085832 PMCID: PMC11289967 DOI: 10.1186/s12889-024-19425-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/09/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Older adults' psychosocial outcomes during the COVID-19 pandemic have been inequitable by socio-economic status (SES). However, studies have focused solely on own SES, ignoring emerging evidence of the relationship between adult child SES and late-life health. We evaluated whether adult child educational attainment - a core marker of SES - is associated with older parents' psychosocial outcomes during the pandemic. METHODS We used data from the Survey of Health, Aging, and Retirement in Europe (SHARE) 2004-2018 and the SHARE Corona Surveys (SCS) 2020 and 2021. We included 40,392 respondents ≥ 65 years who had pre-pandemic information on adult child educational attainment and self-reported psychosocial outcomes during the pandemic, including self-assessments of worsened psychosocial outcomes compared to the pre-pandemic period. We used generalized estimating equations with a Poisson distribution and a log link, adjusted for respondent and family-level characteristics, including respondents' own educational attainment. RESULTS Older adults whose adult children averaged levels of educational attainment at or above (vs. below) their country-specific mean had a lower prevalence of feeling nervous (Prevalence Ratio [PR]: 0.94, 95% Confidence Interval [CI]: 0.90, 0.97), sad or depressed (PR: 0.94, 95% CI: 0.91, 0.98), and having sleep problems (PR: 0.94, 95% CI: 0.90, 0.97) during the pandemic. Additionally, higher adult child educational attainment was associated with a lower risk of perceiving worsened feelings of nervousness (PR: 0.95, 95% CI: 0.90, 1.01) and worsened sleep problems (PR: 0.91, 95% CI: 0.82, 1.01) as compared to the pre-pandemic. In stratified models, protective associations were observed only in countries experiencing "high" levels of COVID-19 intensity at the time of the survey. All of these results are derived from adjusted models. CONCLUSIONS Adult child SES may have "upward" spillover effects on the psychosocial wellbeing of older parents during periods of societal duress like the pandemic.
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Affiliation(s)
- Karla Renata Flores Romero
- Department of Epidemiology & Biostatistics, UC San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Yulin Yang
- Department of Epidemiology & Biostatistics, UC San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Sharon H Green
- Department of Demography, UC Berkeley, Berkeley, CA, USA
| | - Sirena Gutierrez
- Department of Epidemiology & Biostatistics, UC San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Erika Meza
- Department of Epidemiology & Biostatistics, UC San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Jacqueline M Torres
- Department of Epidemiology & Biostatistics, UC San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
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Sloth MMB, Neble Larsen E, Mathisen J, Nilsson CJ, Osler M, Jørgensen TSH. Adult offspring's education and parental mortality: A nationwide cohort study of the mediating role of lifestyle-related diseases. Scand J Public Health 2024:14034948241234711. [PMID: 38523257 DOI: 10.1177/14034948241234711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Aim: The mechanisms behind the association between adult offspring's socioeconomic position and their parents' mortality are not well understood. This study investigates lifestyle-related diseases as a potential mediating pathway between adult offspring's education and parental mortality. Methods: This nationwide register-based cohort study consists of 963,742 older adults aged 65 years between 2000 and 2018. Lifestyle-related diseases were measured between 60 and 65 years and those with prior lifestyle-related diseases were excluded. Natural Effect Models were performed to assess potential mediation through lifestyle-related diseases of the association between offspring's education and parental mortality measured by additive hazard estimates with 95% confidence intervals (CIs). Results: Between 60 and 65 years, 150,501 (15.6%) older adults were diagnosed with lifestyle-related diseases and 149,647 (15.5%) died during follow-up. Compared with having offspring with long education, short education was associated with 631 (95% CI: 555; 707) and 581 (95% CI: 525; 638) additional deaths per 100,000 person-years for women and men, respectively, of which 15.4% (95% CI: 9.0; 21.6) and 16.8% (95% CI: 14.6; 18.9) were mediated by lifestyle-related diseases. The corresponding numbers for medium education were 276 (95% CI: 205; 347) and 299 (95% CI: 255; 343) with 26.2% (95% CI: 12.0; 40.6) and 27.6% (95% CI: 25.1; 31.8) mediated by lifestyle-related diseases. Conclusions: Lifestyle-related diseases accounted for 15-28% of the association between offspring's education and parental mortality for both men and women.
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Affiliation(s)
- Mathilde M B Sloth
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Emma Neble Larsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jimmi Mathisen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
| | - Charlotte J Nilsson
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark
| | - Merete Osler
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
| | - Terese S H Jørgensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Jørgensen TSH, Osler M, Fors S, Nilsson CJ, Meyer A, Modig K. Adult offspring and their socioeconomic resources for development and survival of stroke: A Swedish and Danish nationwide register-based study. Scand J Public Health 2024; 52:216-224. [PMID: 36732922 DOI: 10.1177/14034948231152352] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIMS To explore the relationships between adult offspring's socioeconomic resources and the development of stroke and survival after stroke among older adults in Denmark and Sweden. METHODS The study included 1,464,740 Swedes and 835,488 Danes who had turned 65 years old between 2000 and 2015. Multivariable Cox proportional hazard regression models were used to analyse incident stroke and survival after stroke until 2020. RESULTS Lower level of offspring's education, occupation and income were associated with higher hazards of stroke among both men and women in Sweden and Denmark. Associations with offspring's education, occupation and income were most consistent for death after the acute phase and for educational level. From one to five years after stroke and compared with a high educational level of offspring, low and medium educational level were associated with 1.34 (95% confidence interval (CI): 1.11; 1.62) and 1.18 (95% CI: 1.10; 1.27) as well as 1.26 (95% CI: 1.06; 1.48) and 1.14 (1.07; 1.21) times higher hazard of death in Swedish women and men, respectively. The corresponding estimates in the Danish population were 1.36 (1.20; 1.53) and 1.10 (1.01; 1.20) for women and 1.23 (95% CI: 1.11; 1.32) and 1.13 (95% CI: 1.05; 1.21) for men. CONCLUSIONS Adult offspring socioeconomic resources are, independently of how we measure them and of individual socioeconomic characteristics, associated with development of stroke in old age in both Denmark and Sweden. The relationships between offspring socioeconomic resources and death after stroke are present especially after the acute phase and most pronounced for educational level as a measure of offspring socioeconomic resources.
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Affiliation(s)
- Terese S H Jørgensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Denmark
| | - Merete Osler
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
| | - Stefan Fors
- Aging Research Centre, Karolinska Institutet/Stockholm University, Sweden
- Centre for Epidemiology and Community Medicine, Sweden
| | - Charlotte J Nilsson
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark
| | - Anna Meyer
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
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Larsen EN, Brünnich Sloth MM, Nielsen J, Osler M, Jørgensen TSH. The Association of Children and Their Educational Attainment With Diabetes-related Complications and Mortality Among Older Adults With Type 2 Diabetes: A Nationwide Cohort Study. Can J Diabetes 2023; 47:649-657.e6. [PMID: 37460085 DOI: 10.1016/j.jcjd.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Socioeconomic resources and family support have been shown to improve adherence to treatment in people with type 2 diabetes (T2D) and are associated with a lower risk of diabetes-related complications and death. We investigated the associations of having children and their educational level with diabetes-related complications and death among older adults with T2D. METHODS We included 74,588 adults who were at least 65 years of age at the time of T2D diagnosis over the period from 2000 to 2018 in Denmark and grouped them based on having children (yes [reference]/no), and their children's highest educational level (low/medium/high [reference]). Multistate models were performed with 3 states: T2D diagnosis, diabetes-related complications, and death. All models were stratified by other chronic diseases at baseline (yes/no). RESULTS During follow-up (mean, 5.5 years), 14.6% of the adults developed a complication and 24.8% died with or without complications. Not having children was associated with a higher hazard of death without complications among adults without (hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.17 to 1.33) and with (HR, 1.10; 95% CI, 1.02 to 1.18) other chronic diseases and after complications among adults without other chronic diseases (HR, 1.25; 95% CI, 1.12 to 1.38). Having children with a lower educational level was associated with a higher hazard of complications (HRlow, 1.14; 95% CI, 1.05 to 1.24; HRmedium, 1.11; 95% CI, 1.05 to 1.17), death without complications (HRlow, 1.26; 95% CI, 1.17 to 1.36; HRmedium, 1.07; 95% CI, 1.02 to 1.14), and after complications (HRlow, 1.22; 95% CI, 1.07 to 1.39) among adults without other chronic diseases. CONCLUSIONS Among adults without other chronic diseases, having no children or having children with lower educational levels was associated with a higher hazard of death. Among these adults, having children with lower educational levels was also associated with a higher hazard of diabetes-related complications.
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Affiliation(s)
- Emma Neble Larsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mathilde Marie Brünnich Sloth
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jannie Nielsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Merete Osler
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Terese Sara Høj Jørgensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
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Larsen EN, Sloth MMB, Nielsen J, Andersen SP, Osler M, Jørgensen TSH. The interplay between the impact of household's and children's education on the risk of type 2 diabetes and death among older adults: a Danish register-based cohort study. Public Health 2023; 224:178-184. [PMID: 37804713 DOI: 10.1016/j.puhe.2023.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/16/2023] [Accepted: 08/27/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVES This study aims to assess the association of household's and children's education on the risk of type 2 diabetes (T2D) and subsequent death. STUDY DESIGN Danish register-based cohort study. METHODS In total, 1,021,557 adults were included at their 65th birthday between 2000 and 2018. A multistate survival model was performed to estimate the association of household's and children's education on the transition between the three states: 1) 65th birthday; 2) diagnosis of T2D; and 3) all-cause death. RESULTS The incidence rates per 1000 person-years were 9.1 for T2D, 18.4 for death without T2D, and 45.0 for death with T2D. Compared to long household's education and children's education, long household's education combined with either short-medium children's education or no children were associated with a 1.49- (95% confidence interval [CI]: 1.44; 1.54] and 1.69-times (95% CI: 1.61;1.78) higher hazard of T2D, respectively. Short-medium household's education combined with either long children's education or no children were associated with 0.64- (95% CI: 0.62; 0.66) and 0.77-times (95% CI: 0.74; 0.79) lower hazard of T2D, respectively. Compared to long household's education and children's education, any other combination of household's and children's education was associated with higher hazards of death both without and with T2D. CONCLUSION Older adults living in households with long education with no children or children with short-medium education had higher hazards of T2D. Households with short-medium education and no children or children with long education were associated with lower hazards of T2D. Both household's and children's education were associated with higher hazard of death without and with T2D.
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Affiliation(s)
- E N Larsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - M M B Sloth
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - J Nielsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - S P Andersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M Osler
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, Copenhagen 1353, Denmark
| | - T S H Jørgensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
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Sloth MMB, Neble Larsen E, Godtfredsen NS, Osler M, Jørgensen TSH. Impact of offspring and their educational level on readmission and death among older adults with chronic obstructive pulmonary disease: a nationwide cohort study using multistate survival models. J Epidemiol Community Health 2023; 77:558-564. [PMID: 37311624 DOI: 10.1136/jech-2022-220243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/05/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND It is well described that there is social inequality in the disease course of chronic obstructive pulmonary disease (COPD), but the impact of social relations is less explored. We aimed to investigate the impact of adult offspring and their educational level on readmission and death among older adults with COPD. METHODS In total, 71 084 older adults born 1935-53 with COPD diagnosed at age ≥65 years in 2000-2018 were included. Multistate survival models were performed to estimate the impact of adult offspring (offspring (reference) vs no offspring) and their educational level (low, medium or high (reference)) on the transition intensities between three states: COPD diagnosis, readmission and all-cause death. RESULTS During follow-up, 29 828 (42.0%) had a readmission and 18 504 (26.0%) died with or without readmission. Not having offspring was associated with higher hazards of death without readmission (HRwomen: 1.52 (95% CI: 1.39 to 1.67), HRmen: 1.29 (95% CI: 1.20 to 1.39)) and a higher hazard of death after readmission for women only (HRwomen: 1.19 (95% CI: 1.08 to 1.30). Having offspring with low educational level was associated with higher hazards of readmission (HRwomen: 1.12 (95% CI: 1.06 to 1.19)), (HRmen: 1.06 (95%CI: 1.002 to 1.12)), death without readmission (HRwomen: 1.24 (95% CI: 1.11 to 1.39)), HRmen: 1.16 (95% CI: 1.05 to 1.29) and death after readmission for men only (HRmen: 1.15 (95% CI: 1.05 to 1.25)). Having offspring with medium educational level was associated with a higher hazard of death without readmission for women (HRwomen: 1.11 (95% CI: 1.02 to 1.21)). CONCLUSION Adult offspring and their educational level were associated with higher risk of readmission and death among older adults with COPD.
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Affiliation(s)
- Mathilde Marie Brünnich Sloth
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Copenhagen University Hospital, Frederiksberg, Denmark
| | - Emma Neble Larsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Copenhagen University Hospital, Frederiksberg, Denmark
| | - Nina Skavlan Godtfredsen
- Department of Respiratory Diseases, Hvidovre Hospital, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Merete Osler
- Center for Clinical Research and Prevention, Copenhagen University Hospital, Frederiksberg, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Terese Sara Høj Jørgensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Copenhagen University Hospital, Frederiksberg, Denmark
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Zhang W, Silverstein M. Does the Economic Status of Adult Children Influence Self-Rated Health Among Older Adults in China? J Gerontol B Psychol Sci Soc Sci 2023; 78:1604-1616. [PMID: 37210663 DOI: 10.1093/geronb/gbad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Indexed: 05/22/2023] Open
Abstract
OBJECTIVES We aim to investigate the association between children's economic status and parents' self-rated health and examine the potential mediating mechanisms for this relationship. METHODS Utilizing nationally representative data in China in 2014, this study predicted parent's self-rated health from children's economic status using inverse probability of treatment weighting to account for selection and endogeneity bias. We further examined depressive symptoms, kin and nonkin social support networks, emotional closeness to children, and economic support from children, as potential mediators of this relationship. RESULTS The study reveals that parents whose children had greater economic success tended to have better self-rated health. For both rural and urban older adults, depressive symptoms served as the most influential mediator. However, only among rural older adults did the size of their support networks mediate the relationship between children's economic status and perceived health. DISCUSSION The results from this study suggest that children's economic success contributes to better self-rated health among older adults. In part, this relationship was explained by better emotional well-being and greater availability of support resources among parents in rural areas with successful children. This quasi-causal analysis demonstrates that adult children remain important for the well-being of their older parents in China, but also suggests that health inequalities in later life are exacerbated by the chance of having economically successful offspring.
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Affiliation(s)
- Wencheng Zhang
- Department of Sociology, Syracuse University, Syracuse, New York, USA
| | - Merril Silverstein
- Department of Sociology, Syracuse University, Syracuse, New York, USA
- Department of Human Development and Family Science, Syracuse University, Syracuse, New York, USA
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Potente C, Präg P, Monden CWS. Does Children's Education Improve Parental Health and Longevity? Causal Evidence from Great Britain. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:21-38. [PMID: 36705015 PMCID: PMC10009472 DOI: 10.1177/00221465221143089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Parents with better-educated children are healthier and live longer, but whether there is a causal effect of children's education on their parents' health and longevity is unclear. First, we demonstrate an association between adults' offspring education and parental mortality in the 1958 British birth cohort study, which remains substantial-about two additional years of life-even when comparing parents with similar socioeconomic status. Second, we use the 1972 educational reform in England and Wales, which increased the minimum school leaving age from 15 to 16 years, to identify the presence of a causal effect of children's education on parental health and longevity using census-linked data from the Office for National Statistics Longitudinal Study. Results reveal that children's education has no causal effects on a wide range of parental mortality and health outcomes. We interpret these findings discussing the role of universal health care and education for socioeconomic inequality in Great Britain.
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Affiliation(s)
- Cecilia Potente
- University of Zurich, Zurich,
Switzerland
- University of Oxford, Oxford, UK
| | - Patrick Präg
- CREST, ENSAE, Institut Polytechnique de
Paris, France
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9
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Yang K, Fahad S. Rural migration, governance, and public health nexus: Implications for economic development. Front Public Health 2022; 10:1002216. [PMID: 36304245 PMCID: PMC9592749 DOI: 10.3389/fpubh.2022.1002216] [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: 07/24/2022] [Accepted: 09/20/2022] [Indexed: 01/27/2023] Open
Abstract
With the deepening of rural aging and the increasing role of human capital in the non-agricultural employment labor market, this paper uses the data of China Health and Retirement Longitudinal Study (CHARLS), ordinary least squares (OLS) and instrumental variable method (IV) to try to examine the impact of rural migrant workers' education on their parents' health. Since a rural family may include more than one child, a sample of migrant workers with a high education level is used in the benchmark regression, and a sample of migrant workers with a low education level is used to test the robustness of the relationship. The results showed that the education of migrant workers had a significant positive impact on parents' health. The sample with the least education was used for the robustness, and the results did not change. The IV-probit method is used to address potential endogeneity, and the results remain stable. Heterogeneity analysis shows that there are significant differences in the impact of migrant workers' education on the health of parents from different groups. This positive effect has a greater impact on the health of parents who are older, less educated, and do not live with their children. Mediation analysis shows that children's economic ability, captured by income and work type, and their parents' health behavior, captured by sleep, alcohol consumption, and physical examinations, mediate this relationship. Thus, migrant workers' education affects their parents' health mainly through relaxing budget constraints and improving their parents' health production efficiency. In addition, this paper also found that education of migrant workers may significantly increase parental depression. Based on the above analysis, this paper argues that increasing investment in rural education is conducive to improving the health of migrant farmers' parents, thereby promoting the transfer of rural labor to non-agricultural industries and cities, curbing the rapid rise in labor costs, and promoting the healthy development of the economy.
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Affiliation(s)
- Kewen Yang
- College of Economics and Management, Northwest A&F University, Xianyang, China
| | - Shah Fahad
- School of Management, Hainan University, Haikou, China,*Correspondence: Shah Fahad
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Torres JM, Yang Y, Rudolph KE, Courtin E. Increased adult child schooling and older parents' health behaviors in Europe: A quasi-experimental study. SSM Popul Health 2022; 19:101162. [PMID: 35855968 PMCID: PMC9287559 DOI: 10.1016/j.ssmph.2022.101162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 11/25/2022] Open
Abstract
There is growing evidence that adult child educational attainment is associated with older parents' physical health and longevity. Scholars have hypothesized that these associations may be driven by health-behavior pathways, whereby adult children with more education may share information about healthy lifestyles, role-model healthier behaviors, and/or have more economic resources to support leisure-based physical activity or the purchase of healthy foods for older parents. However, this relationship has not been comprehensively evaluated with methods capable of addressing the confounding bias expected for observational studies on this topic. We estimated the association between increased adult child schooling and older parents' health behaviors using data from the Survey for Health, Aging and Retirement in Europe (SHARE) (n = 8195). We leveraged changes to compulsory schooling laws that would have impacted respondents' adult children as quasi-experiments and estimated the association between increased schooling among oldest adult children and respondents' (parents') body mass index, obesity, physical inactivity, excessive drinking, and current smoking using two-stage least squares regression. Each year of increased schooling among oldest adult children was associated with a lower risk of current smoking (β: −0.029, 95% CI: −0.056, −0.003), physical inactivity (β: −0.034, 95% confidence interval [CI]: −0.077, 0.009), obesity (β: −0.038, 95% CI: −0.065, −0.011) and lower body mass index (β: −0.37, 95% CI: −0.73, −0.02). The direction of associations with excessive drinking varied by parent gender (β: −0.027, 95% CI: −0.046, −0.007 for mothers; β: 0.068, 95% CI: −0.011, 0.148 for fathers). Increases in adult child schooling may have upward influences on parents' late-life health behaviors, although there may be some differences by parent gender. Findings should be replicated across other global settings and studies should directly evaluate parent health behaviors as mediators of the relationship between increased adult child schooling and older parents’ longevity. Growing research suggests adult child education influences parents' mortality. This association may be due to health behavior pathways, but evidence is scarce. We conducted a quasi-experimental study of this topic using European data. Increased child schooling was associated with improved health behaviors for older parents. Associations with older parents' risk of excessive drinking varied by parent gender.
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Affiliation(s)
- Jacqueline M Torres
- Department of Epidemiology & Biostatistics, UC San Francisco, San Francisco, CA, USA
| | - Yulin Yang
- Department of Epidemiology & Biostatistics, UC San Francisco, San Francisco, CA, USA
| | - Kara E Rudolph
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Emilie Courtin
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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Zhang PR, Liu Y. The Higher the Children's Achievements, the Better the Elderly Health? Evidence From China. Front Public Health 2022; 10:871266. [PMID: 35719647 PMCID: PMC9204310 DOI: 10.3389/fpubh.2022.871266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022] Open
Abstract
Health, an important indicator for measuring the elderly's life and wellbeing, is an important part of positive and healthy aging. Children's achievements are closely linked to their parents' health. However, existing literature does not cover how children's achievements impact the health of their elderly parents. Data were derived from the 2014 Chinese Longitudinal Aging Social Survey; this study includes 6,793 elderly people ages 60 and older as samples. A multiple linear regression model was used to analyze the correlation between children's achievements and their elderly parents' health statuses in China. The results show that the higher the children's income and education, the better their health of their elderly parents. Living patterns, children' financial support to their parents, and social capital play a mediating role in the relationship between children and their elderly parents. These findings provide further insight into potential factors associated with the children's achievements and elderly health.
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Affiliation(s)
- Pei ru Zhang
- School of Marxism, Anyang Institute of Technology, Anyang, China
| | - Yiwei Liu
- School of Government, Central University of Finance and Economics, Beijing, China
- *Correspondence: Yiwei Liu
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12
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Liu Y, Ma Y, Smith JP. Adult Children's Education and Older Parents' Chronic Illnesses in Aging China. Demography 2022; 59:535-562. [PMID: 35179200 DOI: 10.1215/00703370-9766973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although intergenerational transmission from parents to children has been widely studied, less is known about human capital spillover from children to parents. Utilizing nationally representative data on both doctor diagnosis and biomarkers, as well as exploiting variations in the implementation of China's Compulsory Education Law, we examine the effects of adult children's education on the prevalence of chronic cardiovascular illnesses among older parents in China and explore potential mechanisms. Instrumental variable estimates indicate that additional years of schooling among adult children decrease the prevalence of hypertension among older parents, whereas no evidence indicates a significant impact on the prevalence of diabetes among the same group. Sons and daughters differentially impact their mothers and fathers. Compared with fathers, mothers benefit more from adult children's education. Although no significant differences are observed in the effects of sons' and daughters' education in urban China, sons' education is more beneficial for parents' health in rural China. Further analyses show that financial support and health support (e.g., diagnosis and management of chronic illnesses and maintenance of health behaviors) are critical pathways for older parents to benefit from their adult children's education.
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Affiliation(s)
- Yafei Liu
- Hubei University of Economics, Wuhan, China
| | - Yuanyuan Ma
- Wenlan School of Business, Zhongnan University of Economics and Law, Wuhan, China
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13
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Wei N, Zhou L, Huang W. Does an upward intergenerational educational spillover effect exist? The effect of children's education on Chinese parents' health. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2022; 22:69-89. [PMID: 34415455 DOI: 10.1007/s10754-021-09308-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 05/10/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Research on the presence of an upward spillover effect of children's education on parental health is rapidly developing. However, there are certain differences in the conclusions of relevant studies, and no consistent viewpoint has been reached. METHODS Using the exogenous differences in education generated by the expansion of higher education enrollment that China implemented as a reform in 1999, we analyze this issue by studying the effect of children's higher education on their parents' health. RESULTS The instrumental variable (IV) estimation results show that children who received higher education have a significant and positive effect on the physical health of their parents. Compared with the ordinary least squares (OLS) estimation results, the coefficient of the effect of children receiving higher education is larger in the IV estimation. CONCLUSIONS Children's education can generate a significant active effect on parental health, affecting parental physical health via its effect on parental health cognition and health behaviors. Based on heterogeneity analyses, the effect of a son's education on parental health is more significant than the effect of a daughter's education, and among rural children, higher education has a more significant effect on parental health.
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Affiliation(s)
- Ning Wei
- School of Management, Jiangsu University, 301 Xuefu Road, Zhenjiang, Jiangsu Province, China
| | - Lülin Zhou
- School of Management, Jiangsu University, 301 Xuefu Road, Zhenjiang, Jiangsu Province, China
| | - Wenhao Huang
- School of Management, Xuzhou Medical University, 209 Tongshan Road, Xuzhou, Jiangsu Province, China.
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14
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Offspring Education and Parents' Health Inequality in China: Evidence from Spillovers of Education Reform. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042006. [PMID: 35206193 PMCID: PMC8872194 DOI: 10.3390/ijerph19042006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/29/2022] [Accepted: 02/08/2022] [Indexed: 12/10/2022]
Abstract
In the context of a rapidly aging population, improving the parents’ health outcomes, especially in parents with poorer health, is essential for narrowing elderly health inequality. Using data from the China Health and Retirement Longitudinal Study, we took the university enrollment expansion policy as the instrumental variable and employed the two-stage least square (2SLS) and instrumental variable quantile regression (IVQR) approaches to explore the spillovers of offspring education on the elderly parents’ frailty index. The results show that one additional year of offspring educational attainment was associated with a 0.017 or 4.66% decline in the parents’ frailty index. These spillovers are stronger where parents are cohabiting with their children than when separating (more than 2 times higher). Moreover, there is substantial heterogeneity that is determined by the gender of parents. The spillover on mothers is greater than that on fathers. Further analysis of a cohort of parents with different frailty indexes reveals that the upward spillovers of offspring education on parents’ health are non-linear and non-averaged. The spillovers may diminish as parents own health improves. These spillovers suppress the “Matthew Effect”, which can lead to the further widening of health inequality.
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15
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Xu Y, Luo Y. The Effect of Adult Children's Education Attainment on Their Parents' Cognitive Health: An Intergenerational Support Perspective. Front Public Health 2022; 10:744333. [PMID: 35223718 PMCID: PMC8864153 DOI: 10.3389/fpubh.2022.744333] [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: 10/01/2021] [Accepted: 01/13/2022] [Indexed: 12/14/2022] Open
Abstract
The purpose of this study is to examine the relationship between adult children's education attainment and their parents' cognitive health, and to further explore the mechanism of intergenerational support. Based on empirical analysis of data from China Health and Retirement Longitudinal Survey, our study finds a positive association between children's educational attainment and parents' cognitive health. This correlation is provided for by emotional communication of informal caregiving, financial support, and healthy behaviors shaped in the parents by adult children. The strength of the effect varied by the adult child's gender. While sons' education attainment significantly improves parental cognitive parameters through informal caregiving, financial support, and development of healthy behaviors, the effect of daughters' education derives from financial support and healthy behaviors, not being related to informal caregiving. The study enriches the evidence on the mobility of children's human capital toward their parents and provides practical insights for advancing children's participation in family caregiving.
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Affiliation(s)
| | - Yaping Luo
- School of Public Policy and Management, Guangxi University, Nanning, China
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16
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Brändström A, Meyer AC, Modig K, Sandström G. Determinants of home care utilization among the Swedish old: nationwide register-based study. Eur J Ageing 2021; 19:651-662. [PMID: 36052192 PMCID: PMC9424454 DOI: 10.1007/s10433-021-00669-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/30/2022] Open
Abstract
AbstractSince the 1990s, Sweden has implemented aging-in-place policies increasing the share of older adults dependent on home care instead of residing in care homes. At the same time previous research has highlighted that individuals receive home care at a higher age than before. Consequently, services are provided for a shorter time before death, increasing reliance on family and kin as caregivers. Previous studies addressing how homecare is distributed rely primarily on small surveys and are often limited to specific regions. This study aims to ascertain how home care services are distributed regarding individual-level factors such as health status, living arrangements, availability of family, education, and socioeconomic position. To provide estimates that can be generalized to Sweden as a whole, we use register data for the entire Swedish population aged 65 + in 2016. The study's main findings are that home care recipients and the amount of care received are among the oldest old with severe co morbidities. Receiving home care is slightly more common among women, but only in the highest age groups. Childlessness and socioeconomic factors play a small role in who receives home care or not. Instead, the primary home care recipients are those older adults living alone who lack direct support from family members residing in the same household.
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Affiliation(s)
- Anders Brändström
- Historical Demography, Department of Historical, Philosophical and Religious Studies, Umeå University, Umeå, Sweden
| | - Anna C. Meyer
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institute, Solna, Sweden
| | - Karin Modig
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institute, Solna, Sweden
| | - Glenn Sandström
- Stockholm University Demography Unit (SUDA), Stockholm University and Historical Demography, Department of Historical, Philosophical and Religious Studies, Umeå University, Stockholm, Sweden
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17
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Li Y, Wang G, Li G. Educational attainment of offspring and obesity among older adults in China. Soc Sci Med 2021; 286:114325. [PMID: 34450393 DOI: 10.1016/j.socscimed.2021.114325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
The study focuses on the role of adult offspring's educational attainment in obesity among older adults in China and investigates age and birth cohort heterogeneities in the educational effect. Using the longitudinal data from the 1993-2015 China Health and Nutrition Survey (CHNS), we employed three-level mixed-effects models and conducted sex-stratified analyses to examine the effects of co-resident offspring's education on body mass index (BMI), overweight, waist circumference (WC), and abdominal obesity among older people born before 1956. After controlling for confounding factors, the overall results showed inverted U-shaped educational gradients in BMI-based outcomes for males and positive gradients for females. The effect of education on WC exhibited an inverted U-shaped pattern for both sexes, but no significant effect on abdominal obesity was found among the overall population. However, further analyses of interaction effects indicated considerable age and cohort variations in the educational effects on obesity outcomes. Offspring's schooling was positively associated with obesity among earlier birth cohorts; Among more recent birth cohorts, especially among females, the educational effects were reversed, and disparities in obesity outcomes across education categories strengthened with age. These findings imply that offspring's education appears to gradually exert a protective role against obesity among Chinese older adults in successive cohorts.
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Affiliation(s)
- Yaoyue Li
- School of Social Development and Public Policy, Fudan University, Shanghai, 200433, China.
| | - Guixin Wang
- School of Social Development and Public Policy, Fudan University, Shanghai, 200433, China
| | - Guofeng Li
- School of Statistics, Shandong University of Finance and Economics, Jinan, Shandong, 250014, China
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18
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Torres JM, Yahirun JJ, Sheehan C, Ma M, Sáenz J. Adult child socio-economic status disadvantage and cognitive decline among older parents in Mexico. Soc Sci Med 2021; 279:113910. [PMID: 33964589 PMCID: PMC8284312 DOI: 10.1016/j.socscimed.2021.113910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/01/2021] [Accepted: 04/04/2021] [Indexed: 12/15/2022]
Abstract
There is growing interest in the contribution of offspring educational attainment to parents' health outcomes. However, less is known about the impacts of offspring socio-economic status (SES) on parents' cognitive decline or about the role of offspring SES disadvantage. We used data from the Mexican Health and Aging Study (n = 10,426) to evaluate the impact of adult child SES disadvantage on parents' verbal memory trajectories over fourteen years (2001-2015). We estimated linear mixed models and used measures of adult child SES (educational, financial, and employment) disadvantage. Our most robust finding was that having an adult child with less than secondary education was associated with faster decline in verbal memory z-scores for older women (β: -0.009 [95% CI: -0.01, -0.001]) and men (β: -0.01 [95% CI: -0.02, -0.01]). Although poor adult child financial well-being was associated with a faster decline in parents' verbal memory z-scores, this finding was less consistent across model specifications. Additional analyses also suggested some evidence of heterogeneity by parents' own educational attainment and gender. These findings highlight the potential importance of children's socio-economic status for the cognitive aging of their older parents.
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Affiliation(s)
- Jacqueline M Torres
- Department of Epidemiology & Biostatistics, University of California San Francisco, USA.
| | | | - Connor Sheehan
- School of Social and Family Dynamics, Arizona State University, USA
| | - Mingming Ma
- Institute for Advanced Research, Shanghai University of Finance and Economics, China; Key Laboratory of Mathematical Economics (SUFE), Ministry of Education of China, China
| | - Joseph Sáenz
- Leonard Davis School of Gerontology, University of Southern California, USA
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19
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Moon JY, Lee JY, Kim JH. Effect of individuals' forecast for their children's economic environment and satisfaction with their relationships with children on their mortality. Geriatr Gerontol Int 2021; 21:568-576. [PMID: 33949067 DOI: 10.1111/ggi.14174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/29/2021] [Accepted: 04/10/2021] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study is to evaluate if the risk of mortality among the elderly Korean individuals is associated with any of the two intergenerational variables: participants' forecast for their children's economic environment (FCEE) and participants' satisfaction with their relationship with their children (SRC). METHODS Data from the Korean Longitudinal Study of Aging (KLoSA) conducted between 2006 and 2016 were examined. In total, 9937 individuals were included at baseline. The FCEE and SRC were measured using an 11-point Likert scale, which were stratified into four levels: "negative" (0-2), "Moderately negative" (3-5), "moderately positive" (6-8) and "positive" (9, 10). RESULTS The Cox proportional hazards model was used to calculate hazard ratios of all-cause mortality across different levels of FCEE and SRC while adjusting for other bio-psycho-social variables. Post-hoc subgroup analyses were conducted to examine how potential confounders contribute to the associations found in our study. Multivariate analyses showed that individuals with more negative FCEE were associated with a greater risk of all-cause mortality. Compared with the "positive" FCEE group, the "negative" group showed a 30.6% increase risk of all-cause mortality (hazard ratio = 1.306, 95% confidence interval = 1.066-1.601, P = 0.010). CONCLUSION The SRC did not exhibit any significant association with the all-cause mortality per multivariate analyses. More negative FCEE was associated with greater all-cause mortality. The FCEE, an individual's appraisal of the financial climate of their children's generation, may be considered a novel correlate of the all-cause mortality in an elderly population. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2021; 21: 568-576.
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Affiliation(s)
- Jong Youn Moon
- Center for Public Healthcare, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Joo-Young Lee
- University of Maryland/Sheppard Pratt Psychiatry Residency Training Program, Baltimore, Maryland, USA
| | - Jae-Hyun Kim
- Department of Health Administration, College of Health Science, Dankook University, Cheonan, Republic of Korea
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20
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Cui Y, Liu H, Zhao L. Protective effect of adult children's education on parental survival in China: Gender differences and underlying mechanisms. Soc Sci Med 2021; 277:113908. [PMID: 33848715 DOI: 10.1016/j.socscimed.2021.113908] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/17/2021] [Accepted: 03/31/2021] [Indexed: 12/15/2022]
Abstract
This study investigates whether adult children's education has a protective effect on parental survival, using data from all waves (2010-2018) of the China Family Panel Studies. We exploited the exogenous temporal and geographical variations in the enforcement of the 1986 compulsory schooling laws in China to construct an instrumental variable (IV) for adult children's education. The IV estimates indicated that the law-induced higher education of adult children led to sizeable improvements in the likelihood of paternal survival, although it had no significant effect on maternal survival. The protective effect on paternal survival was mainly driven by better-educated daughters, while sons' education had only a modest positive effect on maternal survival. Further evidence suggested that such heterogeneity by the gender of adult children might mainly come through more informal caregiving from better-educated daughters to older fathers with a limited role played by financial support from adult children.
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Affiliation(s)
- Ying Cui
- School of Economics, Capital University of Economics and Business, China.
| | - Hong Liu
- School of Labor and Human Resources, Renmin University of China, China.
| | - Liqiu Zhao
- School of Labor and Human Resources, Renmin University of China, China.
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21
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Sagie S, Na'amnih W, Frej J, Alpert G, Muhsen K. Associations of psychosocial factors, knowledge, attitudes and practices with hospitalizations in internal medicine divisions in different population groups in Israel. Int J Equity Health 2021; 20:105. [PMID: 33879185 PMCID: PMC8056509 DOI: 10.1186/s12939-021-01444-z] [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: 10/30/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inequalities in healthcare utilization exist across ethnic groups; however, the contributions of health-related knowledge and psychosocial factors to these inequalities remain unclear. We examined associations of social determinants of health, psychological factors, knowledge, attitudes and health practices, with hospitalizations in internal medicine divisions, among Israeli adults, Jews and Arabs, with non-communicable diseases, in a setting of universal health insurance. METHODS A retrospective study was undertaken among 520 Jews and Arabs aged 40 years or older with non-communicable diseases, members of a large health maintenance organization. Hospitalization (at least once during 2008) in an internal medicine division was determined based on documentation in electronic health records. Participants were randomly selected in strata of sex, population-group and hospitalization status (yes/no). Data were collected from medical records and via face-to-face interviews using a structured questionnaire. Main independent variables included comorbidity burden, health behaviors, mental health wellbeing and self-rated health. Scales measuring health knowledge and attitudes/beliefs were constructed using factor analysis. RESULTS Comorbidity burden (OR 1.41 [95% CI 1.24-1.61]) and self-rated health (not good vs. good) (OR 1.88 [95% CI 1.13-3.12]) were positively associated with hospitalizations in an internal medicine division, while an inverse association was found with better mental health wellbeing (OR 0.98 [95% CI 0.96-0.99, for each 1-point score increase). Among Jewish participants, positive associations were found of the number of offspring, comorbidity burden and perceived difficulty, with hospitalizations. No significant associations were found with hospitalizations of other sociodemographics, health behaviors, knowledge and attitudes/beliefs. CONCLUSIONS Comorbidity burden was the main risk factor of hospitalizations in internal medicine divisions. Psychosocial factors, such as self-rated health, a complex variable affected by social capital, mental wellbeing, the number of offspring, and perceived burden and difficulty, seem also to contribute. These findings suggest the involvement of broad family and social factors, beyond individual level characteristics and medical needs, in hospitalizations in internal medicine divisions. Interventions to reduce hospitalizations should be comprehensive and integrate aspects of mental health wellbeing; they should build on familial characteristics (e.g., number of offspring), factors related to social capital such as self-rated health, and perceived burden and difficulty.
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Affiliation(s)
- Shira Sagie
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6139001, Tel Aviv, Israel. .,Department of Oncology, Sheba Medical Center, 52621, Ramat Gan, Israel.
| | - Wasef Na'amnih
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6139001, Tel Aviv, Israel
| | - Juda Frej
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6139001, Tel Aviv, Israel
| | | | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6139001, Tel Aviv, Israel
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22
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O'Neil A, Russell JD, Thompson K, Martinson ML, Peters SAE. The impact of socioeconomic position (SEP) on women's health over the lifetime. Maturitas 2020; 140:1-7. [PMID: 32972629 PMCID: PMC7273147 DOI: 10.1016/j.maturitas.2020.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/18/2022]
Abstract
The "social gradient of health" refers to the steep inverse associations between socioeconomic position (SEP) and the risk of premature mortality and morbidity. In many societies, due to cultural and structural factors, women and girls have reduced access to the socioeconomic resources that ensure good health and wellbeing when compared with their male counterparts. Thus, the objective of this paper is to review how SEP - a construct at the heart of the Social Determinants of Health (SDoH) theory - shapes the health and longevity of women and girls at all stages of the lifespan. Using literature identified from PubMed, Cochrane, CINAHL and EMBASE databases, we first describe the SDoH theory. We then use examples from each stage of the life course to demonstrate how SEP can differentially shape girls' and women's health outcomes compared with boys' and men's, as well as between sub-groups of girls and women when other axes of inequalities are considered, including ethnicity, race and residential setting. We also explore the key consideration of whether conventional SEP markers are appropriate for understanding the social determinants of women's health. We conclude by making key recommendations in the context of clinical, research and policy development.
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Affiliation(s)
- Adrienne O'Neil
- Heart & Mind Research, iMPACT Institute, Deakin University, 3220, VIC, Australia.
| | - Josephine D Russell
- Heart & Mind Research, iMPACT Institute, Deakin University, 3220, VIC, Australia
| | - Kelly Thompson
- Global Women's Health, The George Institute for Global Health, University of New South Wales, Australia
| | | | - Sanne A E Peters
- The George Institute for Global Health, University of Oxford, Oxford, UK; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; The George Institute for Global Health, University of New South Wales, Sydney, Australia
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23
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Jiang N, Kaushal N. How children's education affects caregiving: Evidence from parent's last years of life. ECONOMICS AND HUMAN BIOLOGY 2020; 38:100875. [PMID: 32445917 DOI: 10.1016/j.ehb.2020.100875] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 05/16/2023]
Abstract
Using data from the Health and Retirement Study (1994-2012), we studied the association between adult children's education and financial and caregiving support they provided to their aging parents in the last years of the parents' life. We controlled for the circumstances of parents' death, their functional limitations, whether they were in long-term care or home-care settings in the last year of their life, and in some models, various measures of parents' self-reported health. Estimates suggest that having a college degree and above has a significantly positive association with monetary transfers and knowledge support children provide to their parents. Estimates remained robust in models that included parent fixed effects. Evidence of children's education on instrumental support to parents was nonlinear in that although some college education increased instrumental support, but, a college degree did not have a statistically significant effect. Gender did not play a moderating role in the relationship between offspring education and support towards parents.
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Affiliation(s)
- Nan Jiang
- Department of Social Work, National University of Singapore, Singapore.
| | - Neeraj Kaushal
- School of Social Work, Columbia University, New York, NY, USA
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24
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Abalos JB, Booth H. Factors associated with regional variation in disability-free life expectancy based on functional difficulty among older persons in the Philippines. ASIAN POPULATION STUDIES 2020. [DOI: 10.1080/17441730.2020.1795997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Jeofrey B. Abalos
- Demographic Research and Development Foundation, Inc., University of the Philippines Diliman, 2/F Palma Hall, Roxas Avenue, corner Roces St, Quezon City, Philippines, 1101
| | - Heather Booth
- School of Demography, ANU College of Arts and Social Sciences, The Australian National University, 9 Fellows Road, Acton ACT 2601, Australia
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Meyer AC, Torssander J, Talbäck M, Modig K. Parents survive longer after stroke than childless individuals: a prospective cohort study of Swedes over the age of 65. Eur J Public Health 2019; 29:1090-1095. [PMID: 31220242 PMCID: PMC6896977 DOI: 10.1093/eurpub/ckz053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Parents have lower mortality than childless individuals, and one possible explanation is support provided by adult children. Since stroke often results in functional limitations, support from children may be of particular importance. Here, we examine whether the presence of children matters for survival after stroke among older Swedish men and women. METHODS This prospective cohort study linked data from several Swedish population registers. Individuals aged 65 years and older hospitalized for their first ischemic stroke between 1998 and 2002 (33 960 men and 36 189 women) were followed 12 years for survival. Hazard ratios for all-cause mortality were calculated by number of children using Cox proportional hazard regression stratified by sex and marital status and adjusted for education, income and comorbidities. RESULTS Childlessness and having only one child was associated with higher mortality after stroke compared with having two children among men and women. The relative survival disadvantage of childless individuals was largest among married women [HR 1.28 (1.18-1.39)] and smallest among married men [1.09 (1.03-1.15)]. The differences in predicted median survival between childless individuals and those with two children were 4 and 7 months among married and unmarried men, and 15 and 9 months among married and unmarried women, respectively. CONCLUSIONS Having children is associated with a longer survival after stroke among men and women regardless of marital status. Our findings further suggest that the presence of children is especially connected to married women's survival. These results may have implications for the improvement of informal care for childless older individuals.
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Affiliation(s)
- Anna C Meyer
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jenny Torssander
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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26
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Does having highly educated adult children reduce mortality risks for parents with low educational attainment in Europe? AGEING & SOCIETY 2019. [DOI: 10.1017/s0144686x19000795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIt is known that the education of significant others may affect an individual's mortality. This paper extends an emerging body of research by investigating the effect of having highly educated adult children on the longevity of older parents in Europe, especially parents with low educational attainment. Using a sample of 15,015 individuals (6,620 fathers and 8,395 mothers) aged 50 and above, with 1,847 recorded deaths, over a mean follow-up period of 10.9 years from the Survey of Health, Ageing and Retirement in Europe (SHARE), we examine whether the well-established socio-economic gradient in mortality among parents is modified when their adult children have higher educational attainment than their parents. We find that having highly educated adult children is associated with reduced mortality risks for fathers and mothers with low educational attainment, compared to their counterparts whose adult children have only compulsory education. The association is stronger in early older age (ages 50–74) than in later older age (ages 75 and over). Part of the association appears to be explained by health behaviours (physical (in)activity) and health status (self-rated health). Our findings suggest that the socio-economic–mortality gradient among older parents might be better captured using an intergenerational approach that recognises the advantage of having highly educated adult children, especially for fathers and mothers with only compulsory education.
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Meyer AC, Brooke HL, Modig K. The role of children and their socioeconomic resources for the risk of hospitalisation and mortality - a nationwide register-based study of the total Swedish population over the age 70. BMC Geriatr 2019; 19:114. [PMID: 31014257 PMCID: PMC6480801 DOI: 10.1186/s12877-019-1134-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/09/2019] [Indexed: 11/21/2022] Open
Abstract
Background Previous studies have shown that mortality in old age is associated with both number of children and their socioeconomic resources. The underlying mechanisms are unclear, as well as when during the process of health deterioration the advantage of parents over non-parents arises. This study aims to examine how the number of children and their socioeconomic resources are associated with different health outcomes among their parents, namely the hazard for i) first hospitalisation, ii) re-admission, iii) mortality after first hospitalisation, and iv) overall mortality. Method This longitudinal cohort study includes all individuals born 1920–1940 who were living in Sweden at age 70 years (890,544 individuals). Individuals were linked to their offspring and spouse using administrative registers and followed for up to 25 years. Associations were estimated using multivariable Cox models adjusted for index persons’ education and income, marital status, their partners’ education, and age at first birth. Results In this study, having children was associated with reduced mortality risk of their parents, but not with the risk of being hospitalised, which increased as number of children increased. A higher education of children was protective for all parental outcomes independent of number of children and their financial resources. In fact, income of the children was only weakly associated with the health of their parents. Conclusions The benefit of having children compared to childlessness for health in old age seems to arise once individuals have become ill rather than before. Children’s education is important for parental health and mortality, in fact more important than the number of children itself in this Swedish cohort. Electronic supplementary material The online version of this article (10.1186/s12877-019-1134-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna C Meyer
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, PO Box 210, SE-171 77, Stockholm, Sweden
| | - Hannah L Brooke
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, PO Box 210, SE-171 77, Stockholm, Sweden.,Department of Public Health and Caring Science, Uppsala Universitet, 751 22, Uppsala, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, PO Box 210, SE-171 77, Stockholm, Sweden.
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Peng S, Bauldry S, Gilligan M, Suitor JJ. Older mother's health and adult children's education: Conceptualization of adult children's education and mother-child relationships. SSM Popul Health 2019; 7:100390. [PMID: 31193097 PMCID: PMC6517527 DOI: 10.1016/j.ssmph.2019.100390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/15/2019] [Accepted: 03/20/2019] [Indexed: 11/30/2022] Open
Abstract
This study joins and extends an emerging body of work examining the association between adult children's education and their parents' health by (1) providing a conceptual treatment of adult children's education, (2) examining the link between adult children's education and older mothers' physical and mental health, and (3) investigating whether mother-child relationships moderate the association between children's education and mothers' health. Data on 541 older mothers in the U.S. who reported on all of their adult children collected as part of the Within-Family Differences Study. Results indicate the best performing measure of adult children's education, the proportion with a college degree or higher, reflects a cumulative, credential-based approach. In addition, the proportion of adult children with a college degree or higher maintains a negative association with mother's depressive symptoms and activity limitations net of mother's own education as well as a number of sociodemographic factors and adult children's measures. There was no evidence that various aspects of mother-child relationships (geographic proximity, frequency of contact, and quality of relationships) moderated these negative associations.
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Jørgensen TSH, Nilsson CJ, Lund R, Siersma V, Fors S. Intergenerational relations and social mobility: Social inequality in physical function in old age. Arch Gerontol Geriatr 2018; 80:58-64. [PMID: 30368028 DOI: 10.1016/j.archger.2018.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 10/12/2018] [Accepted: 10/12/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The concept of social foreground describes how adult offspring's socioeconomic resources may influence older adults' health and several studies have shown an association between socioeconomic position of adult offspring and the health of their older parents. However, little is known about the factors that generate these associations. We study 1) how adult offspring's social class is associated with physical function (PF) among older adults, 2) whether geographical closeness and contact frequency with offspring modify the association, and 3) whether intergenerational social mobility of offspring is associated with PF of older adults. METHOD Data are obtained from the 2002 (n = 621) and 2011 (n = 931) waves of the Swedish Panel Study of Living Conditions of the Oldest Old. Multivariable linear regression models were employed and adjusted for own and partner's prior social class and offspring's age and gender. RESULTS Compared to offspring with non-manual occupation, offsprings with manual occupation was associated with poorer PF in older adults (-0.14, CI95%:-0.28;0.00). In stratified analyses, offspring's social class was only associated with older adults' PF among those who lived geographically close. Contact frequency between the offspring and the older adults did not modify the associations. Older adults whose offspring experienced downward intergenerational social mobility were associated with the poorest PF. CONCLUSION This study supports evidence of a relationship between social foreground and older adults' PF where geographical closeness and social mobility are important components.
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Affiliation(s)
- Terese Sara Høj Jørgensen
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; Center for Healthy Aging, University of Copenhagen, 1123 Copenhagen K, Denmark.
| | - Charlotte Juul Nilsson
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, 1123 Copenhagen K, Denmark
| | - Rikke Lund
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, 1123 Copenhagen K, Denmark; Danish Aging Research Center, Department of Public Health, University of Southern Denmark Odense, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stefan Fors
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; Centre for Health Equity Studies, Stockholm University and Karolinska Institutet, Sweden
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Multigenerational socioeconomic attainments and mortality among older men: An adjacent generations approach. DEMOGRAPHIC RESEARCH 2018. [DOI: 10.4054/demres.2018.39.26] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Wolfe JD, Bauldry S, Hardy MA, Pavalko EK. Multigenerational Attainments, Race, and Mortality Risk among Silent Generation Women. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2018; 59:335-351. [PMID: 29949716 DOI: 10.1177/0022146518784596] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study extends health disparities research by examining racial differences in the relationships between multigenerational attainments and mortality risk among "Silent Generation" women. An emerging literature suggests that the socioeconomic attainments of adjacent generations, one's parents and adult children, provide an array of life-extending resources in old age. Prior research, however, has demonstrated neither how multigenerational resources are implicated in women's longevity nor how racial disparities faced by Silent Generation women may differentially structure the relationships between socioeconomic attainments and mortality. With data from the National Longitudinal Survey of Mature Women, the analysis provided evidence of a three-generation model in which parent occupation, family wealth, and adult child education were independently associated with women's mortality. Although we found evidence of racial differences in the associations between parental, personal, and spousal education and mortality risk, the education of adult children was a robust predictor of survival for black and white women.
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Affiliation(s)
- Joseph D Wolfe
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
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Elo IT, Martikainen P, Aaltonen M. Children's educational attainment, occupation, and income and their parents' mortality. POPULATION STUDIES 2018; 72:53-73. [PMID: 28994347 PMCID: PMC6034683 DOI: 10.1080/00324728.2017.1367413] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Using data from Finland, this paper contributes to a small but growing body of research regarding adult children's education, occupation, and income and their parents' mortality at ages 50+ in 1970-2007. Higher levels of children's education are associated with 30-36 per cent lower parental mortality at ages 50-75, controlling for parents' education, occupation, and income. This association is fully mediated by children's occupation and income, except for cancer mortality. Having at least one child educated in healthcare is associated with 11-16 per cent lower all-cause mortality at ages 50-75, an association that is largely driven by mortality from cardiovascular diseases. Children's higher white-collar occupation and higher income is associated with 39-46 per cent lower mortality in the fully adjusted models. At ages 75+, these associations are much smaller overall and children's schooling remains more strongly associated with mortality than children's occupation or income.
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Affiliation(s)
| | - Pekka Martikainen
- University of Helsinki
- Stockholms University and Karolinska Institute
- The Max Planck Institute for Demographic Research
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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.
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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.
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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.
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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
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Peters SAE, Yang L, Guo Y, Chen Y, Bian Z, Millwood IY, Wang S, Yang L, Hu Y, Liu J, Wang T, Chen J, Peto R, Li L, Woodward M, Chen Z. Parenthood and the risk of cardiovascular diseases among 0.5 million men and women: findings from the China Kadoorie Biobank. Int J Epidemiol 2017; 46:180-189. [PMID: 27649806 PMCID: PMC5837253 DOI: 10.1093/ije/dyw144] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2016] [Indexed: 11/14/2022] Open
Abstract
Background Women's parity has been associated with risk of cardiovascular disease (CVD). It is unclear, however, whether it reflects biological effects of childbearing or uncontrolled socio-economic and lifestyle factors associated with childrearing. We assessed the association between number of children and incident CVD outcomes separately in women and men. Methods In 2004-08, the nationwide China Kadoorie Biobank recruited 0.5 million individuals aged 30-79 years from 10 diverse regions. During 7 years of follow-up, 24 432 incident cases of coronary heart disease (CHD) and 35 736 of stroke were recorded among 489 762 individuals without prior CVD. Multivariable Cox regression models were used to estimate sex-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for CHD and stroke associated with number of children. Results Overall, 98% of all participants had children and the mean number of children declined progressively from four in older participants to one or two in younger participants. Compared with childless women, women with children had an increased risk of CHD, but not of stroke [HR (95% CI): 1.14 (1.00; 1.30) and 1.03 (0.92; 1.16)]. Corresponding results for men were 1.20 (1.06; 1.35) and 1.13 (1.03; 1.24), respectively. In individuals with children, there was a log-linear association between number of children and CVD outcomes; in women, each additional child was associated with adjusted HRs of 1.02 (1.01; 1.04) for CHD and 1.02 (1.01; 1.03) for stroke, similar in magnitude to that in men [1.03 (1.01; 1.04) for CHD and 1.02 (1.01; 1.03) for stroke]. Conclusion In Chinese adults, the association between the number of children and risk of CHD and stroke was similar between men and women, suggesting that factors associated with parenthood and childrearing are more likely to affect the risk of CVD outcomes than factors associated with childbearing.
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Affiliation(s)
- Sanne AE Peters
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Ling Yang
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
| | - Yiping Chen
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
| | - Iona Y Millwood
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Shaojie Wang
- Qingdao CDC NCDs Prevention and Control Department, Qingdao, Shandong, China
| | - Liqiu Yang
- Nangang CDC, Haerbin, Heilongjiang, China
| | - Yihe Hu
- Suzhou CDC NCDs Prevention and Control Department, Suzhou, Jiangsu, China
| | | | - Tao Wang
- Maiji CDC, Tianshui, Gansu, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Chaoyang District, Beijing, China
| | - Richard Peto
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Liming Li
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
- Department of Public Health, Beijing University, Beijing, China
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, University of Sydney, Australia and
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Zhengming Chen
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
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De Neve JW, Harling G. Offspring schooling associated with increased parental survival in rural KwaZulu-Natal, South Africa. Soc Sci Med 2017; 176:149-157. [PMID: 28153751 PMCID: PMC5322823 DOI: 10.1016/j.socscimed.2017.01.015] [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: 08/09/2016] [Revised: 01/09/2017] [Accepted: 01/11/2017] [Indexed: 11/20/2022]
Abstract
Background Investing in offspring's human capital has been suggested as an effective strategy for parents to improve their living conditions at older ages. A few studies have assessed the role of children's schooling in parental survival in high-income countries, but none have considered lower-resource settings with limited public wealth transfers and high adult mortality. Methods We followed 17,789 parents between January 2003 and August 2015 in a large population-based open cohort in rural KwaZulu-Natal, South Africa. We used Cox proportional hazards models to investigate the association between offspring's schooling and time to parental death. We assessed the association separately by parental sex and for four cause of death groups. Results A one year increase in offspring's schooling attainment was associated with a 5% decline in the hazard of maternal death (adjusted Hazard Ratio [aHR]: 0.95, 95%CI: 0.94–0.97) and a 6% decline in the hazard of paternal death (aHR: 0.94, 95%CI: 0.92–0.96), adjusting for a wide range of demographic and socio-economic variables of the parent and their children. Among mothers, the association was strongest for communicable, maternal, perinatal and nutritional conditions (aHR: 0.87, 95%CI: 0.82–0.92) and AIDS and tuberculosis (aHR: 0.92, 95%CI: 0.89–0.96), and weakest for injuries. Among fathers, the association was strongest for injuries (aHR: 0.87, 95%CI: 0.79–0.95) and AIDS and tuberculosis (aHR: 0.92, 95%CI: 0.89–0.96), and weakest for non-communicable diseases. Conclusion Higher levels of schooling in offspring are associated with increased parental survival in rural South Africa, particularly for mothers at risk of communicable disease mortality and fathers at risk of injury mortality. Offspring's human capital may be an important factor for health disparities, particularly in lower-resource settings. Investing in offspring's education may improve parental survival. We follow 17,789 parents over a 13 year period in rural South Africa. Higher offspring schooling is associated with increased parental survival. Strongest association for mothers is for communicable disease mortality. Strongest association for fathers is for injury mortality.
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Affiliation(s)
- Jan-Walter De Neve
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, United States; Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg 69120, Germany.
| | - Guy Harling
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, United States; Research Department of Infection and Population Health, University College London, off Caper Street, London, WC1E 6JB, United Kingdom; Africa Health Research Institute, University of KwaZulu-Natal, Somkhele, 3935, South Africa
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Akinyemiju T, Ogunsina K, Sakhuja S, Ogbhodo V, Braithwaite D. Life-course socioeconomic status and breast and cervical cancer screening: analysis of the WHO's Study on Global Ageing and Adult Health (SAGE). BMJ Open 2016; 6:e012753. [PMID: 27881528 PMCID: PMC5129035 DOI: 10.1136/bmjopen-2016-012753] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Socioeconomic differences in screening have been well documented in upper-income countries; however, few studies have examined socioeconomic status (SES) over the life-course in relation to cancer screening in lower-income and middle-income countries. Here, we examine individual, parental and life-course SES differences in breast and cervical cancer screening among women in India, China, Mexico, Russia and South Africa. SETTING Data from the WHO's Study on Global Ageing and Adult Health (SAGE) 2007-2008 data were used for survey-weighted multivariable regression analysis. We examined the association between individual, parental and life-course SES in relation to breast and cervical cancer screening using education-based and employment-based measures of SES. PARTICIPANTS 22 283 women aged 18-65 years, recruited from China, India, Mexico, Russia and South Africa. RESULTS Having a college degree (OR 4.18; 95% CI 2.36 to 7.40) increased the odds of breast cancer screening compared with no formal education. Women with higher parental SES were almost 10 times more likely to receive breast cancer screening (OR 9.84; 95% CI 1.75 to 55.5) compared with women with low parental SES. Stable higher life-course (OR 3.07; 95% CI 1.96 to 4.79) increased breast cancer screening by threefold and increased cervical cancer screening by more than fourfold (OR 4.35; 95% CI 2.94 to 6.45); however, declining life-course SES was associated with reduced breast cancer screening (OR 0.26; 95% CI 0.08 to 0.79) compared to low life-course SES. CONCLUSIONS Higher individual, parental and life-course SES was positively associated with breast and cervical cancer screening, although education-based SES measures were stronger predictors of screening compared with employment-based measures. Improving knowledge of the benefits of cancer screening and integrating cancer screening into routine healthcare practice for low SES women are actionable strategies that may significantly improve screening rates in low-income and middle-income countries.
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Affiliation(s)
- Tomi Akinyemiju
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kemi Ogunsina
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Swati Sakhuja
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Valentine Ogbhodo
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Dejana Braithwaite
- Division of Cancer Epidemiology, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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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.
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Affiliation(s)
- Lei Yang
- Population Research Unit, Department of Social Research, University of Helsinki
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