Education and mortality in three Eastern European populations: findings from the PrivMort retrospective cohort study

Hazardous alcohol consumption in slow- and fast-privatized Russian industrial towns

Hazardous drinking, defined as the consumption of homemade, unofficially made alcohol and non-beverages, is prevalent and accounts for a high proportion of alcohol-related deaths in Russia. Individual-level characteristics are important explanations of hazardous drinking, but they are unlikely to explain spatial variation in this type of alcohol consumption. Areas that attracted insufficient attention in the research of hazardous drinking are the legacy of industrialization and the speed of economic reforms, mainly through the privatization policy of major enterprises in the 1990s. Applying mixed-effects logistic regressions to a unique dataset from 30 industrial towns in the European part of Russia, we find that in addition to individual-level characteristics such as gender, age, marital status, education, social isolation, labor market status, and material deprivation, the types of towns where informants' relatives resided such as industrial structure and speed of privatization also accounted for the variance in hazardous alcohol consumption among both male and female populations of the analyzed towns.

Effects of education on adult mortality: a global systematic review and meta-analysis

BACKGROUND

The positive effect of education on reducing all-cause adult mortality is known; however, the relative magnitude of this effect has not been systematically quantified. The aim of our study was to estimate the reduction in all-cause adult mortality associated with each year of schooling at a global level.

METHODS

In this systematic review and meta-analysis, we assessed the effect of education on all-cause adult mortality. We searched PubMed, Web of Science, Scopus, Embase, Global Health (CAB), EconLit, and Sociology Source Ultimate databases from Jan 1, 1980, to May 31, 2023. Reviewers (LD, TM, HDV, CW, IG, AG, CD, DS, KB, KE, and AA) assessed each record for individual-level data on educational attainment and mortality. Data were extracted by a single reviewer into a standard template from the Global Burden of Diseases, Injuries, and Risk Factors Study. We excluded studies that relied on case-crossover or ecological study designs to reduce the risk of bias from unlinked data and studies that did not report key measures of interest (all-cause adult mortality). Mixed-effects meta-regression models were implemented to address heterogeneity in referent and exposure measures among studies and to adjust for study-level covariates. This study was registered with PROSPERO (CRD42020183923).

FINDINGS

17 094 unique records were identified, 603 of which were eligible for analysis and included data from 70 locations in 59 countries, producing a final dataset of 10 355 observations. Education showed a dose-response relationship with all-cause adult mortality, with an average reduction in mortality risk of 1·9% (95% uncertainty interval 1·8-2·0) per additional year of education. The effect was greater in younger age groups than in older age groups, with an average reduction in mortality risk of 2·9% (2·8-3·0) associated with each additional year of education for adults aged 18-49 years, compared with a 0·8% (0·6-1·0) reduction for adults older than 70 years. We found no differential effect of education on all-cause mortality by sex or Socio-demographic Index level. We identified publication bias (p<0·0001) and identified and reported estimates of between-study heterogeneity.

INTERPRETATION

To our knowledge, this is the first systematic review and meta-analysis to quantify the importance of years of schooling in reducing adult mortality, the benefits of which extend into older age and are substantial across sexes and economic contexts. This work provides compelling evidence of the importance of education in improving life expectancy and supports calls for increased investment in education as a crucial pathway for reducing global inequities in mortality.

FUNDING

Research Council of Norway and the Bill & Melinda Gates Foundation.

Educational inequalities in mortality and their mediators among generations across four decades: nationwide, population based, prospective cohort study based on the ChinaHEART project

OBJECTIVES

To assess the different educational inequalities in mortality among generations born between 1940 and 1979 in China, and to investigate the role of socioeconomic, behavioural, and metabolic factors as potential contributors to the reduction of educational inequalities.

DESIGN

Nationwide, population based, prospective cohort study.

SETTING

The ChinaHEART (China Health Evaluation And risk Reduction through nationwide Teamwork) project in all 31 provinces in the mainland of China.

PARTICIPANTS

1 283 774 residents aged 35-75 years, divided into four separate cohorts born in 1940s, 1950s, 1960s, and 1970s.

MAIN OUTCOME MEASURES

Relative index of inequality and all cause mortality.

RESULTS

During a median follow-up of 3.5 years (interquartile range 2.1-4.7), 22 552 deaths were recorded. Among the four generations, lower education levels were found to be associated with a higher risk of all cause death: Compared with participants with college level education or above, the hazard ratio for people with primary school education and below was 1.4 (95% confidence interval 1.2 to 1.7) in the 1940s cohort, 1.8 (1.5 to 2.1) in the 1950s cohort, 2.0 (1.7 to 2.4) in the 1960s cohort, and 1.8 (1.4 to 2.4) in the 1970s cohort. Educational relative index of inequality in mortality increased from 2.1 (95% confidence interval 1.9 to 2.3) in the 1940s cohort to 2.6 (2.1 to 3.3) in the 1970s cohort. Overall, the mediation proportions were 37.5% (95% confidence interval 32.6% to 42.8%) for socioeconomic factors, 13.9% (12.0% to 16.0%) for behavioural factors, and 4.7% (3.7% to 5.8%) for metabolic factors. Except for socioeconomic measurements, the mediating effects by behavioural and metabolic factors decreased in younger generations.

CONCLUSION

Educational inequalities in mortality increased over generations in China. Improving healthy lifestyles and metabolic risk control for less educated people, especially for younger generations, is essential to reduce health inequalities.

How democracy alters our view of inequality - and what it means for our health

BACKGROUND

Income inequality is associated with poor health when economic disparities are especially salient. Yet, political institutions may alter this relationship because democracies (as opposed to autocracies) may be more inclined to frame inequalities in negative rather than positive ways. Living in a particular political system potentially alters the messages individuals receive about whether inequality is large or small, good or bad, and this, in turn, might affect whether beliefs about inequality influence health. Further, media coverage of economic inequality may negatively affect health if it contributes toward the general perception that the gap between rich and poor has gone up, even if there has been no change in income differentials.

METHODS

In this study, we explore the relationship between democracy, perceptions of inequality, and self-rated health across 28 post-communist countries using survey and macro-level data, multilevel regression models, and inverse probability weighting to estimate the average treatment effect on the treated.

RESULTS

We find that self-rated health is higher in more democratic countries and lower among people who believe that inequality has risen in the last few years. Moreover, we observe that people in democracies are more likely to learn about rising inequality through watching television and that when they do it has a more harmful effect on their health than when people in autocracies learn about rising inequality through the same channel, suggesting that in countries where there is less trust in the television media learning about rising inequality is not as harmful for health.

CONCLUSIONS

Our results indicate that while democracies are generally good for well-being, they may not be unambiguously positive for health. This does not mean, of course, that inequality is good for health nor that, on average, autocracies have better health than democracies; but rather that being more aware of inequality can negatively affect self-rated health.

Is industrial pollution detrimental to public health? Evidence from the world's most industrialised countries

BACKGROUND

Industrial pollution is considered to be a detrimental factor for human health. This study, therefore, explores the link between health status and industrial pollution for the top 20 industrialised countries of the world.

METHODS

Crude death rate is used to represent health status and CO2 emissions from manufacturing industries and construction, and nitrous oxide emissions are considered to be indicators of industrial pollution. Using annual data of 60 years (1960-2019), an unbalanced panel data estimation method is followed where (Driscoll, J. C. et al. Rev Econ Stat, 80, 549-560, 1998) standard error technique is employed to deal with heteroscedasticity, autocorrelation and cross-sectional dependence problems.

RESULTS

The research findings indicate that industrial pollution arising from both variables has a detrimental impact on human health and significantly increases the death rate, while an increase in economic growth, number of physicians, urbanisation, sanitation facilities and schooling decreases the death rate.

CONCLUSIONS

Therefore, minimisation of industrial pollution should be the topmost policy agenda in these countries. All the findings are consistent theoretically, and have empirical implications as well. The policy implication of this study is that the mitigation of industrial pollution, considering other pertinent factors, should be addressed appropriately by enunciating effective policies to reduce the human death rate and improve health status in the studied panel countries.

Intergenerational social mobility and health in Russia: Mind over matter?

The consequences of changing one's socio-economic status over the life course-i.e. social mobility-for individual health are not well understood. Theories of the health implications of social mobility draw on the human perception of one's changing conditions, but empirical studies mostly examine the health implications of moving from objectively defined indicators of parental socio-economic position such as education, occupation, or income, to own socio-economic position in adult life. Little is known about the consequences of individuals' own assessment of changes in socio-economic position for health outcomes. In this study, we examine the association of social mobility and health in a unique sample of the Russian population after the transition to a market society. We take a broad perspective on social mobility, putting emphasis on subjectively perceived social mobility. Results show that individuals' objective characteristics only partially explain the variation in their subjective perceptions of intergenerational mobility. Net of social origin and destination variables, subjective social mobility is associated with individuals' health outcomes, as measured by the 12-Item Short Form Health Survey. Those who perceive being upwardly mobile report better health, and downward mobility is associated with poorer health. The association holds for mental and physical health, for perceived downward and upward social mobility, and for a general subjective measure of mobility and a subjective measure prompting respondents to only think of mobility in terms of occupation. These findings are robust to controlling for a rich set of socio-demographic predictors on childhood adversity, contemporaneous material wellbeing, and family-related circumstances. We conclude that a conventional focus on single socio-economic status dimensions such as occupation might be too narrow to capture the health consequences of social mobility.

Changes in inequalities of mortality by education level in Lithuania between 2001 and 2014

OBJECTIVE

The aim of the study is to analyse the changes in inequalities of mortality by education level in Lithuania between 2001 and 2014.

STUDY DESIGN

This is a record-linked cohort study.

METHODS

Information on deaths (in the population aged ≥30 years) from all causes and cardiovascular diseases, cancer, external causes and diseases of the digestive system was obtained from Statistics Lithuania. Mortality rates for these causes were calculated by the level of education per 100,000 person-years. Inequalities in mortality were assessed using a rate ratio and a relative index of inequality with 95% confidence intervals (CIs). Joinpoint regression analysis was used to assess inequality trends between 2001 and 2014.

RESULTS

During the study period, mortality from all causes and from cardiovascular diseases, cancer, external causes and diseases of the digestive system was statistically significantly higher in the group with less education for both men and women, with the exception for female mortality from cancer in 2001. The highest decline was observed in the inequalities of mortality from external causes, whereas a major increase was observed in the inequalities of mortality from diseases of the digestive system. A large increase in inequalities was observed in mortality from external causes for men (on average by 3.5% per year [95% CI = 2-5.1]), whereas, for women, the highest increase in inequalities was observed in mortality from diseases of the digestive system (on average by 3% per year [95% CI = 0.6-5.5]). The slowest increase in mortality inequalities was noted for cardiovascular diseases for both men (on average by 1.1% per year [95% CI = 0.4-1.9]) and women (on average by 0.8% per year [95% CI = 0.3-1.3]).

CONCLUSION

Between 2001 and 2014, the inequalities in mortality by level of education in Lithuania significantly increased in terms of mortality from all causes, cardiovascular diseases, cancer, external causes and diseases of the digestive system.

Parental education, health literacy and children's adult body height

Human anthropometric traits, while significantly determined by genetic factors, are also affected by an individual's early life environment. An adult's body height is a valid indicator of their living conditions in childhood. Parental education has been shown to be one of the key covariates of individuals' health and height, both in childhood and adulthood. Parental functional literacy has been demonstrated to be another important determinant of child health, but this has largely been overlooked in studies on height. The objective of this study was to analyse the associations between parents' education, their functional literacy and their children's adult body height. The study used data for 39,240 individuals from the 2016 wave of the nationally representative Life in Transition Survey (LITS) conducted in 34 countries in Southern and Eastern Europe, the Middle East and Central Asia. Using linear and Poisson models, regression adjustment treatment estimators and multilevel mixed-effects linear regressions, the study analysed the links between mother's and father's educational attainment, parental functional literacy, measured by the number of books in the childhood home, and children's adult height. The models also included other individual and contextual covariates of height. The results demonstrated that mother's educational attainment and parental functional literacy have independent associations with children's adult body height. Sufficient literacy skills of the parent may have a positive effect on children's growth even if parental education is low. These associations remained significant across time. The study also provides evidence of a widening of the height gap for men born in the period just before and after systemic transition in post-socialist societies, which may suggest an increase in social differences in early living standards.

Inequality, validity of self-reported height, and its implications for BMI estimates: An analysis of randomly selected primary sampling units' data

Any systematic errors in self-reported height, a measure commonly used in health research, may produce biased BMI estimates and reduce the effectiveness of public health interventions. To our knowledge, none of the studies evaluating the validity of self-reported height explore this issue in cross-national settings. This study analyses data on a sub-set of 750 individuals with information on self-reported and measured height from the Life in Transition Survey (LITS) conducted in 34 European and Central Asian countries in 2016. We make use of the unique design of LITS in which all respondents reported their height, but in one randomly selected primary sampling unit in each country the actual height was also measured, using a portable stadiometer. In addition to analysing individual-level characteristics, using a multiply imputed dataset for missing data and multilevel mixed-effects regressions, we test if macro-level factors are associated with respondents under- or over-reporting their height. We find that on the aggregate level self-reported and measured height estimates are not statistically different, but some socio-demographic groups such as women and those who live in rural areas are likely to overestimate their height. Adjusting for this bias would lead to the higher estimates of the proportion of individuals who are overweight and obese. The results from multilevel analysis also show that macro-level factors do not per se explain the likelihood of misreporting height, but rather some of the effects of individual characteristics are moderated by income inequality.

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Systematic errors in self-reported height may produce biased BMI estimates.

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On the aggregate level self-reported and measured height are indistinguishable.

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Women and those who live in rural areas are likely to overestimate their height.

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This bias can increase the estimated population BMI level by 2.1%.

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Some of the effects of individual variables are moderated by income inequality.