Education and Health across Lives and Cohorts: A Study of Cumulative (Dis)advantage and Its Rising Importance in Germany

Young people's health and well-being during the school-to-work transition: a prospective cohort study comparing post-secondary pathways

Background

At the end of secondary education, young people can either start vocational training, enter university, directly transition to employment or become unemployed. Research assumes that post-secondary pathways have immediate and/or long-term impacts on health and well-being, but empirical investigations on this are scarce and restricted to few countries. Therefore, this study traced the development of health and well-being throughout the highly institutionalised school-to-work transition (STWT) in Germany.

Methods

We used longitudinal data of the National Educational Panel Study (NEPS), a representative sample of 11,098 school-leavers (50.5% girls) repeatedly interviewed between 2011 and 2020. We estimated the effect of post-secondary transitions on self-rated health and subjective well-being by applying fixed-effects (FE) regression, eliminating bias resulting from time-constant confounding and self-selection into different pathways. A multiple-sample strategy was used to account for the increasing diversity of STWTs patterns. Models were controlled for age, as well as household and residential changes to minimise temporal heterogeneity.

Results

Findings indicate that leaving school was good for health and well-being. Compared with participants who did not find a training position after school, direct transitions to vocational training or university were linked to higher absolute levels of health and well-being, but also to a lower relative decline over time. Furthermore, upward transitions (e.g. to programs leading to better education or from unemployment to employment) were associated with improvements in health and well-being, while downward transitions were followed by deteriorations.

Conclusion

Findings suggest that school-leave is a sensitive period and that post-secondary pathways provide young people with different abilities to maintain health and well-being. Youth health interventions might benefit when setting a stronger focus on unsuccessful school-leavers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14227-0.

Dualized Labor Market and Polarized Health: A Longitudinal Perspective on the Association between Precarious Employment and Mental and Physical Health in Germany

This study analyzes the longitudinal association between precarious employment and physical and mental health in a dualized labor market by disaggregating between-employee and within-employee effects and considering mobility in precariousness of employment. Analyses were based on the German Socio-Economic Panel from 2002 to 2018 considering all employees ages 18 to 67 years (n = 38,551). Precariousness of employment was measured as an additive index considering working poverty, nonstandard working time arrangements, perceived job insecurity, and low social rights. Health outcomes were mental and physical health. Random effects models were used and controlled for sociodemographic and socioeconomic variables. Results indicated that the association between precariousness of employment and mental and physical health is mainly based on between-employee differences and that prolonged precariousness of employment or upward or downward mobility are associated with poor health. We found evidence of polarization in health by precariousness of employment within a dualized labor market.

Urbanization and systolic/diastolic blood pressure from a gender perspective: Separating longitudinal from cross-sectional association

There has been a generally negative view of the impact of urbanization on a rising burden of non-communicable diseases including cardiovascular disease. However, the evidence on the relationship between urbanization and cardiovascular health has remained inconclusive. A comprehensive picture of the relationship is lacking, given an implicit assumption that the longitudinal association between changes in cardiovascular health and an increasingly urbanized environment is similar between less and more urbanized communities, men and women. We used the longitudinal data on adults (18-64 years) from the China Health and Nutrition Survey (1991-2015) and employed within-between random-effects models to disaggregates the longitudinal and cross-sectional associations between urbanization and systolic/diastolic blood pressure (SBP/DBP) and examined heterogeneities in the longitudinal association by average urbanization level and gender. We found that the positive longitudinal association of urbanization with SBP/DBP was stronger in less urbanized than more urbanized communities. The cross-sectional association between urbanization and SBP was negative and significant, although the cross-sectional association between urbanization and DBP was of no statistical significance. Moreover, the positive longitudinal association between urbanization and DBP was stronger among men than women, although the gender heterogeneity in the longitudinal association of urbanization with SBP was not significant.

School-to-work transition and subjective well-being in Australia

The school-to-work transition is a demanding period during an individual's life course in all societies particularly because the educational decisions made during this period have long-lasting consequences in multiple life domains. Moreover, adverse starting points after secondary school are likely to lead to adverse outcomes that might cumulate over the life course. This study analyses subjective well-being during this sensitive period and examines the following two questions. First, how do different school-to-work transitions relate to subjective well-being changes? Second, how does subjective well-being develop during and after secondary schooling? As the school-to-work transition period is structured by gender, each analytical step aims to identify gender differences. Furthermore, based on life course theories, this study investigates whether adverse starting points after secondary school lead to cumulative effects in the development of subjective well-being. Based on data from the Household, Income and Labour Dynamics in Australia (HILDA) survey and fixed effects regressions, our results reveal that transitions to employment increase subjective well-being, while transitions to unemployment decrease subjective well-being. Furthermore, transitions to study increase subjective well-being only among men, while such transitions appear to decrease subjective well-being among women. The results related to the development of subjective well-being indicate that subjective well-being decreases during secondary schooling and continues to decrease after individuals leave school. This decrease is stronger among men. Finally, our results reveal the negative cumulative effects of adverse starting points on the development of subjective well-being. Overall, the results reveal great intra-individual variation in subjective well-being during the school-to-work transition period in Australia.

Is it adding up? The cumulative effect of sickness benefits on life expectancy in old age in 15 OECD countries 1960-2015

Since the 1950s, high-income countries have experienced an immense increase in life expectancy. Previous studies have largely assessed how individual-level factors influence longevity, whereas cumulative dis/advantage theory (CDA) has in general been used to explain the relationship between individual resources and mortality in relation to aging. Rare studies have investigated the institutional impact on mortality within the framework of CDA. The research field is thus lacking studies that compare more than a handful of countries over a longer period. This study attempts to align CDA and comparative welfare state research by analysing the relationship between sickness benefits and life expectancy at age 65, comparing fifteen affluent countries over the period 1960 to 2015. The found results demonstrate that countries with higher benefit coverage have a larger increase in life expectancy, among both men and women. The effect of income replacement was mixed and appear to depend on the share of population covered by sickness benefits. This institutional interplay between coverage and income replacement supports previous insights about the beneficial effects of universal programs on population health.

Subjective health in adolescence: Comparing the reliability of contemporaneous, retrospective, and proxy reports of overall health

Self-rated health (SRH) is one of the most important social science measures of health. Yet its measurement properties remain poorly understood. Most studies ignore the measurement error in SRH despite the bias resulting from even random measurement error. Our goal is to estimate the measurement reliability of SRH in contemporaneous, retrospective, and proxy indicators. We use the National Longitudinal Study of Adolescent to Adult Health to estimate the reliability of SRH relative to proxy assessments and respondents' recollections of past health. Even the best indicators - contemporaneous self-reports - have a modest reliability of ~0.6; retrospective and proxy assessments fare much worse, with reliability less than 0.2. Moreover, not correcting for measurement error in SRH leads to a ~20-40% reduction in its correlation with other measures of health. Researchers should be skeptical of analyses that treat these subjective reports as explanatory variables and fail to take account of their substantial measurement error.

Is College Completion Associated with Better Cognition in Later Life for People Who Are the Least, or Most, Likely to Obtain a Bachelor's Degree?

OBJECTIVES

Drawing on insights from theorizing on cumulative dis/advantage (CDA), we aimed to advance understanding of educational attainment as a protective factor for later-life cognition by examining whether associations between obtaining a bachelor's degree and later-life cognition differ according to individuals' likelihood of completing college based on characteristics in adolescence.

METHODS

We conducted a propensity score analysis with data from the Wisconsin Longitudinal Study (WLS). Measures to predict college completion were assessed prospectively in adolescence, and a global measure of later-life cognition was based on cognitive assessments at age 65.

RESULTS

College completion by age 25 (vs high school only) was associated with better later-life cognition for both men and women. Among men specifically, associations were stronger for those who were less likely as adolescents to complete college.

DISCUSSION

Results indicate the utility of a CDA perspective for investigating the implications of interconnected early life risk and protective factors for later-life cognition, as well as ways in which college education can both contribute to, as well as mitigate, processes of CDA.

Putting cumulative (dis)advantages in context: Comparing the role of educational inequality in later-life functional health trajectories in England and Germany

BACKGROUND

The cumulative (dis)advantage (CAD) perspective more and more is examined in a comparative way, to highlight the role of context in generating inequality over the life course. This study adds to this field of research by examining trajectories of activities of daily living (ADL) in later life by educational level in a country comparison of England and Germany, emphasizing differing institutional conditions.

METHOD

Data used are the English Longitudinal Study of Ageing (ELSA; 11,352 individuals) and the German subsample of the Survey of Health and Retirement in Europe (SHARE; 5,573 individuals). Using population averaged Poisson panel regression models, 12-year trajectories of six birth cohorts are investigated, covering the age range of 50 to 90 years.

RESULTS

Respondents in England have a higher level of limitations at age 50, and more limited increases over age than in Germany. An educational gradient exists in both countries at age 50. Notably, the educational gradient increases for more recently born cohorts, but declines with increasing age in England, while in Germany educational differences increase for more recently born cohort only.

DISCUSSION

The current study indicates that CAD processes between educational groups are context sensitive. While England showed convergence of disparities with increasing age, in Germany no differential development was found.

Gender disparities in the education gradient in self-reported health across birth cohorts in China

Background

Variation in the relationship between education and health has been studied intensely over the past few decades. Although there is research on gender disparity and cohort variations in educational effect on health using samples from the U.S. and Europe, research about China’s is limited. Given the specific social changes in China, our study is designed to analyze the gender and cohort patterns in the education-health gradient.

Method

The latent growth-curve modeling was used to analyze the gender and cohort variations in the education gradient in self-rated health among Chinese respondents. The study employed longitudinal and nationally representative data from the Chinese Family Panel Studies from the years 2010 to 2016. Each cohort is specified according to their distinct periods of social change in China. Following the analysis, we used latent growth-curve model to illustrate gender and cohort differences in the age-graded education and health trajectories.

Results

Although Chinese men have reported to have better health than women in general, women reported 1.6 percentage points higher in self-reported health for each additional year of schooling compared to that of men (P < 0.001). The latent growth curve model showed women’s extra education benefits were persistent overtime. Compared to the people born during the “Old China” (1908–1938), the education gradient in self-rated health did not change for cohorts born before 1955 and after 1977, but the education-health gap changed significantly in the 1956–1960 (O.R. = 1.038, P < 0.05), 1967–1976 (O.R. = 1.058, P < 0.001), and 1977–1983 (O.R. = 1.063, P < 0.001) cohorts. There was a gender difference for the cohort variations in the education-health gradient. For women, the education effect in the 1956–1960 (O.R. = 1.063, P < 0.05), 1967–1976 (O.R. = 1.088, P < 0.001) and 1977–1983 (O.R. = 1.102, P < 0.001) cohorts was significantly higher than that of the 1908–1938 cohort. On the contrary, the education-health gradient remained the same across all cohorts for men.

Conclusion

Our study suggests that the education-health gradient varies across cohorts for women, but the size of education effect remains consistent for men across cohorts. The findings support the resource-substitution hypothesis and not the rising-importance hypothesis in China. We discussed the potential influences of the unique, social transformation and educational expansion in China.

Health Measurement and Health Inequality Over the Life Course: A Comparison of Self-rated Health, SF-12, and Grip Strength

The cumulative (dis)advantage hypothesis predicts education differences in health to increase with age. All previous tests of this hypothesis were based on self-reported health measures. Recent research has suggested that self-reported health measures may not adequately capture differences in key analytical constructs, including education, age, cohort, and gender. In this study, I tested the cumulative (dis)advantage hypothesis using a self-reported subjective measure (self-rated health), a self-reported semi-objective measure (PCS based on SF-12), and an objective measure (grip strength) of general physical health. Hierarchical linear models applied to five waves of panel data (SOEP, 2006-2014, N = 3,635 individuals aged 25 to 83, comprising N = 9,869 person-years) showed large differences between health measures. Among men, education differences in both self-reported measures of health widened substantially with age, consistent with the cumulative (dis)advantage hypothesis. For grip strength, education differences were small and changed little with age, inconsistent with the hypothesis. Among women, education differences in both self-reported measures of health remained stable over the life course, but they widened substantially when measured by grip strength. I conclude that evidence on the cumulative (dis)advantage hypothesis is sensitive to the choice of a health measure.

Education and adult health: Is there a causal effect?

Many studies find a strong positive correlation between education and adult health. A subtler question is whether this correlation can be interpreted as a causal relationship. We combine multi-country data from two cross-sections of the European Union Statistics on Income and Living Conditions (EU-SILC) survey and use exogenous variation in compulsory years of schooling across countries and cohorts induced by compulsory schooling laws. We find no causal effect of education on any of our several health measures. This finding is extremely robust to different changes in our main specification and holds using other databases. We discuss different explanations for our results.

Changing educational gradient in long-term care-free life expectancy among German men, 1997-2012

BACKGROUND

The inverse association between mortality and individual socioeconomic status is well-documented. Due to the lack of appropriate data, little is known about the nature of this association among individuals with long-term care (LTC) needs.

OBJECTIVES

We aim to fill in this knowledge gap by estimating life expectancy (LE), life expectancy without (CFLE) and with (CLE) long-term care by education for older German men; and by assessing the trends in the education-LE/CFLE/CLE gradient over time.

DATA AND METHODS

We apply survival analysis and Gompertz regression to German Socioeconomic Panel data (1997-2012) to estimate the mortality levels and to construct the life tables for three educational categories. Using the administrative data from the health insurance, we adjust mortality rates upward to account for the institutionalized population. We estimate age-specific LTC prevalence from the German Microcensus data (2004, 2012) and compute life expectancy with and without LTC by employing Sullivan's method. Slope and Relative Indices of Inequality are computed to evaluate the magnitude of educational inequalities in CFLE.

RESULTS

There is a clear and growing educational gradient in LE and CFLE among older men in Germany. In 2004, LE at age 65 among men with low education was 14.2 years, or 3.3 years lower than among highly educated individuals. The CFLE of these two educational categories ranged from 13.6 to almost 17 years. The gradient increased over time and in 2012 the difference constituted 4.6 years. The gaps between educational groups were not pronounced for CLE. The declining health ratio of years without LTC to remaining LE suggests the expansion of LTC needs, irrespective of the educational level.

CONCLUSIONS

Growing inequalities by educational status among older German men with care needs demand the attention of policy-makers. Prompt actions are needed to increase the survival chances of the most vulnerable groups.

Mapping inequality: Childhood asthma and environmental injustice, a case study of St. Louis, Missouri

As a geographic continuum of poverty and affluence has emerged, so too has a geographic continuum of good and poor health. Asthma is currently one of the most prevalent chronic childhood diseases. Over the past three decades, the greatest increases in asthma rates have been in urban areas and have disproportionately affected youth in poverty and those in racial and ethnic minority groups. Neighborhoods serve as a mechanism fostering environmental injustice and perpetuating these disparities in health outcomes and life opportunity for our most vulnerable populations. Using Geographic Information Systems (GIS) methods in a case study of St. Louis Missouri, this study examines local environmental risk by identifying 'hotspots,' or statistically significant spatial clustering of high or low levels of childhood asthma, and associations with neighborhood characteristics, socio-demographic characteristics, and access to healthcare resources within these hotspots. Results revealed statistically significant clustering of high asthma rates in areas with more non-White and poor residents, higher rates of public housing, deteriorating housing, and violent crime. High asthma hotspots were also located in areas with limited physical access to healthcare resources, such as physicians and medication, and lower school attendance rates. Residents of these high asthma hotspots experience greater environmental risk, and significant disparities in health and education outcomes, physical and financial healthcare resources, and overall well-being. This study demonstrates these place-based inequalities and presents clear evidence of environmental injustice, supporting the need for investments and interventions to improve the environments, health, and economic resources of our most vulnerable youth.