Adult Children's Education and Parents' Functional Limitations in Mexico

Does schooling attained by adult children affect parents' psychosocial well-being in later life? Using Mexico's 1993 compulsory schooling law as a quasi-experiment

Higher adult child educational attainment may benefit older parents' psychosocial well-being in later life. This may be particularly important in low- and middle-income countries, where recent generations have experienced comparatively large increases in educational attainment. We used data from the 2012 Mexican Health and Aging Study, a nationally representative study of adults aged ≥50 years and leveraged the exogenous variation in adult child education induced by Mexico's compulsory schooling law passed in 1993. We employed two-stage least squares (2SLS) regression to estimate the effects of increased schooling among adult children on parents' (respondents') depressive symptoms and life satisfaction scores, controlling for demographic and socioeconomic characteristics. We considered heterogeneity by parent and child gender and other sociodemographic characteristics. Our study included 7186 participants with an average age of 60.1 years; 54.9% were female. In the 2SLS analyses, increased schooling among oldest adult children was associated with fewer depressive symptoms (β = -0.25; 95% CI: -0.51, 0.00) but no difference in life satisfaction (β = 0.01; 95% CI: -0.22, 0.25). Stratified models indicated differences in the magnitude of association with depressive symptoms for mothers (β = -0.27, 95% CI: -0.56, 0.01) and fathers (β = -0.18, 95% CI: -0.63, 0.26) and when considering increased schooling of oldest sons (β = -0.37; 95% CI: -0.73, -0.02) and daughters (β = -0.05, 95% CI: -0.23, 0.13). No parent and child gender differences were found for life satisfaction. Power was limited to detect heterogeneity across other sociodemographic characteristics in the second stage although first-stage estimates were larger for urban (vs. rural) dwelling and more (vs. less) highly educated respondents. Results were similar when considering the highest educated child as well as increased schooling across all children. Our findings suggest that longer schooling among current generations of adult children, particularly sons, may benefit their older parents' psychosocial well-being.

Black-White Differences in Offspring Educational Attainment and Older Parents' Dementia

Emerging research documents the health benefits of having highly educated adult offspring. Yet less is known about whether those advantages vary across racial groups. This study examines how offspring education is tied to parents' dementia risk for Black and White parents in the United States. Using data from the Health and Retirement Study, findings suggest that children's education does not account for the Black-White gap in dementia risk. However, results confirm that parental race moderates the relationship between children's education and dementia risk and that the association between children's education and parents' dementia risk is strongest among less-educated parents. Among less-educated parents, higher levels of children's attainment prevent the risk of dementia onset for Black parents, but low levels of offspring schooling increase dementia risk among White parents. The study highlights how offspring education shapes the cognitive health of social groups differently and points to new avenues for future research.

Children's Transitions to Adulthood and Midlife Parents' Depressive Symptoms and Activities of Daily Living Conditions in the United States

BACKGROUND

Parents and children are close over the life course. However, these relationships often change as parents age and children enter adulthood. Today, the entrance into adulthood for children has become delayed and increasingly unstable. Such changes may interrupt the child's acquisition of resources used to support themselves and their midlife parents, having implications for parents' mental and physical health. The purpose of this study is to examine the role of adult children's transitions to adulthood on parents' mental and physical health.

METHODS

Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) and the Add Health Parent Study (AHPS), we investigated how certain transitions to adulthood (e.g., education, marriage, residential independence, employment, parenthood, and incarceration) for children were linked to the mental and physical health of their midlife parents.

RESULTS

In sum, we found that children's educational attainment was linked to fewer activities of daily living (ADL) limitations and depressive symptoms among parents. Children's marriage and employment were also associated with fewer ADL limitations among parents.

CONCLUSIONS

Our findings reveal that adult children's circumstances are associated with the mental and physical health of their midlife parents.

Functional Dependency in Mexico: Measurement Issues and Policy Challenges

BACKGROUND

Different definitions have been used to measure functional dependency (FD) in Mexico. This study aims to explore if different definitions of FD lead to low consistency between the estimations of its prevalence. Accurate estimations of FD are useful to estimate the potential demand for long-term care (LTC) services in the country.

METHODS

A literature review including documents with estimations on the number or prevalence of dependents in Mexico with national representativeness between 2000 and 2019 was performed as well as estimations of different definitions of FD, using the National Study on Health and Aging in Mexico (ENASEM).

RESULTS

There is a lack of consensus on the definition of FD. Among the most frequently used terms to define FD are "disability" and "dependency." The heterogeneity of definitions results in a wide range of estimations of the demand for LTC. Methodological choices can lead to important differences in FD prevalence estimations. Results from ENASEM 2001 show that FD prevalence could range from 13% to 35% in people 60+; sex prevalences also vary when using different ways to measure FD.

CONCLUSION

Besides the highlighted issues in calculating FD in the population, Mexico should consider broadening the assessment of FD, including people with dementia and younger populations. Although the literature search is not systematic, it helps exemplifying the current issues when measuring FD in Mexico. A consensual definition of dependency is required to have a more accurate estimated demand for LTC. Having good data sources is not enough when dissimilar estimations of an indicator like dependency result from the same study. Wide heterogeneity in estimations of dependency could be an obstacle to inform public policies during the construction of a care system in Mexico.

Adult Children's Education and Older Parents' Chronic Illnesses in Aging China

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.

Does an upward intergenerational educational spillover effect exist? The effect of children's education on Chinese parents' health

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.

Offspring Education and Parents' Health Inequality in China: Evidence from Spillovers of Education Reform

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.

Educational attainment of offspring and obesity among older adults in China

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.

Children's education and level of health care utilization among parents: a pooled cross-sectional study from national population-based survey in India

The study of upward spill over on parents of their offspring's education is vital for understanding the family dynamics and role of adult children in the decisions of parents. Such association has widespread implication and application on ageing policies. We use pooled data from population-based cross-sectional health consumption surveys conducted by the National Sample Survey Organization in 2014 and 2018 (rounds 71 and 75, respectively) in this study. The analysis is restricted to individuals aged 60 and above, who are head of the household or their spouse and have children aged 25 years or above. The analysis is carried out for inpatient and outpatient cases separately. For inpatient analysis, the dependent variable is designed as a rank variable representing an increasing level of health care utilization. For the same partial proportional odds are calculated. For outpatient cases, the dependent variable is binary that takes the value 0 if the parents use public facilities and 1 if private facilities are used. Here, binary logistic regression is used for analysis. The odds of parents using a higher level of inpatient as well as outpatient health care are higher for those with better-educated children (inpatient: OR are 2.6 (p < 0.001, CI: 2.0-3.5); outpatient: OR are 1.5 (p < 0.001, CI: 1.1-2.2)). Education of children does influence the level of health care utilization among parents. Therefore, policy interventions can target offspring of working age group, who can assimilate information better and transfer it to their parents.

Protective effect of adult children's education on parental survival in China: Gender differences and underlying mechanisms

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.

Offspring Educational Attainment and Older Parents' Cognition in Mexico

Population-level disparities in later-life cognitive health point to the importance of family resources. Although the bulk of prior work establishes the directional flow of resources from parents to offspring, the "linked lives" perspective raises the question of how offspring resources could affect parental health as well. This paper examines whether adult children's education influences older parents' (aged 50+) cognitive health in Mexico, where schooling reforms have contributed to significant gains in the educational achievements of recent birth cohorts. Harnessing a change in compulsory school laws and applying an instrumental variables approach, we found that each year of offspring schooling was associated with higher overall cognition among parents, but was less predictive across different cognitive functioning domains. More offspring schooling improved parents' cognitive abilities in verbal learning, verbal fluency, and orientation, but not in visual scanning, visuo-spatial ability, or visual memory. The beneficial effects of offspring schooling on those cognitive domains are more salient for mothers compared to fathers, suggesting potential gendered effects in the influence of offspring schooling. The results remained robust to controls for parent-child contact and geographic proximity, suggesting other avenues through which offspring education could affect parental health and a pathway for future research. Our findings contribute to growing research which stresses the causal influence of familial educational attainment on population health.

Comparison of oral health behaviour between dental and non-dental undergraduates in a university in southwestern China--exploring the future priority for oral health education

Background

Based on a national survey in 2015, people’s oral health behaviour (OHB) has not kept up with the pace of knowledge and attitudes in China after decades of oral health education (OHE). Thus, we need to improve OHE to strengthen people’s OHB. Undergraduates are regarded as the best candidates for the improvement of OHE. The objective of this study is to determine undergraduates’ oral health status and existing problems in OHB by comparing dental and non-dental students at Sichuan University. We hope to provide some suggestions for future OHE to improve people’s OHB.

Methods

A quasi-experimental study designed with a pre-test and post-test group was conducted. A total of 217 dental students and 135 non-dental students were enrolled. They were administered an OHE course focused on OHB. A survey about oral health behaviour and knowledge was conducted before and after the course.

Results

According to the pre-course survey, dental students surpassed non-dental students in terms of toothbrushing frequency, method, and time, but unfortunately, flossing was overlooked by all the students. After the course, both dental and non-dental students showed strong willingness to improve their OHB. More non-dental students than dental students were willing to use toothpicks and Chinese herbal toothpaste before and after the course.

Conclusions

OHE focused on behaviour has a positive effect on university students. Future OHE and interventions should focus on flossing, toothbrushing methods, toothpicks, Chinese herbal toothpaste and modifications to adopt new media.

Children's education and parental old-age health: Evidence from a population-based, nationally representative study in India

Previous research has documented intergenerational transmission of human capital from children to parents. Less is known, however, about heterogeneity in this 'upward transmission' in low-resource settings. We examine whether co-resident adult children's education is associated with improved health among older parents in India, using nationally representative data from the 2014 Indian National Sample Survey. Parents of children with tertiary education had a lower probability of reporting poor health than parents of children with less than primary education. The benefits of children's education persisted after controlling for economic factors, suggesting that non-pecuniary pathways-such as health knowledge or skills-may play an important role. The association was more pronounced among economically dependent parents and those living in the North and West regions. Taken together, our results point to a strong positive association between children's education and parental health, the role of non-pecuniary pathways, and the importance of subnational heterogeneity in India.

Improvement in Activities of Daily Living Among Danish Centenarians?-A Comparative Study of Two Centenarian Cohorts Born 20 Years Apart

Background

With the continued rise in the proportion of the oldest-old in high-income countries, it is of interest to know whether the functional health of today's oldest-olds is better or worse than in previous cohorts. Using two Danish centenarian birth cohorts born 20 years apart we aimed at investigating if the later born cohort had better functioning in terms of activities of daily living (ADL).

Methods

Identification, methodology, and assessment instruments were identical in the 1895-West and 1915-West Birth Cohort Studies: All persons living in the western part of Denmark and turning 100 years old in 1995 and 2015, respectively. Data were collected through structured in-home interviews. Participation rates were 74% (n = 106) and 79% (n = 238), respectively.

Results

The proportion of nondisabled women of the 1915-West cohort was more than twice as high compared to the 1895-West cohort and with corresponding lower proportions of moderately and severely disabled persons (17% vs 7%, 33% vs 40% and 50% vs 53% in the 1915-West and 1895-West cohorts, respectively, p = .047). Only nonsignificant improvements were seen among men in the 1915-West cohort. In both sexes, considerably higher proportions of the latest cohort used assistive devices than the former (statistically significant for the majority of assistive devices).

Conclusion

This comparative study shows improvements in reported ADL in the later born cohort of centenarians, even though only significant among women. As women constitute the majority of the oldest-olds, our findings are encouraging from a public health care view.

Does having highly educated adult children reduce mortality risks for parents with low educational attainment in Europe?

It 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.

Does children's education matter for parents' health and cognition? Evidence from China

Intergenerational transmission of human capital from parents to offspring is widely documented. However, whether there are upward spillovers from children to parents remains understudied. This paper uses data from the China Health and Retirement Longitudinal Study to estimate the causal impact of educational attainment of children on various health and cognition outcomes of older parents. Identification is achieved by using the exposure of children to the compulsory education law in China and its interaction with local schooling level before law enforcement as instruments for children's years of schooling. IV estimation results demonstrate that increasing years of education of children lead to better cognitive functions, higher survival expectations and improved lung function of Chinese older parents. Further evidence suggests that children's education might shape health of older parents by providing financial support, affecting the access to resources and influencing the labor supply and psychological well-being of parents.

Older mother's health and adult children's education: Conceptualization of adult children's education and mother-child relationships

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.

Offspring education and parental mortality: Evidence from South Asia

Decades of research show that education not only confers individual health benefits, but it also spills over to advantage subsequent generations. More recently, research has confirmed that the intergenerational health benefits of education can also flow upward: aging adults with more highly educated children experience better health and higher survival. Research has documented this finding in high-income settings, and also in select low- and middle-income contexts, raising questions about how having an adult child who attended relatively low levels of education can benefit aging parents' well-being. In this study, we use multilevel, long-term panel data on a cohort of older adults from the Chitwan Valley Family Study in rural Nepal to establish whether the association between offspring education and parents' survival is observable in this extremely poor, agrarian context. Extending past studies, we then leverage additional data on older adults to examine the association between offspring education and two theorized mechanisms: older adults' better health behaviors and their greater support in later life.

Intergenerational relations and social mobility: Social inequality in physical function in old age

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.

Spillover effects of children’s political status on elderly parents’ health in China

Background

Due to the sustained increases in life expectancy over the past half century, the elderly today will receive supports from their children for a longer period than ever before. Therefore, understanding the spillover effects of children’s socioeconomic status on parents’ health becomes increasingly important for both scholars and policy makers.

Methods

The Ordinary Least Squares regression is applied to the China Health and Retirement Longitudinal Study 2011, a national representative dataset including approximately 10 000 households and 17 600 middle-aged and elderly respondents. The Sobel test is used to examine the mediation role of social integration.

Results

The elderly who have a cadre child reported better health (coefficient=0.1347; 95% CI 0.067 to 0.202), had fewer activities of daily living (ADLs) limitations (coefficient=−0.1289; 95% CI −0.216 to −0.042) and were more socially integrated (coefficient=0.2321; 95% CI 0.103 to 0.361). Such effects are mainly driven by the parents of higher-ranking cadres. For the parents of higher ranking cadres, the Sobel test suggests that 12.6% of the total effects on self-reported health and 21.9% of the total effects on ADL limitations are mediated by the increase in parents’ social integration.

Conclusion

The findings suggest positive spillover effects of children’s political status on parents’ health. The benefits of having a cadre child are at least equivalent to the rural–urban gap in health and even stronger for the parents of higher ranking cadres. One potential explanation for such spillover effects is that a child’s political status can improve parents’ community involvement and social interactions.

Children's education and parental old age survival - Quasi-experimental evidence on the intergenerational effects of human capital investment

While a large literature has investigated the role of parental human capital on children's well-being, relatively little is known regarding the effects of human capital investment in children on long run outcomes of parents. In this study we explore the human capital variations created by the 1974 Tanzania education reform to estimate the effect of children's primary schooling attainment on parental survival. Using 5,026,315 census records from 1988, 2002, and 2012, we show that the 1974 reform resulted in an additional 1.1 years (31%) of educational attainment among exposed cohorts. Using the reform as instrument for child education we find that each additional year of primary schooling in children resulted in a 3.7 percentage point reduction (p < .001) in the probability of maternal death, and a 0.8 percentage point reduction (p = .011) in the probability of paternal death by the time exposed child cohorts reach age 50. The results suggest that-at least in a setting where social security coverage is largely absent-a substantial fraction of human capital gains generated by reforms are shared with the parental generation.

Children's educational attainment, occupation, and income and their parents' mortality

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.

Adult children's education and changes to parents' physical health in Mexico

The well-being of older adults is frequently tied to support from their adult children. Here, we assess whether the education of adult offspring is associated with changes to older parents' short- and long-term health in Mexico, a rapidly aging context with historically limited institutional support for the elderly. Educational expansion over the past half century, however, provides older adults with greater resources to rely on via the education of their children. Using longitudinal data from the Mexican Health and Aging Study (2001-2012), we find that offspring education is not associated with short-term changes in parents' physical functioning, but is associated with increased parental longevity, net of children's financial status and transfers. In addition, we find that mothers' longevity is more sensitive to offspring education than fathers. Our findings add to a growing body of literature that urges policy-makers to consider the multi-generational advantages of expanding educational opportunities in Mexico.

Spillovers between siblings and from offspring to parents are understudied: A review and future directions for research

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.

Offspring schooling associated with increased parental survival in rural KwaZulu-Natal, South Africa

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.