The impact of early and adult life conditions on educational health inequality over the life course: a counterfactual decomposition of survival functions and hazard rates

"The positive relation between education and health has been shown to be remarkably pronounced over the life course. Less is, however, known about the underlying mechanisms. Two groups of explanatory factors have been advanced: Initial life conditions affecting both education and health in early life, and health related educational returns during adulthood. We apply a counterfactual decomposition of hazard rate models to study the relative importance of these two pathways on the transition to poor health. Using data from SHARE (2006/07) and SHARELIFE (2008/09), we find that early socioeconomic conditions contribute most to the educational health differences. This is true especially for the oldest cohort. In the successive cohorts the impact of the early conditions weakens, while determinants during adulthood become also important." (author's abstract

Education and health across lives, cohorts, and countries : a study of cumulative (dis)advantage in Germany, Sweden, and the United States

Defence date: 4 May 2017Examining Board: Professor Hans-Peter Blossfled, European University Institute (Supervisor); Professor Fabrizio Bernardi, European University Institute; Professor Johan Mackenback, Erasmus Medical Centre, University of Rotterdam; Professor Johan Fritzell, CHESS, University of StockholmAccording to the cumulative (dis)advantage hypothesis, social disparities in health increase over the life course. Evidence on this hypothesis is largely limited to the U.S. context. The present dissertation draws on recent theoretical and methodological advances to test the cumulative (dis)advantage hypothesis in two other contexts – Sweden and West Germany. Three empirical studies examine the core association between socioeconomic position and health (a) from a life-course perspective considering individual change, (b) from a cohort perspective considering socio-historical change, and (c) from a comparative perspective considering cross-national differences. The analyses are based on large-scale longitudinal data from the Swedish Level of Living Survey, the German Socio-economic Panel Study, the Health and Retirement Study, and the Survey of Health, Ageing and Retirement in Europe. The key analytical constructs are education as a measure of socioeconomic position and self-rated health, mobility limitations, and chronic conditions as measures of health. The results show large differences within countries and between countries in the age patterns and cohort patterns of change in health inequality. In the U.S., educational gaps in health widen strongly over the life course, and this divergence intensifies across cohorts. In Sweden, health gaps are much smaller, widen only moderately with age, and remain stable across cohorts. In Germany, health gaps widen with age and across cohorts, but these patterns pertain only to men. Taken together, these findings show that health inequality across lives and cohorts is mitigated in Western European welfare states, which target social inequality in health-related resources. In the U.S. context, which is characterized by a lack of social security, unequal access to health care, and large social disparities in quality of living, health inequality increases across lives and cohorts.Chapter 2 ‘Cumulative disadvantage in an egalitarian country? Socioeconomic Health Disparities over the Life Course in Sweden' of the PhD thesis draws upon an earlier version published as an article 'Cumulative advantage in an egalitarian country? : socioeconomic health disparities over the life course in Sweden' (2016) in the journal ‘Journal of health and social behavior

Ideal Weight and Weight Discrepancy: A Study of Life Course Trajectories and Intercohort Change in the Netherlands

Objective: This study examined how individuals’ ideal weight and weight discrepancy (between ideal and actual weight) changed over the life course and across cohorts. Method: The study used population-representative longitudinal data collected in the Netherlands (N = 61,431 observations between 2007 and 2018 among N = 13,409 individuals aged 16 to 80 and born 1927 to 2000). Results: Ideal weight increased linearly with age. Weight discrepancy showed a bell-shaped age pattern. Approximately half of the age-related increase in ideal weight was associated with concurrent increases in actual weight. Ideal weight and weight discrepancy increased slightly across cohorts. The cohort-related increase in ideal weight vanished after adjusting for change in actual weight. Analyses of population heterogeneity showed similar patterns of change in both outcomes across groups, although levels differed by gender, education, and migration status even after adjusting for differences in actual weight between these groups. Conclusions: These results show that ideal weight and weight discrepancy in the Netherlands change substantially with age and modestly across cohorts. Potential explanations include changes in physical appearance and in the importance of physical appearance

Cumulative advantage in an egalitarian country? : socioeconomic health disparities over the life course in Sweden

According to the cumulative advantage hypothesis, health gaps between socioeconomic groups widen with age. In the United States, studies have supported this hypothesis. Outside this context, evidence remains scarce. The present study tests the cumulative advantage hypothesis in Sweden, a society that contrasts sharply with the United States in terms of policies designed to reduce social disparities in health-related resources. I draw on longitudinal data from the Swedish Level of Living Survey (N = 9,412 person-years), spanning the period between 1991 and 2010. The results show that gaps in self-rated health increase from early to middle adulthood. This applies to differences between educational groups and between occupational classes. In older age, health gaps remain constant. Cross-cohort analyses reveal a rising importance of cumulative advantage between educational groups but not between occupational classes. I conclude that the forces of accumulation prevail even in one of the most egalitarian welfare states

DataSheet1_Ideal Weight and Weight Discrepancy: A Study of Life Course Trajectories and Intercohort Change in the Netherlands.pdf

Objective: This study examined how individuals’ ideal weight and weight discrepancy (between ideal and actual weight) changed over the life course and across cohorts.Methods: The study used population-representative longitudinal data collected in the Netherlands (N = 61,431 observations between 2007 and 2018 among N = 13,409 individuals aged 16 to 80 and born 1927–2000).Results: Ideal weight increased linearly with age. Weight discrepancy showed a bell-shaped age pattern. Approximately half of the age-related increase in ideal weight was associated with concurrent increases in actual weight. Ideal weight and weight discrepancy increased slightly across cohorts. The cohort-related increase in ideal weight vanished after adjusting for change in actual weight. Analyses of population heterogeneity showed similar patterns of change in both outcomes across groups, although levels differed by gender, education, and migration status even after adjusting for differences in actual weight between these groups.Conclusion: These results show that ideal weight and weight discrepancy in the Netherlands change substantially with age and modestly across cohorts. Potential explanations include changes in physical appearance and in the importance of physical appearance.</p

Education and physical health trajectories in old age. Evidence from the Survey of Health, Ageing and Retirement in Europe (SHARE)

The model of cumulative inequality predicts that health differences between educational levels increase with age. Using a variety of analytical approaches and measures of health, studies have, however, reported increasing as well as decreasing and constant patterns of educational health inequality. The aim of this study is use a standardized research design to compare different dimensions of health inequality trajectories across educational levels. We used data from two waves (2004/2005 and 2006/2007) of SHARE. The sample consisted of respondents aged 50-80 (n = 14,818). Using OLS regression models, we analyzed trajectories of health inequality in self-reported measures (ADL, IADL, mobility, chronic diseases, and self-rated health) as well as non-invasive objective measures (grip strength) of physical health. Inequality between higher and lower educated individuals increased significantly in limitations of physical functioning and grip strength. In chronic diseases and self-rated health, the gap between these two groups remained constant. Although our results mainly supported the model of cumulative inequality, they also showed that the trajectory of the education-health gradient is not uniform but varies across different dimensions of physical health

Education differences in women's body weight trajectories: The role of motherhood.

Studies have found that education differences in women's body weight increase until middle adulthood. The explanatory mechanisms behind this increase are not well-understood. This study examined the role of education differences in the prevalence of motherhood as a risk factor for weight gain and in vulnerability to its effects on weight gain. We used longitudinal data from the German Socio-economic Panel Study. Our sample included 2,668 women aged between 17 and 45 and observed at least twice between 2002 and 2016 (n = 13,899 panel observations). We used OLS regression models to estimate initial education differences in body weight and fixed-effects panel regression models to estimate education differences in body-weight trajectories. Motherhood was associated with increasing body weight, and the effects of motherhood on weight gain varied by education. Motherhood partially accounted for the increase of education differences during reproductive age. Until the age of 30, differences in the prevalence of motherhood accounted for about 20% of the bodyweight gap between lower and higher educated women. From age 35 until 45, differential vulnerability to the effects of motherhood on body weight explained about 15% of the education gap in body weight