Marital Partner and Mortality: The Effects of the Social Positions of Both Spouses

Background Individual education, social class, social status and income are all associated with mortality, and this is likewise the case for the position of the marital partner. We investigate the combined effect on mortality of own and partner’s positions regarding these four factors. Methods Prospective follow-up of information in the 1990 Census of the Swedish population aged 30-59 (N=1 502 148). Data on all-cause mortality and deaths from cancer and circulatory disease for the period 1991-2003 were collected from the Cause of Death Register. Relative mortality risks were estimated by Cox regression. Results All-cause mortality of both men and women differs by women’s education and status and by men’s social class and income. Men’s education has an effect on their own mortality but not on their partner’s, when other factors are included in the models. Women’s education and men’s social class are particularly important for women’s deaths from circulatory diseases. Conclusions The partner’s social position has a clear effect on individual mortality, and women’s education seems to be particularly important. The results appear above all to support hypotheses about the importance of lifestyle and economic resources for socio-economic differences in mortality.-

"Stratification and Mortality - A Comparison of Education, Class, Status and Income"

In many analyses of social inequality in health, different dimensions of social stratification have been used more or less interchangeably as measures of the individual’s general social standing. This procedure, however, has been questioned in previous studies, most of them comparing education, class and/or income. In the present article, the importance of education and income as well as two aspects of occupation – class and status – are examined. The results are based on register data and refer to all Swedish employees in the age range 35-59 years. There are clear gradients in total death risk for all socioeconomic factors except for income from work among women. The size of the independent effects of education, class, status and income differ between men and women. For both sexes, there are clear net associations between education and mortality. Class and income show independent effects on mortality only for men and status shows an independent effect only for women. While different stratification dimensions – education, social class, income, status – all can be used to show a “social gradient” with mortality, each of them seems to have a specific effect in addition to the general effect related to the stratification of society for either men or women.-

Family of origin and educational inequalities in mortality:results from 1.7 million Swedish siblings

Circumstances in the family of origin have short- and long-term consequences for people's health. Family background also influences educational achievements – achievements that are clearly linked to various health outcomes. Utilizing population register data, we compared Swedish siblings with different levels of education (1,732,119 individuals within 662,095 sibships) born between 1934 and 1959 and followed their death records until the end of 2012 (167,932 deaths). The educational gradient in all-cause mortality was lower within sibships than in the population as a whole, an attenuation that was strongest at younger ages (< 50 years of age) and for those with a working class or farmer background. There was substantial variation across different causes of death with clear reductions in educational inequalities in, e.g., lung cancer and diabetes, when introducing shared family factors, which may indicate that part of the association can be ascribed to circumstances that siblings have in common. In contrast, educational inequalities in suicide and, for women, other mental disorders increased when adjusting for factors shared by siblings. The vast variation in the role of childhood conditions for the education-mortality association may help us to further understand the interplay between family background, education, and mortality. The increase in the education gradient in suicide when siblings are compared may point towards individually oriented explanations (‘non-shared environment’), perhaps particularly in mental disorders, while shared family factors primarily seem to play a more important role in diseases in which health behaviors are most significant

Partner resources and incidence and survival in two major causes of death

Because people tend to marry social equals – and possibly also because partners affect each other’s health – the social position of one partner is associated with the other partner’s health and mortality. Although this link is fairly well established, the underlying mechanisms are not fully identified. Analyzing disease incidence and survival separately may help us to assess when in the course of the disease a partner’s resources are of most significance. This article addresses the importance of partner’s education, income, employment status, and health for incidence and survival in two major causes of death: cancer and cardiovascular diseases (CVD). Based on a sample of Finnish middle-aged and older couples (around 200,000 individuals) we show that a partner’s education is more often connected to incidence than to survival, in particular for CVD. Once ill, any direct effect of partner’s education seems to decline: The survival chances after being hospitalized for cancer or CVD are rather associated with partner’s employment status and/or income level when other individual and partner factors are adjusted for. In addition, a partner’s history of poor health predicted higher CVD incidence and, for women, lower cancer survival. The findings suggest that various partner’s characteristics may have different implications for disease and survival, respectively. A wider focus on social determinants of health at the household level, including partner’s social resources, is needed.Peer reviewe

Equality in Death? : How the Social Positions of Individuals and Families are Linked to Mortality

Socioeconomic positions of individuals are clearly associated with the chances of living a healthy long life. In four empirical studies based on Swedish population registers, two topics are examined in this thesis: The relationships between different indicators of social position and mortality, and the importance of family members’ socioeconomic resources for the survival of the individual. The overall conclusion from the separate studies is that no single individual socioeconomic factor gives a complete picture of mortality inequalities. Further, the socioeconomic resources of partners and adult children are important in addition to the individual ones. The specific results from each study include that: I education, social class, social status and income are, to various extent, independently associated with mortality risk. Education and social status are related to women’s mortality, and education, social class, and income to men’s mortality. II one partner’s social position is related to the other partner’s survival, also when individual socioeconomic factors are statistically controlled for. In particular, men’s mortality is linked to their wives’ education and women’s mortality to their husbands’ social class. III adult children’s education is related to their parents’ risk of dying, also when both parents’ socioeconomic resources are taken into consideration. Further, the association between the offspring’s level of education and parental mortality cannot be explained by charac­teristics that parents share with their siblings. IV children’s social class and income are related to parental mortality, but not as strongly as the education of the children. There is no relationship between a mother’s own education and breast cancer mortality, while mothers seem to have better chances of surviving breast cancer if they have well-educated children.At the time of doctoral defence the following paper was unpublished and had a status as follows: Paper 4: Manuscript</p

Stratification and Mortality - A Comparison of Education, Class, Status and Income

In many analyses of social inequality in health, different dimensions of social stratification have been used more or less interchangeably as measures of the individual’s general social standing. This procedure, however, has been questioned in previous studies, most of them comparing education, class and/or income. In the present article, the importance of education and income as well as two aspects of occupation – class and status – are examined. The results are based on register data and refer to all Swedish employees in the age range 35-59 years. There are clear gradients in total death risk for all socioeconomic factors except for income from work among women. The size of the independent effects of education, class, status and income differ between men and women. For both sexes, there are clear net associations between education and mortality. Class and income show independent effects on mortality only for men and status shows an independent effect only for women. While different stratification dimensions – education, social class, income, status – all can be used to show a “social gradient” with mortality, each of them seems to have a specific effect in addition to the general effect related to the stratification of society for either men or women

Marital Partner and Mortality : The Effects of the Social Positions of Both Spouses

Background Individual education, social class, social status and income are all associated with mortality, and this is likewise the case for the position of the marital partner. We investigate the combined effect on mortality of own and partner's positions regarding these four factors. Methods Prospective follow-up of information in the 1990 Census of the Swedish population aged 30-59 (N=1 502 148). Data on all-cause mortality and deaths from cancer and circulatory disease for the period 1991-2003 were collected from the Cause of Death Register. Relative mortality risks were estimated by Cox regression. Results All-cause mortality of both men and women differs by women's education and status and by men's social class and income. Men's education has an effect on their own mortality but not on their partner's, when other factors are included in the models. Women's education and men's social class are particularly important for women's deaths from circulatorydiseases. Conclusions The partner's social position has a clear effect on individual mortality, and women's education seems to be particularly important. The results appear above all to support hypotheses about the importance of lifestyle and economic resources for socio-economic differences in mortality

Four Decades of Educational Inequalities in Hospitalization and Mortality among Older Swedes.

BACKGROUND:The inverse association between education and mortality has grown stronger the last decades in many countries. During the same period, gains in life expectancy have been concentrated to older ages; still, old-age mortality is seldom the focus of attention when analyzing trends in the education-mortality gradient. It is further unknown if increased educational inequalities in mortality are preceded by increased inequalities in morbidity of which hospitalization may be a proxy. METHODS:Using administrative population registers from 1971 and onwards, education-specific annual changes in the risk of death and hospital admission were estimated with complimentary log-log models. These risk changes were supplemented by estimations of the ages at which 25, 50, and 75% of the population had been hospitalized or died (after age 60). RESULTS:The mortality decline among older people increasingly benefitted the well-educated over the less well-educated. This inequality increase was larger for the younger old, and among men. Educational inequalities in the age of a first hospital admission generally followed the development of growing gaps, but at a slower pace than mortality and inequalities did not increase among the oldest individuals. CONCLUSIONS:Education continues to be a significant predictor of health and longevity into old age. That the increase in educational inequalities is greater for mortality than for hospital admissions (our proxy of overall morbidity) may reflect that well-educated individuals gradually have obtained more possibilities or resources to survive a disease than less well-educated individuals have the last four decades

Average annual change in hospital admissions, in per cent (95% CI), estimated from clog-log models by age group and period, women.

<p>Average annual change in <u>hospital admissions</u>, in per cent (95% CI), estimated from clog-log models by age group and period, <u>women</u>.</p