RESUMEN

Parents with better-educated children are healthier and live longer, but whether there is a causal effect of children's education on their parents' health and longevity is unclear. First, we demonstrate an association between adults' offspring education and parental mortality in the 1958 British birth cohort study, which remains substantial-about two additional years of life-even when comparing parents with similar socioeconomic status. Second, we use the 1972 educational reform in England and Wales, which increased the minimum school leaving age from 15 to 16 years, to identify the presence of a causal effect of children's education on parental health and longevity using census-linked data from the Office for National Statistics Longitudinal Study. Results reveal that children's education has no causal effects on a wide range of parental mortality and health outcomes. We interpret these findings discussing the role of universal health care and education for socioeconomic inequality in Great Britain.

Asunto(s)

Longevidad , Padres , Adulto , Humanos , Niño , Adolescente , Estudios Longitudinales , Estudios de Cohortes , Reino Unido , Escolaridad

RESUMEN

In high-income countries, women increasingly remain permanently childless. Little is known about the relationship between childlessness and socioeconomic development in non-Western societies and particularly sub-Saharan Africa. At lower levels of development, poverty-driven (i.e., involuntary) childlessness may decrease with increases in levels of development, while at higher levels of development opportunity-driven (i.e., voluntary and circumstantial) childlessness may rise with development. Thus, we expect a U-shaped relationship between childlessness and development overall. We examine this idea for sub-Saharan Africa. We further contribute by differentiating between female and male childlessness; and between involuntary, voluntary and circumstantial childlessness. Moreover, we construct new indicators of subnational historical development to assess both inter- and intra-country variation, and distinguish between three components (health, education and income) to investigate the drivers behind the hypothesized U-shaped relationship. Using 291 Demographic and Health Surveys between 1986 and 2018 from 38 countries and 384 regions, we find a U-shaped relationship between female childlessness and development, and a linear relationship for men. The U-shape for women results from negative associations of female involuntary childlessness with health and educational advancements, combined with positive correlations of voluntary and circumstantial childlessness with education and income improvements. While these positive associations are stronger among men than women, the negative relationships of involuntary childlessness with health and education observed for women are absent for men, resulting in an overall positive and linear relationship between development and childlessness among men. Our findings have implications for how we might expect childlessness rates to evolve with future levels of development. Supplementary Information: The online version contains supplementary material available at 10.1007/s10680-022-09608-5.

RESUMEN

Depressive symptoms are disproportionately high among women and less educated individuals. One mechanism proposed to explain this is the differential vulnerability hypothesis-that these groups experience particularly strong increases in symptoms in response to stressful life events. We identify limitations to prior work and present evidence from a new approach to life stress research using the UK Household Longitudinal Study. Preliminarily, we replicate prior findings of differential vulnerability in between-individual models. Harnessing repeated measures, however, we show that apparent findings of differential vulnerability by both sex and education are artifacts of confounding. Men and women experience similar average increases in depressive symptoms after stressful life events. One exception is tentative evidence for a stronger association among women for events occurring to others in the household. We term this the "female vulnerability to network events" hypothesis and discuss with reference to Kessler and McLeod's related "cost of caring" hypothesis.

Asunto(s)

Depresión , Estrés Psicológico , Depresión/diagnóstico , Femenino , Humanos , Acontecimientos que Cambian la Vida , Estudios Longitudinales , Masculino , Factores de Riesgo

RESUMEN

Since the 1980s, the demographic literature has suggested that maternal schooling plays a key role in determining children's chances of survival in low- and middle-income countries; however, few studies have successfully identified a causal relationship between maternal education and under-5 mortality. To identify such a causal effect, we exploited exogenous variation in maternal education induced by schooling reforms introducing universal primary education in the second half of the 1990s in Malawi and Uganda. Using a two-stage residual inclusion approach and combining individual-level data from Demographic and Health Surveys with district-level data on the intensity of the reform, we tested whether increased maternal schooling reduced children's probability of dying before age 5. In Malawi, for each additional year of maternal education, children have a 10 % lower probability of dying; in Uganda, the odds of dying for children of women with one additional year of education are 16.6 % lower. We also explored which pathways might explain this effect of maternal education. The estimates suggest that financial barriers to medical care, attitudes toward modern health services, and rejection of domestic violence may play a role. Moreover, being more educated seems to confer enhanced proximity to a health facility and knowledge about the transmission of AIDS in Malawi, and wealth and improved personal illness control in Uganda.

Asunto(s)

Éxito Académico , Mortalidad del Niño/tendencias , Madres/estadística & datos numéricos , Preescolar , Humanos , Lactante , Recién Nacido , Malaui/epidemiología , Factores Socioeconómicos , Uganda/epidemiología

RESUMEN

BACKGROUND: Sub-Saharan Africa has the world's highest under-5 and neonatal mortality rates as well as the highest naturally occurring twin rates. Twin pregnancies carry high risk for children and mothers. Under-5 mortality has declined in sub-Saharan Africa over the last decades. It is unknown whether twins have shared in this reduction. METHODS: We pooled data from 90 Demographic and Health Surveys for 30 sub-Saharan Africa countries on births reported between 1995 and 2014. We used information on 1 685 110 singleton and 56 597 twin livebirths to compute trends in mortality rates for singletons and twins. We examined whether the twin-singleton rate ratio can be attributed to biological, socioeconomic, care-related factors, or birth size, and estimated the mortality burden among sub-Saharan African twins. FINDINGS: Under-5 mortality among twins has declined from 327·7 (95% CI 312·0-343·5) per 1000 livebirths in 1995-2001 to 213·0 (196·7-229·2) in 2009-14. This decline of 35·0% was much less steep than the 50·6% reduction among singletons (from 128·6 [95% CI 126·4-130·8] per 1000 livebirths in 1995-2001 to 63·5 [61·6-65·3] in 2009-14). Twins account for an increasing share of under-5 deaths in sub-Saharan Africa: currently 10·7% of under-5 mortality and 15·1% of neonatal mortality. We estimated that about 315 000 twins (uncertainty interval 289 000-343 000) die in sub-Saharan African each year. Excess twin mortality cannot be explained by common risk factors for under-5 mortality, including birthweight. The difference with singletons was especially stark for neonatal mortality (rate ratio 5·0, 95% CI 4·5-5·6). 51·7% of women pregnant with twins reported receiving medical assistance at birth. INTERPRETATION: The fate of twins in sub-Saharan Africa is lagging behind that of singletons. An alarming one-fifth of twins in the region dies before age 5 years, three times the mortality rate among singletons. Twins account for a substantial and growing share of under-5 and neonatal mortality, but they are largely neglected in the literature. Coordinated action is required to improve the situation of this extremely vulnerable group. FUNDING: None.

Asunto(s)

Peso al Nacer , Demografía , Mortalidad Infantil/tendencias , Gemelos , Adolescente , Adulto , África del Sur del Sahara , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Embarazo , Factores de Riesgo , Factores Socioeconómicos

RESUMEN

BACKGROUND: There is an average negative mental health effect for individuals who experience divorce. Little is known whether the pattern of such divorce effects varies within couples. We study whether the husband and wife experience similar harmful effects of divorce, whether they experience opposite effects, or whether divorce effects are purely individual. METHODS: We use Finnish registry data to compare changes over a period of 5 years in antidepressant use of husbands and wives from 4,558 divorcing couples to 108,637 continuously married pairs aged 40-64, all of whom were healthy at baseline. RESULTS: In the period three years before and after divorce antidepressant use increases substantially. However, the likelihood of uptake of antidepressant medication during this process of divorce by one partner appears to be independent of medication uptake in the other partner. In contrast, among continuously married couples there is a clear pattern of convergence: If one partner starts to use antidepressants this increases the likelihood of uptake of antidepressant medication in the other partner. CONCLUSIONS: Our findings suggest that divorce effects on antidepressant use are individual and show no pattern of either convergence or divergence at the level of the couple. The increased incidence of antidepressant use associated with divorce occurs in individuals independent of what happens to their ex-partner.

Asunto(s)

Antidepresivos/uso terapéutico , Divorcio/psicología , Adulto , Composición Familiar , Femenino , Finlandia , Humanos , Masculino , Matrimonio , Salud Mental , Persona de Mediana Edad , Sistema de Registros , Esposos

RESUMEN

How are one's own education, father's education, and especially the combination of the two, related to self-assessed health across European societies? In this study, we test hypotheses about differences in self-assessed health between 16 post-socialist countries in Central and Eastern Europe and 17 Western European countries. We find substantial cross-national variation in the (relative) importance of own and father's education for self-assessed health. Over 65 per cent of this cross-national variation is accounted for by the East-West divide. This simple dichotomy explains cross-national differences better than gross domestic product or income inequality. An individual's father's education is more important, both in absolute and relative terms, for self-assessed heath in Eastern Europe than in Western Europe. Intergenerational mobility moderates the relative effects of one's own and one's father's education. In Eastern Europe the relative importance of one's father's education is greater than it is in Western Europe--particularly for those who are downwardly mobile and have a father with tertiary education. The results are sometimes contradictory to initial expectations; the theoretical implications are discussed.

Asunto(s)

Escolaridad , Padre , Estado de Salud , Autoevaluación (Psicología) , Europa (Continente) , Europa Oriental , Producto Interno Bruto , Humanos , Renta , Masculino

RESUMEN

BACKGROUND: The male:female (M:F) mortality ratio for under-five mortality varies considerably across and within societies. Maternal education has been linked to better outcomes for girls, but the evidence is mixed. We examined how the M:F ratio for under-five mortality varies by maternal education in sub-Saharan Africa and southern Asia. METHODS: We used recent Demographic and Health Surveys from 31 sub-Saharan African and 4 southern Asian countries. M:F mortality ratios were determined using information on 49 769 deaths among 521 551 children. We estimate M:F ratios for under-five (month 0-59), neonatal (month 0), post-neonatal (month 1-11) and child mortality (month 12-59) by maternal education while controlling for demographic and household characteristics. M:F ratios for under-five mortality and child mortality are compared with more 'gender neutral' thresholds (of 1.25 and 1.17, respectively) estimated on the basis of the Human Mortality Database. RESULTS: In sub-Saharan Africa, the M:F ratio for under-five mortality is 1.09 [95% confidence interval (CI) 1.06-1.13] among non-educated mothers, 1.14 (95% CI 1.09-1.19) among mothers with some primary education and 1.25 (95% CI 1.16-1.34) among mothers with some secondary or more education. For southern Asia, the ratios are 0.88 (95% CI 0.82-0.95), 1.10 (95% CI 0.97-1.25) and 1.13 (95% CI 1.02-1.26), respectively. The M:F ratio for child mortality also shows an educational gradient in both regions, with the M:F ratio being lower among non-educated mothers. In southern Asia, the M:F ratio for child mortality is particularly low among mothers with no education, M:F ratio = 0.54 (95% CI 0.41-0.72). CONCLUSIONS: Among mothers with more education, the difference in the mortality chances of boys and girls more closely resembles a 'gender neutral' situation than among women with no or little education. Girls benefit both in absolute and relative terms from having a more educated mother.

Asunto(s)

Mortalidad del Niño , Escolaridad , Mortalidad Infantil , Madres/educación , Adulto , África del Sur del Sahara/epidemiología , Asia/epidemiología , Preescolar , Atención a la Salud , Demografía , Femenino , Encuestas Epidemiológicas , Humanos , Lactante , Recién Nacido , Masculino , Distribución por Sexo , Factores Socioeconómicos

RESUMEN

OBJECTIVES: Whereas being tall has consistently been found a favorable characteristic at the marriage market for men, much less is known about the association between stature and marital success among women. Taller women are healthier than shorter women, give birth more easily and their offspring are healthier. We therefore would expect them to be more successful at the marriage market. However, existing evidence is mixed. We study the association between women's height and the odds of being married, marrying young, experiencing a divorce, and becoming widowed, and the association between women's height and their husbands' educational attainment and occupational status. METHODS: Data come from the Indian National Family Health Survey 2005-2006, a representative study among 124,385 women and 74,369 men in all Indian states. Effects of female height on being married, marrying young, divorce, widowhood, and husband's occupation were estimated using logistic regression models. Effects of female height on husband's education were estimated using OLS regression models. Woman's education and age were always taken into account. Where possible controls for husband's height, husband's education, and age at marriage were included. RESULTS: Positive effects of women's height on favorable marital outcomes were found. Taller than average women are more likely to marry, get higher educated husbands with better jobs and are less likely to marry at a very young age or to lose their husbands through divorce or premature death. CONCLUSIONS: Taller Indian women seem to be more successful at the marriage market.

Asunto(s)

Estatura , Matrimonio/estadística & datos numéricos , Adulto , Distribución por Edad , Divorcio , Escolaridad , Empleo , Femenino , Humanos , India , Masculino , Persona de Mediana Edad , Análisis de Regresión , Viudez , Adulto Joven

RESUMEN

The association between educational attainment and self-assessed health is well established but the mechanisms that explain this association are not fully understood yet. It is likely that part of the association is spurious because (genetic and non-genetic) characteristics of a person's family of origin simultaneously affect one's educational attainment and one's adult health. In order to obtain an unbiased estimate of the association between education and health, we have to control for all relevant family factors. In practice, however, it is impossible to measure all relevant family factors. Sibling models are particularly appropriate in this case, because they control for the total impact of family factors, even if not all relevant aspects can be measured. I use data on siblings from a US study (MIDUS) and Dutch study (NKPS) to assess the total family impact on self-assessed health and, more importantly, to assess whether there is a family bias in the association between educational attainment and self-assessed health. The results suggest that there is a substantial family effect; about 20% of the variation in self-assessed health between siblings can be ascribed to (measured and unmeasured) family factors. Measured family factors, such as parental education and father's occupation, could account only for a small part of the family effect. Furthermore, the results imply that it is unlikely that there is substantial bias due to family effects in the association between education and self-assessed health. This strengthens the conclusions from prior studies on the association between education and self-assessed health.

RESUMEN

This paper investigates whether education buffers the impact of physical disability on psychological distress. It further investigates what makes education helpful, by examining whether cognitive ability and occupational class can explain the buffering effect of education. Two waves of the 1958 British National Child Development Study are used to test the hypothesis that the onset of a physical disability in early adulthood (age 23 to 33) has a smaller effect on psychological distress among higher educated people. In total 423 respondents (4.6%) experienced the onset of a physical disability between the ages of 23 and 33. We find that a higher educational level cushions the psychology impact of disability. Cognitive ability and occupational class protect against the effect of a disability too. The education buffer arises in part because individuals with a higher level of education have more cognitive abilities, but the better social position of those with higher levels of education appears to be of greater importance. Implications of these findings for the social gradient in health are discussed.

Asunto(s)

Personas con Discapacidad/psicología , Escolaridad , Resiliencia Psicológica , Estrés Psicológico , Adulto , Cognición , Personas con Discapacidad/estadística & datos numéricos , Empleo/clasificación , Empleo/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Clase Social , Adulto Joven

RESUMEN

Previous research reports mixed results about the association between maternal height and child mortality. Some studies suggest that the negative association might be stronger in contexts with fewer resources. This hypothesis has yet not been tested in a cross-nationally comparative design. We use data on 307,223 children born to 194,835 women in 444 districts of 42 developing countries to estimate the association between maternal height and child mortality and test whether this association is modified by indicators at the level of the household (like sex, age and twin status of the child and socio-economic characteristics of the mother and her partner), district (regional level of development, public health facilities and female occupational attainment) and country (GDP per capita). We find a robust negative effect of logged maternal height on child mortality. The effect of maternal health is strongest for women with least education and is more important in the first year after birth and for twin births. The indicators of development at the district and country level do not modify the effect of maternal height.

Asunto(s)

Estatura , Mortalidad del Niño , Países Desarrollados , Madres , Preescolar , Femenino , Encuestas Epidemiológicas , Humanos , Lactante , Masculino , Modelos de Riesgos Proporcionales , Factores de Riesgo , Gemelos

RESUMEN

Childhood socio-economic environment and neighbourhood socio-economic environment later in life are closely related. However, few studies have considered their effects simultaneously. Using cross-sectional data of approximately 8000 respondents in 86 neighbourhoods in the city of Eindhoven, The Netherlands, we study associations of both determinants with self-assessed health, smoking, alcohol consumption and overweight. Growing up in a low socio-economic environment increased the probability to live a more deprived neighbourhood in adulthood. Controlling for individual socio-economic characteristics, both childhood and neighbourhood socio-economic environment were related to smoking and overweight, but not with excessive alcohol consumption. Associations between childhood socio-economic environment and smoking and overweight are still substantial after controlling for neighbourhood socio-economic environment. Similarly, neighbourhood inequalities in smoking and overweight remain substantial after controlling for childhood socio-economic environment.

Asunto(s)

Conductas Relacionadas con la Salud , Estado de Salud , Características de la Residencia , Clase Social , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Encuestas y Cuestionarios

RESUMEN

We gain insight into the dynamics of ethnic intermarriage in times of social change by studying marriages between Latvians and Russians (including Belarussians and Ukrainians) that occurred in Latvia before and after independence from the Soviet Union. Before independence, ethnic intermarriage was already rather common, involving about 17% of the marriages annually. Since independence, intermarriage between Russians and Latvians has increased substantially. Part of this increase can be explained by selective emigration, but at least half of it may be due to integrative processes. Although there were more marriages between Russian men and Latvian women before independence, the gender pattern reversed after independence. Intermarriage levels were the highest among the less educated, children of mixed couples, partners with similar educational levels, and people in the countryside.

Asunto(s)

Etnicidad/etnología , Matrimonio/etnología , Hombres , Cambio Social , Mujeres , Adulto , Comunismo/estadística & datos numéricos , Demografía , Escolaridad , Emigración e Inmigración/estadística & datos numéricos , Etnicidad/educación , Etnicidad/estadística & datos numéricos , Femenino , Humanos , Letonia , Modelos Lineales , Modelos Logísticos , Masculino , Matrimonio/estadística & datos numéricos , Hombres/educación , Hombres/psicología , Análisis Multivariante , Oportunidad Relativa , Política , Crecimiento Demográfico , Prejuicio , República de Belarús/etnología , Características de la Residencia , Federación de Rusia/etnología , Identificación Social , Factores Socioeconómicos , Ucrania/etnología , Mujeres/educación , Mujeres/psicología

RESUMEN

BACKGROUND: Dramatic social changes took place in the Baltic States (Estonia, Latvia and Lithuania) in the 1990s. This study investigates the extent to which social variations in self-assessed health changed during that period. METHODS: Norbalt Living Conditions Survey I (1994) and II (1999) random population-based samples in Estonia, Latvia and Lithuania were analysed. Associations of self-assessed health with six social dimensions (education, economic activity, car ownership, number of rooms, ethnicity and residence) were studied for males and females aged 25-74 years (n = 16 970). RESULTS: Substantial and significant associations with poor health were found for education, economic activity, car ownership and, to a lesser extent, number of rooms. Ethnic differences were found only among women in Estonia. By and large, social variations in health were comparable for most indicators between the three countries. Differences in self-assessed health were stable between 1994 and 1999, except for the relatively worse position of the economically non-active in 1999. CONCLUSIONS: Substantial social inequalities in self-assessed poor health exist in the Baltic States. Despite dramatic social changes taking place, social variations in self-assessed health have been rather stable in the second half of the 1990s. The economically non-active seem to have become more disadvantaged.

Asunto(s)

Estado de Salud , Autorrevelación , Cambio Social/historia , Clase Social , Adulto , Anciano , Países Bálticos , Recolección de Datos , Femenino , Historia del Siglo XX , Humanos , Masculino , Persona de Mediana Edad , Vigilancia de la Población

RESUMEN

Previous research has shown that the association between education and health is partly mediated by working conditions. So far, most studies fail to take into account working careers and instead focus on working conditions at one point in time. This study examines the extent to which current and lifetime exposure to working conditions differ between educational groups, and whether taking into account lifetime exposure rather than current exposure improves our understanding of educational differences in health. A representative sample of the Dutch population (n = 1561) with retrospective information about working careers shows that lower educated men are significantly more exposed to adverse working conditions than higher educated men. These differences increase over the life course. Among women there are relatively small educational differences in exposure. Lifetime exposure to adverse working conditions explains a significant part (a third) of the health differences between the highest and lowest educated men. Moreover, measurements of lifetime exposure to working conditions offer a better explanation for educational differences in health than measurements of current exposure. Among women, only relative lifetime exposure to working conditions can explain a small part of the educational differences in health, while current and absolute lifetime exposure do not explain these differences.

Asunto(s)

Escolaridad , Estado de Salud , Exposición Profesional , Adulto , Anciano , Recolección de Datos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos

RESUMEN

BACKGROUND: Studies explaining educational differences in health often employ current smoking as a mediator. To what extent does lifetime smoking mediate the association between education and self-reported health better than current smoking? METHODS: Analysis of cross-sectional data from a representative general population sample of Dutch men and women (n = 1,561) with complete retrospective smoking histories. RESULTS: Educational differences in smoking over the life course are more pronounced than educational differences in current smoking, especially among men. The association between education and self-reported health is reduced when controlling for smoking for men. Among women, smoking is not such a mediator. The odds ratio for men with primary education to report less than good health is reduced from 2.94 (95% CI: 1.20-6.30) to 2.62 (95% CI: 1.13-6.05) when current smoking is taken into account and to 2.14 (95% CI: 0.90-5.04) when lifetime smoking is controlled for. This reduction in the difference between the highest and lowest educated is approximately 30% and statistically significant. For women, reductions are smaller and non-significant. CONCLUSIONS: Educational differences in smoking among men are underestimated if current instead of lifetime smoking is studied. Consequently, the contribution of smoking to bringing about social inequalities in health is underestimated if current smoking is measured.

Asunto(s)

Escolaridad , Estado de Salud , Fumar/epidemiología , Factores Socioeconómicos , Adulto , Anciano , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Retrospectivos , Distribución por Sexo , Encuestas y Cuestionarios

RESUMEN

This study analyses the importance of partner status and partner's education, adjusted for own education, on self-assessed health, smoking and excessive alcohol consumption. The relationship between socio-economic factors and health-related outcomes is traditionally studied from an individual perspective. Recently, applying social-ecological models that include socio-economic factors on various social levels is becoming popular. We argue that partners are an important influence on individual health and health-related behaviour at the household level. Therefore, we include partners in the analysis of educational health inequalities. Using data of almost 40,000 individuals (with almost 15,000 Dutch cohabiting couples), aged 25-74 years, who participated in the Netherlands Health Interview Survey between 1989 and 1996, we test hypotheses on the importance of own and partner's education. We apply advanced logistic regression models that are especially suitable for studying the relative influence of partners' education. Controlled for own education, partner's education is significantly associated with self-assessed health and smoking, for men and women. Accounting for both partners' education the social gradient in self-assessed health and smoking is steeper than based on own or partner's education alone. The social gradient in health is underestimated by not considering partner's education, especially for women.

Asunto(s)

Consumo de Bebidas Alcohólicas/psicología , Conductas Relacionadas con la Salud , Fumar/psicología , Esposos/educación , Esposos/psicología , Adulto , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Escolaridad , Femenino , Estado de Salud , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Análisis de Regresión , Autoimagen , Factores Sexuales , Fumar/epidemiología

RESUMEN

BACKGROUND: The aim of this study is to assess the effect of parental and partner's education and smoking behavior on an individual's chance of smoking cessation over the life course. METHODS: Self-reported life histories of smoking behavior, education, and relationships were recorded in face-to-face interviews with a random general-population sample of 850 respondents and their partners (if present). The data were collected in 2000. A discrete-time event history model is applied in the analyses of cessation over the life course. RESULTS: Parents' education and smoking behavior (during adolescence) and partners' education have no significant influence on cessation. Living with an ex-smoker or never-smoker increases the likelihood of quitting, compared to being single or living with a partner who smokes. Respondents whose partners were ex-smokers are almost five times more likely to quit smoking than single respondents. They are almost twice as likely to quit compared to those living with a never-smoker. CONCLUSIONS: The difference between having and not having a partner seems as important for cessation as the difference between having a partner who smokes, has never smoked, or has stopped smoking. An ex-smoking partner stimulates cessation more than a partner who has never smoked. Studies into cessation should take into account partners' smoking histories.

Asunto(s)

Estado Civil , Padres , Cese del Hábito de Fumar , Adulto , Escolaridad , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Países Bajos

RESUMEN

In this article, we study trends in self-reported health (general health and chronic conditions) and health inequality in the Netherlands between 1974 and 1998 using an age-period-cohort framework. We answer two questions: (1) to what extent can trends in self-reported health be explained by the current macro-context (period effect) and by infant mortality in year of birth (cohort effect)? And (2) do the effects of period and cohort differ for educational groups? Health indicators are self-reported poor health and chronic conditions. The use of 26 Dutch cross-sectional surveys makes it possible to estimate largely unbiased effects of period and cohort simultaneously (controlled for age effects) and thus to adequately describe trends in social inequality in health. Our results give rise to four conclusions. First, for men poor health has been more or less stable, for women there has been an increase. The prevalence of chronic conditions has increased for both sexes. Second, adding cohort specific experiences to a model including age and period effects is only relevant for women's poor health. Decreasing infant mortality in year of birth leads to better health and consequently the period effect initially found for women appears to be slightly underestimated. Third, we found no trends in social inequalities in self-reported health due to period effects. Fourth, our analyses do show socially unequal trends in health as a result of cohort specific experiences. Contrary to our hypothesis, we found that decreased infant mortality in year of birth makes for a stronger impact of educational differences on self-reported poor health. Concerning chronic conditions no trends for educational groups were found.

Asunto(s)

Enfermedad Crónica/epidemiología , Escolaridad , Indicadores de Salud , Factores Socioeconómicos , Adulto , Distribución por Edad , Anciano , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Lactante , Mortalidad Infantil , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Autorrevelación , Distribución por Sexo , Tiempo