Lynch Jamie L, von Hippel Paul T
Department of Sociology, St. Norbert College, Boyle Hall 454, 100 Grant Street, De Pere, WI 54115, USA.
LBJ School of Public Affairs, University of Texas at Austin, 2315 Red River, Box Y, Austin, TX 78712, USA.
Soc Sci Med. 2016 Apr;154:18-27. doi: 10.1016/j.socscimed.2016.02.029. Epub 2016 Feb 23.
There is a positive gradient associating educational attainment with health, yet the explanation for this gradient is not clear. Does higher education improve health (causation)? Do the healthy become highly educated (selection)? Or do good health and high educational attainment both result from advantages established early in the life course (confounding)? This study evaluates these competing explanations by tracking changes in educational attainment and Self-rated Health (SRH) from age 15 to age 31 in the National Longitudinal Study of Youth, 1997 cohort. Ordinal logistic regression confirms that high-SRH adolescents are more likely to become highly educated. This is partly because adolescent SRH is associated with early advantages including adolescents' academic performance, college plans, and family background (confounding); however, net of these confounders adolescent SRH still predicts adult educational attainment (selection). Fixed-effects longitudinal regression shows that educational attainment has little causal effect on SRH at age 31. Completion of a high school diploma or associate's degree has no effect on SRH, while completion of a bachelor's or graduate degree have effects that, though significant, are quite small (less than 0.1 points on a 5-point scale). While it is possible that educational attainment would have greater effect on health at older ages, at age 31 what we see is a health gradient in education, shaped primarily by selection and confounding rather than by a causal effect of education on health.
教育程度与健康之间存在正向梯度关联，但这种梯度的成因尚不清楚。是高等教育改善了健康状况（因果关系）？还是健康的人接受了高等教育（选择因素）？又或者良好的健康状况和高教育程度都是人生早期就确立的优势所导致的结果（混杂因素）？本研究通过追踪1997年全国青年纵向研究队列中15岁至31岁人群的教育程度和自评健康状况（SRH）变化，对这些相互竞争的解释进行了评估。有序逻辑回归证实，自评健康状况良好的青少年更有可能接受高等教育。部分原因在于青少年的自评健康状况与早期优势相关，包括青少年的学业成绩、大学计划和家庭背景（混杂因素）；然而，排除这些混杂因素后，青少年的自评健康状况仍能预测其成人后的教育程度（选择因素）。固定效应纵向回归显示，教育程度对31岁时的自评健康状况几乎没有因果效应。获得高中文凭或副学士学位对自评健康状况没有影响，而获得学士学位或研究生学位虽有显著影响，但影响相当小（在5分制中不到0.1分）。虽然教育程度在年龄较大时可能对健康有更大影响，但在31岁时，我们看到的是教育方面的健康梯度，其主要由选择因素和混杂因素塑造，而非教育对健康的因果效应。
