Viner Russell M, Hargreaves Dougal S, Ward Joseph, Bonell Chris, Mokdad Ali H, Patton George
UCL Institute of Child Health, 30 Guilford St., London WC1N 1EH, UK.
London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK.
SSM Popul Health. 2017 Dec;3:162-171. doi: 10.1016/j.ssmph.2016.12.004.
The health benefits of secondary education have been little studied. We undertook country-level longitudinal analyses of the impact of lengthening secondary education on health outcomes amongst 15-24 year olds.
Exposures: average length of secondary and primary education from 1980 to 2013.Data/Outcomes: Country level adolescent fertility rate (AFR), HIV prevalence and mortality rate from 1989/90 to 2013 across 186 low-, middle- and high-income countries.Analysis: Longitudinal mixed effects models, entering secondary and primary education together, adjusted for time varying GDP and country income status. Longitudinal structural marginal models using inverse probability weighting (IPW) to take account of time varying confounding by primary education and GDP. Counterfactual scenarios of no change in secondary education since 1980/1990 were estimated from model coefficients for each outcome.
Each additional year of secondary education decreased AFR by 8.4% in mixed effects models and 14.6% in IPW models independent of primary education and GDP. Counterfactual analyses showed the proportion of the reduction in adolescent fertility rate over the study period independently attributable to secondary education was 28% in low income countries. Each additional year of secondary education reduced mortality by 16.9% for 15-19 year and 14.8% for 20-24 year old young women and 11.4% for 15-19 year and 8.8% for 20-24 year old young men. Counterfactual scenarios suggested 12% and 23% of the mortality reduction for 15-19 and 20-24 year old young men was attributable to secondary education in low income countries. Each additional year of secondary education was associated with a 24.5% and 43.1% reduction in HIV prevalence amongst young men and women.
The health benefits associated with secondary education were greater than those of primary education and were greatest amongst young women and those from low income countries. Secondary education has the potential to be a social vaccine across many outcomes in low and middle income countries.
中等教育对健康的益处鲜有研究。我们对15至24岁人群中延长中等教育对健康结果的影响进行了国家级纵向分析。
暴露因素：1980年至2013年中等教育和初等教育的平均时长。数据/结果：1989/90年至2013年186个低收入、中等收入和高收入国家的国家级青少年生育率（AFR）、艾滋病毒流行率和死亡率。分析：纵向混合效应模型，将中等教育和初等教育一起纳入，对随时间变化的国内生产总值和国家收入状况进行调整。使用逆概率加权（IPW）的纵向结构边际模型，以考虑初等教育和国内生产总值随时间变化的混杂因素。根据每个结果的模型系数估计了自1980/1990年以来中等教育无变化的反事实情景。
在混合效应模型中，每多接受一年中等教育，青少年生育率降低8.4%，在逆概率加权模型中降低14.6%，不受初等教育和国内生产总值影响。反事实分析表明，在低收入国家，研究期间青少年生育率下降中可独立归因于中等教育的比例为28%。每多接受一年中等教育，15至19岁年轻女性死亡率降低16.9%，20至24岁年轻女性降低14.8%，15至19岁年轻男性降低11.4%，20至24岁年轻男性降低8.8%。反事实情景表明，在低收入国家，15至19岁和20至24岁年轻男性死亡率降低中分别有12%和23%可归因于中等教育。每多接受一年中等教育，年轻男性和女性的艾滋病毒流行率分别降低24.5%和43.1%。
与中等教育相关的健康益处大于初等教育，在年轻女性和低收入国家人群中最为显著。在低收入和中等收入国家，中等教育有可能成为针对多种结果的社会疫苗。
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