Wagner Cornelia, Cullati Stéphane, Sieber Stefan, Huijts Tim, Chiolero Arnaud, Carmeli Cristian
Population Health Laboratory (#PopHealthLab), University of Fribourg, Switzerland.
Department of Readaptation and Geriatrics, University of Geneva, Switzerland.
SSM Popul Health. 2023 Feb 22;22:101367. doi: 10.1016/j.ssmph.2023.101367. eCollection 2023 Jun.
While educational gradients in longevity have been observed consistently in adult Europeans, these inequalities have been understudied within the context of family- and country-level influences. We utilized population-based multi-generational multi-country data to assess the role (1) of parental and individual education in shaping intergenerational inequalities in longevity, and (2) of country-level social net expenditure in mitigating these inequalities.
We analyzed data from 52,271 adults born before 1965 who participated in the Survey of Health, Ageing and Retirement in Europe, comprising 14 countries. Mortality from all causes (outcome) was ascertained between 2013 and 2020. Educational trajectories (exposure) were High-High (reference), Low-High, High-Low, and Low-Low, corresponding to the sequence of parental-individual educational attainment. We quantified inequalities as years of life lost (YLL) between the ages of 50 and 90 estimated via differences in the area under standardized survival curves. We assessed the association between country-level social net expenditure and YLL via meta-regression.
Inequalities in longevity due to educational trajectories were associated with low individual education regardless of parental education. Compared to High-High, having High-Low and Low-Low led to 2.2 (95% confidence intervals: 1.0 to 3.5) and 2.9 (2.2 to 3.6) YLL, while YLL for Low-High were 0.4 (-0.2 to 0.9). A 1% increase in social net expenditure led to an increase of 0.01 (-0.3 to 0.3) YLL for Low-High, 0.007 (-0.1 to 0.2) YLL for High-Low, and a decrease of 0.02 (-0.1 to 0.2) YLL for Low-Low.
In European countries, individual education could be the main driver of inequalities in longevity for adults older than 50 years of age and born before 1965. Further, higher social expenditure is not associated with smaller educational inequalities in longevity.
虽然在成年欧洲人中一直观察到寿命方面的教育梯度，但在家庭和国家层面影响的背景下，这些不平等现象尚未得到充分研究。我们利用基于人群的多代多国数据来评估：（1）父母教育和个人教育在塑造寿命方面代际不平等中的作用；（2）国家层面社会净支出在减轻这些不平等方面的作用。
我们分析了来自欧洲健康、老龄化和退休调查（涵盖14个国家）中1965年以前出生的52271名成年人的数据。在2013年至2020年期间确定了所有原因导致的死亡率（结果）。教育轨迹（暴露因素）分为高高（参照组）、低高、高低和低低，分别对应父母-个人教育程度的顺序。我们将不平等量化为通过标准化生存曲线下面积差异估计的50至90岁之间的寿命损失年数（YLL）。我们通过元回归评估国家层面社会净支出与YLL之间的关联。
无论父母教育程度如何，因教育轨迹导致的寿命不平等都与个人教育程度低有关。与高高组相比，高低组和低低组分别导致2.2（95%置信区间：1.0至3.5）和2.9（2.2至3.6）的寿命损失年数，而低高组的寿命损失年数为0.4（-0.2至0.9）。社会净支出每增加1%，低高组的寿命损失年数增加0.01（-0.3至0.3），高低组增加0.007（-0.1至0.2），低低组减少0.02（-0.1至0.2）。
在欧洲国家，个人教育可能是1965年以前出生的50岁以上成年人寿命不平等的主要驱动因素。此外，较高的社会支出与寿命方面较小的教育不平等无关。
