NORCE - Norwegian Research Center, Bergen, Norway; Department of Community Medicine, UiT - the Arctic University of Norway, Tromsø, Norway.
Centre for Health Economics, Monash University, Melbourne, Australia.
Soc Sci Med. 2023 Apr;323:115832. doi: 10.1016/j.socscimed.2023.115832. Epub 2023 Mar 11.
Positive associations between own educational attainment and own health have been extensively documented. Studies have also shown spousal educational attainment to be associated with own health. This paper investigates the extent to which spousal education contributes to the social gradient in health, net of own education; and whether parts of a seeming spousal education effect are attributable to differences in early-life human capital, as measured by respondents' height and childhood living standard. Furthermore, we investigate the relative contribution of predictors in the regression analysis by use of Shapley value decomposition. We use data from a comprehensive health survey from Northern Norway (conducted in 2015/16, N = 21,083, aged 40 and above). We apply three alternative health outcome measures: the EQ-5D-5L index, a visual analogue scale (EQ-VAS) and self-rated health. In all models considered, spousal education is generally positively significant for both men and women. The results also suggest that spousal education is generally more important for men than women. In the sub-sample of individuals having a spouse, decomposition analyses showed that the relative contribution of spousal education to the goodness-of-fit in men's (women's) health was 13% (14%) with the EQ-5D-5L; 25% (20%) with the EQ-VAS and; 30% (21%) with self-rated health. Heterogeneity analyses showed stronger spousal education effects in younger age groups. In conclusion, we have provided empirical evidence that spousal education may contribute to explaining the amplified health gradient in an egalitarian country like Norway.
自身受教育程度与自身健康之间存在正相关关系，这一现象已被广泛证实。研究还表明，配偶的受教育程度与自身健康有关。本文调查了配偶教育在多大程度上有助于消除自身教育的影响，进而对健康的社会梯度产生影响；以及配偶教育对健康的影响是否部分归因于早期人力资本的差异，这种差异可以通过受访者的身高和童年生活水平来衡量。此外，我们还通过 Shapley 值分解来研究回归分析中预测因素的相对贡献。我们使用了来自挪威北部一项全面健康调查的数据（于 2015/16 年进行，N=21083 人，年龄在 40 岁及以上）。我们采用了三种替代健康结果衡量标准：EQ-5D-5L 指数、视觉模拟量表（EQ-VAS）和自我报告健康状况。在考虑的所有模型中，配偶教育对男性和女性的健康都具有普遍的正向显著影响。结果还表明，配偶教育对男性的重要性通常高于女性。在有配偶的个体子样本中，分解分析表明，配偶教育对男性（女性）健康状况拟合优度的相对贡献分别为 EQ-5D-5L 中的 13%（14%）；EQ-VAS 中的 25%（20%）；自我报告健康状况中的 30%（21%）。异质性分析表明，在年龄较小的群体中，配偶教育的影响更大。总之，我们提供了经验证据，表明配偶教育可能有助于解释在像挪威这样的平等主义国家中放大的健康梯度。
