Division of Psychiatry, University College London, London, UK.
Department of Statistical Sciences, University College London, London, UK.
Int J Epidemiol. 2023 Dec 25;52(6):1878-1886. doi: 10.1093/ije/dyad104.
On average, educated people are healthier, wealthier and have higher life expectancy than those with less education. Numerous studies have attempted to determine whether education causes differences in later health outcomes or whether another factor ultimately causes differences in education and subsequent outcomes. Previous studies have used a range of natural experiments to provide causal evidence. Here we compare two natural experiments: a policy reform, raising the school leaving age in the UK in 1972; and Mendelian randomization.
We used data from 334 974 participants of the UK Biobank, sampled between 2006 and 2010. We estimated the effect of an additional year of education on 25 outcomes, including mortality, measures of morbidity and health, ageing and income, using multivariable adjustment, the policy reform and Mendelian randomization. We used a range of sensitivity analyses and specification tests to assess the plausibility of each method's assumptions.
The three different estimates of the effects of educational attainment were largely consistent in direction for diabetes, stroke and heart attack, mortality, smoking, income, grip strength, height, body mass index (BMI), intelligence, alcohol consumption and sedentary behaviour. However, there was evidence that education reduced rates of moderate exercise and increased alcohol consumption. Our sensitivity analyses suggest that confounding by genotypic or phenotypic confounders or specific forms of pleiotropy are unlikely to explain our results.
Previous studies have suggested that the differences in outcomes associated with education may be due to confounding. However, the two independent sources of exogenous variation we exploit largely imply consistent causal effects of education on outcomes later in life.
受教育程度较高的人通常比受教育程度较低的人更健康、更富有、预期寿命更长。许多研究试图确定教育是否会导致后期健康结果的差异，或者是否有其他因素最终导致教育和后续结果的差异。以前的研究使用了一系列自然实验来提供因果证据。在这里，我们比较了两种自然实验：一项政策改革，即 1972 年提高英国的离校年龄；以及孟德尔随机化。
我们使用了英国生物库 334974 名参与者的数据，这些参与者于 2006 年至 2010 年间进行了抽样。我们使用多变量调整、政策改革和孟德尔随机化，估计了额外一年教育对 25 项结果的影响，包括死亡率、发病率和健康状况、衰老和收入。我们使用了一系列敏感性分析和规范测试来评估每种方法假设的合理性。
三种不同的教育程度对糖尿病、中风和心脏病发作、死亡率、吸烟、收入、握力、身高、体重指数（BMI）、智力、饮酒和久坐行为的影响的估计方向大致一致。然而，有证据表明，教育降低了适度运动的比例，增加了饮酒量。我们的敏感性分析表明，遗传或表型混杂因素或特定形式的连锁不平衡不太可能解释我们的结果。
以前的研究表明，与教育相关的结果差异可能是由于混杂因素造成的。然而，我们利用的两种独立的外生变异来源，很大程度上暗示了教育对晚年生活结果的因果影响是一致的。
