Jenny Torssander

Marital partner and mortality: the effects of the social positions of both spouses

Background: Dimensions of the individual socioeconomic position—education, social class, social status and income—are associated with mortality. Inequalities in death also related to the social position of the household. It is, however, less clear how the socioeconomic position of one marital/cohabiting partner influences the mortality of the other partner. We examine the independent effect on mortality of own and partner’s positions regarding these four socioeconomic factors. Methods: Register data on education, social class, social status and income of both marital/cohabiting partners were collected from the 1990 Census of the employed Swedish population aged 30–59 (N = 1 502 148). Data on all-cause mortality and deaths from cancer and circulatory disease for the subsequent period 1991–2003 were collected from the Cause of Death Register. Relative mortality risks for different socioeconomic groups were estimated by Cox regression. Results: All-cause mortality of both men and women differs by women’s education and status and by men’s social class and income. For men, the wife’s education is more important for the mortality risk than his own education when the man’s social class is included in the model. For women, the husband’s social class yields larger mortality differences than own occupational measures. Women’s education and men’s social class and income are particularly important for women’s deaths from circulatory diseases. Conclusion: The partner’s social position has a clear independent association with individual mortality, and women’s education and men’s social class seem to be particularly important. Suggested explanations of health inequality are not always compatible with the observed relationship between partners’ social and economic resources and mortality.

Social class and cause of death

BACKGROUND Previous studies have shown that causes of death differ in their relationship to social class, but we lack a more comprehensive description of this variation. The present study provides a detailed and extensive list of social class differences for a large number of specific causes of death. METHODS All deaths between 1991 and 2003 in Sweden were linked with information on household social class from 1990. Relative death risks and excess mortality in groups of causes according to the European shortlist were estimated separately for men and women in eight classes using Cox Regression. RESULTS A clear mortality gradient among employees was found for the majority of causes, from low-relative death risks among higher managerial and professional occupations to relatively high risks for the unskilled working class. There is considerable variation in the strength of the association, from causes such as malignant melanoma, breast cancer and transport accidents among women, where no clear class differences were found. At the other extreme, mental and behavioural disorders, endocrine, nutritional and metabolic diseases and diseases of the respiratory system all show steep slopes for both men and women. Circulatory diseases and cancer together account for 15-20% of excess mortality. CONCLUSIONS Exceptions to the general pattern--causes of death in which higher social classes are exposed to greater death risks or in which there is no mortality gradient--are practically non-existent. There is nevertheless significant variation in the strength of the class differences in specific causes.

Clerics die, doctors survive: a note on death risks among highly educated professionals.

Aims: Mortality is strongly associated with education. We present relative death risks of men and women in 12 educational/ occupational groups in Sweden today, with a focus on individuals with higher education. Methods: Results from Cox regressions are reported for 12 educational groups with special emphasis on those with professional education, e.g. clerics, physicians, people with medical PhDs, and university teachers. The study is based on register data of the total Swedish population in the age group of 30—64 (n = 3,734,660). Results: There is a considerable variation in mortality between educational groups. Men with compulsory education run a risk that is more than three times higher than that of professors outside medicine, and other educational groups fall in between. Medical doctors and physicians have relatively low death risks compared to those with compulsory education — less than 50% among men and less than 60% among women — although professors in medicine deviate by having higher risks than their colleagues in other subjects. Those with a theological exam show higher risks of dying during the follow-up period compared to others of a similar educational level. Professors outside medicine experience the lowest death risks of all identified groups. Conclusions: Men and women with a professional education have comparatively low death risks, particularly low among medical doctors and university employees, while the clergy seems to experience relatively higher death risks than others with a similar level of education. These patterns may reflect the effects of education as well as the selection of men and women to higher education.

Partner resources and incidence and survival in two major causes of death

Because people tend to marry social equals – and possibly also because partners affect each other’s health – the social position of one partner is associated with the other partner’s health and mortality. Although this link is fairly well established, the underlying mechanisms are not fully identified. Analyzing disease incidence and survival separately may help us to assess when in the course of the disease a partner’s resources are of most significance. This article addresses the importance of partner’s education, income, employment status, and health for incidence and survival in two major causes of death: cancer and cardiovascular diseases (CVD). Based on a sample of Finnish middle-aged and older couples (around 200,000 individuals) we show that a partner’s education is more often connected to incidence than to survival, in particular for CVD. Once ill, any direct effect of partner’s education seems to decline: The survival chances after being hospitalized for cancer or CVD are rather associated with partner’s employment status and/or income level when other individual and partner factors are adjusted for. In addition, a partner’s history of poor health predicted higher CVD incidence and, for women, lower cancer survival. The findings suggest that various partner’s characteristics may have different implications for disease and survival, respectively. A wider focus on social determinants of health at the household level, including partner’s social resources, is needed.

Family of origin and educational inequalities in mortality: Results from 1.7 million Swedish siblings

Circumstances in the family of origin have short- and long-term consequences for peoples health. Family background also influences educational achievements – achievements that are clearly linked to various health outcomes. Utilizing population register data, we compared Swedish siblings with different levels of education (1,732,119 individuals within 662,095 sibships) born between 1934 and 1959 and followed their death records until the end of 2012 (167,932 deaths). The educational gradient in all-cause mortality was lower within sibships than in the population as a whole, an attenuation that was strongest at younger ages (< 50 years of age) and for those with a working class or farmer background. There was substantial variation across different causes of death with clear reductions in educational inequalities in, e.g., lung cancer and diabetes, when introducing shared family factors, which may indicate that part of the association can be ascribed to circumstances that siblings have in common. In contrast, educational inequalities in suicide and, for women, other mental disorders increased when adjusting for factors shared by siblings. The vast variation in the role of childhood conditions for the education-mortality association may help us to further understand the interplay between family background, education, and mortality. The increase in the education gradient in suicide when siblings are compared may point towards individually oriented explanations (‘non-shared environment’), perhaps particularly in mental disorders, while shared family factors primarily seem to play a more important role in diseases in which health behaviors are most significant.

Four Decades of Educational Inequalities in Hospitalization and Mortality among Older Swedes.

Background The inverse association between education and mortality has grown stronger the last decades in many countries. During the same period, gains in life expectancy have been concentrated to older ages; still, old-age mortality is seldom the focus of attention when analyzing trends in the education-mortality gradient. It is further unknown if increased educational inequalities in mortality are preceded by increased inequalities in morbidity of which hospitalization may be a proxy. Methods Using administrative population registers from 1971 and onwards, education-specific annual changes in the risk of death and hospital admission were estimated with complimentary log-log models. These risk changes were supplemented by estimations of the ages at which 25, 50, and 75% of the population had been hospitalized or died (after age 60). Results The mortality decline among older people increasingly benefitted the well-educated over the less well-educated. This inequality increase was larger for the younger old, and among men. Educational inequalities in the age of a first hospital admission generally followed the development of growing gaps, but at a slower pace than mortality and inequalities did not increase among the oldest individuals. Conclusions Education continues to be a significant predictor of health and longevity into old age. That the increase in educational inequalities is greater for mortality than for hospital admissions (our proxy of overall morbidity) may reflect that well-educated individuals gradually have obtained more possibilities or resources to survive a disease than less well-educated individuals have the last four decades.