Journal Article

Causal effect of education on mortality in a quasi-experiment on 1.2 million Swedes

Torssander, Jenny, Lager, Anton Carl Jonas

2012

Overview

In 1949–1962, Sweden implemented a 1-y increase in compulsory schooling as a quasi-experiment. Each year, children in a number of municipalities were exposed to the reform and others were kept as controls, allowing us to test the hypothesis that education is causally related to mortality. We studied all children born between 1943 and 1955, in 900 Swedish municipalities, with control for birth-cohort and area differences. Primary outcome measures are all-cause and cause-specific mortality until the end of 2007. The analyses include 1,247,867 individuals, of whom 92,351 died. We found lower all-cause mortality risk in the experimental group after age 40 [hazard ratio (HR) = 0.96, 95% confidence interval (CI) 0.93–0.99] but not before (HR = 1.03, 95% CI 0.98–1.07) or during the whole follow-up (HR = 0.98, 95% CI 0.95–1.01). After age 40, the experimental group had lower mortality from overall cancer, lung cancer, and accidents. In addition, exposed women had lower mortality from ischemic heart disease, and exposed men lower mortality from overall external causes. In analyses stratified for final educational level, we found lower mortality in the experimental group within the strata that settled for compulsory schooling only (HR = 0.94, 95% CI 0.89–0.99) and compulsory schooling plus vocational training (HR = 0.92, 95% CI 0.88–0.97). Thus, the experimental group had lower mortality from causes known to be related to education. Lower mortality in the experimental group was also found among the least educated, a group that clearly benefited from the reform in terms of educational length. However, all estimates are small and there was no evident impact of the reform on all-cause mortality in all ages.

• Publisher: National Academy of Sciences,National Acad Sciences
• Subject: accidents / Accidents - mortality / Biological Sciences / Cancer / Cardiovascular diseases / Causality / Cause of Death / Children / Cohort Studies / confidence interval / Education / Education, Continuing / Education, Continuing - methods / Education, Continuing - statistics & numerical data / Educational Status / Elementary schools / epidemiology / Female / Health risks / Humans / Incidence / Lung cancer / Lung neoplasms / Lung Neoplasms - mortality / Male / Men / methods / Middle Aged / Mortality / Mortality - trends / Mortality risk / Municipalities / Myocardial ischemia / natural experiment / Natural experiments / Neoplasms / Neoplasms - mortality / Older adults / Proportional Hazards Models / Pulmonary heart disease / risk / Risk Assessment / Risk Assessment - statistics & numerical data / Secondary schools / Social Sciences / statistics & numerical data / Sweden / Sweden - epidemiology / Time Factors / trends / vocational education / women