Educational differences in mortality and hospitalisation for cardiovascular diseases

Area of Science:

• Social Epidemiology
• Public Health
• Health Economics

Background:

• An educational gradient in mortality exists, influenced by disparities in cardiovascular disease (CVD) hospitalisation.
• Selective hospitalisation and educational attainment require careful consideration in health outcome analyses.

Purpose of the Study:

• To quantify the educational gradient in mortality by examining educational differences in CVD hospitalisation.
• To simulate educational gains in survival probability and premature mortality.
• To decompose educational gains into direct and indirect effects via hospitalisation.

Main Methods:

• Utilised Swedish Military Conscription Data (1951-1960) for males, linked to administrative registers.
• Employed a 'Timing-of-events' model to address selective hospitalisation.
• Applied inverse propensity weighting to account for selection into education.

Main Results:

• Implied educational gains in survival probability to age 63 range from 2% to 5.5% points, with greater benefits for the low-educated.
• For the high-educated, survival gains are primarily driven by hospitalisation differences (1.3% points).
• For the low-educated, survival gains are mainly attributed to other factors (4.9% points), with no significant impact from hospitalisation differences on months lost due to premature mortality.

Conclusions:

• Improving education significantly enhances survival probability and reduces premature mortality, especially for lower socioeconomic groups.
• The pathways through which education impacts mortality differ between educational attainment levels.
• While hospitalisation differences play a role for the high-educated, other factors are more critical for the low-educated.