Commentary: Education, education, education

Abstract

There is no doubt that, broadly within a given society, poorer education is linked with poorer health. The research question is why this linkage exists, and having gained an understanding of the mechanisms, to examine what is to be done about it at policy level. Kilander et al.'s new analysis1 of 25-year mortality of men born 1920–1924 in Uppsala, Sweden, provides further valuable evidence for the education-health association, and focuses on the role of lifestyle factors as mediators between level of education and elevated risks of coronary and cancer death. Compared with those who completed high school or university education, men who had ≤7 years of schooling were more likely to die of cardiovascular disease (CVD) (relative risk [RR] = 1.7) and cancer (RR = 1.9). Those who had an intermediate education level (8–10 years of schooling) were at intermediate risk for CVD mortality (RR = 1.3), but at similar two-fold increased risk for cancer mortality (RR = 2.2) as those in the lowest education category. The educational gradient in CVD mortality was statistically well accounted for by differences in lifestyle, whereas for cancer deaths adjustment for all measured lifestyle risk factors left around half of the education effect unexplained. These findings mirror the current state of aetiological knowledge. Cardiovascular disease has better characterized behavioural causes than cancer.

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