Articlegold2023

Education level as a predictor of the onset of health problems among China’s middle-aged population: Cox regression analysis

13 citations0/0 files storedFrontiers in Public Health

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Health disparities and outcomes Intergenerational and Educational Inequality Studies Public Health and Social Inequalities

Abstract

Background: Despite the importance of midlife with reference to one's health, educational inequalities in midlife health have attracted little attention in China. Using Cox proportional hazards regression analysis, this study examined the association between educational attainment and the onset of midlife health problems and investigated the potential mediating effects of socioeconomic position (SEP) other than educational attainment, depression, and health behavior. Methods: = 8,050). Health outcomes included the onset of poor self-rated health (SRH), limitation in activities of daily living (ADL) and instrumental ADL (IADL), multimorbidity, hypertension, dyslipidemia, heart diseases, and stroke over the 7-year follow-up period. Cox proportional hazard models were used to examine the associations of the outcomes with educational attainment, while controlling for potential mediators (other SEP, depression, and health behaviors). Results: Lower educational level was associated with increased incidences of poor SRH and ADL/IADL limitations, but with decreased incidences of dyslipidemia and heart disease. After adjusting for baseline covariates, the RII was 2.17 (95% confidence interval [CI]: 1.74, 2.70) for poor SRH, 2.15 (95% CI: 1.42, 3.26) for ADL limitation, 3.84 (95% CI: 2.98, 4.94) for IADL limitation, 0.52 (95% CI: 0.40, 0.68) for dyslipidemia, and 0.55 (95% CI: 0.40, 0.74) for heart disease. Significant proportions (2.1 to 27.0%) of the RII were explained by the mediators. No sex or urban-rural differences were found in this study. Conclusion: Our findings suggest that educational attainment is an important predictor of the incidences of key midlife health problems, with significant mediating effects exerted by other indicators of SEP, depression, and health behavior.

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References

2005Indicators of socioeconomic position (part 1): Figure 1 2005Income inequality and population health: A review and explanation of the evidence 1997Price of Adaptation—Allostatic Load and Its Health Consequences 2004The Relationship Between Education and Adult Mortality in the United States 1999Cross-validation of a short form of the CES-D in Chinese elderly 1999A Revised CES-D Measure of Depressive Symptoms and a DSM-Based Measure of Major Depressive Episodes in the Elderly 2019Variations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE): a prospective cohort study 2005The Center for Epidemiologic Studies Depression Scale in older Chinese: thresholds for long and short forms

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