Education-based health inequalities in 18,000 Norwegian couples: the Nord-Trøndelag Health Study (HUNT)

BMC Public Health

Steinar Westin⁴  Steinar Krokstad³  Linda Ernstsen¹  Johan Håkon Bjørngaard⁵  Sara Marie Nilsen² 

[1] Faculty of Nursing, Sør-Trøndelag University College, Trondheim, Norway;Faculty of Medicine, NTNU, Trondheim, NO, 7489, Norway;Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway;Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway;Forensic Department and Research Centre Bröset, St. Olav’s University Hospital Trondheim, Trondheim, Norway

关键词: Subjective health;    Multilevel analysis;    Family health;    Education;    Depression;    Couples;    Anxiety;   

Others  :  1162810
DOI  :  10.1186/1471-2458-12-998

 received in 2012-02-07, accepted in 2012-11-14,  发布年份 2012

【 摘 要 】

Background

Education-based inequalities in health are well established, but they are usually studied from an individual perspective. However, many individuals are part of a couple. We studied education-based health inequalities from the perspective of couples where indicators of health were measured by subjective health, anxiety and depression.

Methods

A sample of 35,980 women and men (17,990 couples) was derived from the Norwegian Nord-Trøndelag Health Study 1995–97 (HUNT 2). Educational data and family identification numbers were obtained from Statistics Norway. The dependent variables were subjective health (four-integer scale), anxiety (21-integer scale) and depression (21-integer scale), which were captured using the Hospital Anxiety and Depression Scale. The dependent variables were rescaled from 0 to 100 where 100 was the worst score. Cross-sectional analyses were performed using two-level linear random effect regression models.

Results

The variance attributable to the couple level was 42% for education, 16% for subjective health, 19% for anxiety and 25% for depression. A one-year increase in education relative to that of one’s partner was associated with an improvement of 0.6 scale points (95% confidence interval = 0.5–0.8) in the subjective health score (within-couple coefficient). A one-year increase in a couple’s average education was associated with an improvement of 1.7 scale points (95% confidence interval = 1.6–1.8) in the subjective health score (between-couple coefficient). There were no education-based differences in the anxiety or depression scores when partners were compared, whereas there were substantial education-based differences between couples in all three outcome measures.

Conclusions

We found considerable clustering of education and health within couples, which highlighted the importance of the family environment. Our results support previous studies that report the mutual effects of spouses on education-based inequalities in health, suggesting that couples develop their socioeconomic position together.

【 授权许可】

   
2012 Nilsen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Marmot MG: Understanding social inequalities in health. Perspect Biol Med 2003, 46(3 Suppl):9-23.
• [2]Skalicka V, Kunst AE: Effects of spouses’ socioeconomic characteristics on mortality among men and women in a Norwegian longitudinal study. Soc Sci Med 2008, 66(9):2035-2047.
• [3]Jaffe DH, Eisenbach Z, Neumark YD, Manor O: Effects of husbands’ and wives’ education on each other’s mortality. Soc Sci Med 2006, 62(8):2014-2023.
• [4]Dahl E: Inequality in health and the class position of women – the Norwegian experience. Sociol Health Illn 1991, 13(4):492-505.
• [5]Luoto R, Pekkanen J, Uutela A, Tuomilehto J: Cardiovascular risks and socioeconomic status: differences between men and women in Finland. J Epidemiol Community Health 1994, 48(4):348-354.
• [6]Mackenbach JP, Kunst AE, Groenhof F, Borgan JK, Costa G, Faggiano F, Jozan P, Leinsalu M, Martikainen P, Rychtarikova J, et al.: Socioeconomic inequalities in mortality among women and among men: an international study. Am J Public Health 1999, 89(12):1800-1806.
• [7]Erikson R: Social class assignment and mortality in Sweden. Soc Sci Med 2006, 62(9):2151-2160.
• [8]Koskinen S, Martelin T: Why are socioeconomic mortality differences smaller among women than among men? Soc Sci Med 1994, 38(10):1385-1396.
• [9]Erikson R, Torssander J: Marital partner and mortality: the effects of the social positions of both spouses. J Epidemiol Community Health 2009, 63(12):992-998.
• [10]Monden C, van Lenthe F, de Graaf ND, Kraaykamp G: Partner’s and own education: does who you live with matter for self-assessed health, smoking and excessive alcohol consumption? Soc Sci Med 2003, 57(10):1901-1912.
• [11]Krokstad S, Kunst AE, Westin S: Trends in health inequalities by educational level in a Norwegian total population study. J Epidemiol Community Health 2002, 56(5):375-380.
• [12]Link BG, Phelan J: Social conditions as fundamental causes of disease. J Health Soc Behav 1995. Spec No:80–94
• [13]Strand BH, Grøholt E-K, Steingrímsdóttir ÓA, Blakely T, Graff-Iversen S, Næss Ø: Educational inequalities in mortality over four decades in Norway: prospective study of middle aged men and women followed for cause specific mortality, 1960–2000. BMJ 2010, 340:c654.
• [14]Mackenbach JP, Stirbu I, Roskam A-JR, Schaap MM, Menvielle G, Leinsalu M, Kunst AE: Socioeconomic inequalities in health in 22 European countries. N Engl J Med 2008, 358(23):2468-2481.
• [15]Mackenbach JP, Kunst AE, Cavelaars AE, Groenhof F, Geurts JJ: Socioeconomic inequalities in morbidity and mortality in western europe. The EU working group on socioeconomic inequalities in health. Lancet 1997, 349(9066):1655-1659.
• [16]Jaffe D, Eisenbach Z, Neumark Y, Manor O: Does one’s own and one’s spouse’s education affect overall and cause-specific mortality in the elderly? Int J Epidemiol 2005, 34(6):1409-1416.
• [17]Egeland GM, Tverdal A, Meyer HE, Selmer R: A man’s heart and a wife’s education: A 12-year coronary heart disease mortality follow-up in Norwegian men. Int J Epidemiol 2002, 31(4):799-805.
• [18]Feaster D, Brincks A, Robbins M, Szapocznik J: Multilevel models to identify contextual effects on individual group member outcomes: a family example. Fam Process 2011, 50(2):167-183.
• [19]Kalmijn M: Intermarriage and homogamy: causes, patterns, trends. Annu Rev Sociol 1998, 24:395-421.
• [20]Birkelund GE, Heldal J: Who marries whom? Educational homogamy in Norway. Demogr Res 2003, 8(1):1-30.
• [21]Schwartz CR, Mare RD: Trends in educational assortative marriage from 1940 to 2003. Demography 2005, 42(4):621-646.
• [22]Meyler D, Stimpson JP, Peek MK: Health concordance within couples: A systematic review. Soc Sci Med 2007, 64(11):2297-2310.
• [23]Smith KR, Zick CD: Linked lives, dependent demise? survival analysis of husbands and wives. Demography 1994, 31(1):81-93.
• [24]Holmen J, Midthjell K, Krüger Ø, Langhammer A, Holmen TL, Bratberg GH, Vatten L, Lund-Larsen PG: The nord-trøndelag health study 1995–97 (HUNT 2): objectives, contents, methods and participation. Nor J Epidemiol 2003, 13(1):19-32.
• [25]Krokstad S, Langhammer A, Hveem K, Holmen T, Midthjell K, Stene T, Bratberg G, Heggland J, Holmen J: Cohort profile: the HUNT study, Norway. Int J Epidemiol 2012. in press
• [26]Jylhä M: What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med 2009, 69(3):307-316.
• [27]Bjelland I, Dahl AA, Haug TT, Neckelmann D: The validity of the hospital anxiety and depression scale: an updated literature review. J Psychosom Res 2002, 52(2):69-77.
• [28]Mykletun A, Stordal E, Dahl AA: Hospital anxiety and depression (HAD) scale: factor structure, item analyses and internal consistency in a large population. Br J Psychiatry 2001, 179(6):540-544.
• [29]Noack T: Cohabitation in Norway: an accepted and gradually more regulated way of living. Int J Law Pol Fam 2001, 15(1):102-117.
• [30]Rabe-Hesketh S, Skrondal A: Multilevel and longitudinal modeling using Stata, second edition. Berkley: Stata Press; 2008.
• [31]Carlin JB, Gurrin LC, Sterne JA, Morley R, Dwyer T: Regression models for twin studies: a critical review. Int J Epidemiol 2005, 34(5):1089-1099.
• [32]Lawlor DA, Mishra GD: Family matters: designing, analysing and understanding family-based studies in life course epidemiology. Oxford: Oxford University Press; 2009.
• [33]Galobardes B, Shaw M, Lawlor DA, Lynch JW, Davey Smith G: Indicators of socioeconomic position (part 1). J Epidemiol Community Health 2006, 60(1):7-12.
• [34]Kravdal O: A broader perspective on education and mortality: are we influenced by other people’s education? Soc Sci Med 2008, 66(3):620-636.
• [35]Lorant V, Deliège D, Eaton W, Robert A, Philippot P, Ansseau M: Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol 2003, 157(2):98-112.
• [36]Bjelland I, Krokstad S, Mykletun A, Dahl AA, Tell GS, Tambs K: Does a higher educational level protect against anxiety and depression? The HUNT study. Soc Sci Med 2008, 66(6):1334-1345.
• [37]Chandola T, Bartley M, Wiggins R, Schofield P: Social inequalities in health by individual and household measures of social position in a cohort of healthy people. J Epidemiol Community Health 2003, 57(1):56-62.
• [38]Chandola T, Clarke P, Wiggins RD, Bartley M: Who you live with and where you live: setting the context for health using multiple membership multilevel models. J Epidemiol Community Health 2005, 59(2):170-175.
• [39]Monden C: Partners in health? exploring resemblance in health between partners in married and cohabiting couples. Sociol Health Illn 2007, 29(3):391-411.
• [40]Ross CE, Wu C: The links between education and health. Am Sociol Rev 1995, 60(5):719-745.
• [41]Torvik F, Rognmo K, Tambs K: Alcohol use and mental distress as predictors of non-response in a general population health survey: the HUNT study. Soc Psychiatry Psychiatr Epidemiol 2012, 47(5):805-16.
• [42]Goldberg M, Chastang JF, Leclerc A, Zins M, Bonenfant S, Bugel I, Kaniewski N, Schmaus A, Niedhammer I, Piciotti M, et al.: Socioeconomic, demographic, occupational, and health factors associated with participation in a long-term epidemiologic survey: a prospective study of the french GAZEL cohort and its target population. Am J Epidemiol 2001, 154(4):373-384.
• [43]Theall KP, Scribner R, Broyles S, Yu Q, Chotalia J, Simonsen N, Schonlau M, Carlin BP: Impact of small group size on neighbourhood influences in multilevel models. J Epidemiol Community Health 2011, 65(8):688-695.