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Research Article

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

Anton Carl Jonas Lager and Jenny Torssander
PNAS May 29, 2012 109 (22) 8461-8466; https://doi.org/10.1073/pnas.1105839109
Anton Carl Jonas Lager
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  • For correspondence: anton.lager@chess.su.se
Jenny Torssander
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  1. Edited by Kenneth Wachter, University of California, Berkeley, CA, and approved April 4, 2012 (received for review April 19, 2011)

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    Analytic sample of study.

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    Table 1.

    Mortality rates between ages 15 and 64 (deaths per 100,000 person years) by age, sex, and birth cohort

    Age and cohortMenWomen
    Age15–1920–2930–3940–4950–5960–6415–1920–2930–3940–4950–5960–64
    Birth cohort
     1943N/A106147266561979N/A5184165371631
     1944N/A109139250523N/AN/A4781161358N/A
     194598102142249499N/A385076169343N/A
     194687104141253496N/A434969154332N/A
     194790104138246501N/A404571149321N/A
     194888108139225461N/A394667152314N/A
     194988113133214N/AN/A434468146N/AN/A
     195087110120223N/AN/A384971138N/AN/A
     195180111125221N/AN/A364777144N/AN/A
     195282111124223N/AN/A364064135N/AN/A
     195397105124211N/AN/A424172144N/AN/A
     195491109129213N/AN/A384558131N/AN/A
     195591114132201N/AN/A374660129N/AN/A
     All89108134231507979394671148340631
    • N/A, not applicable.

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    Table 2.

    Effect of the reform on all-cause mortality among men and women before age 40, in age 40 and after, and during the full follow-up, hazard ratios (95% CI)

    Follow-up period (no. of deaths: men/women)Men (n before 40 and all ages = 639,473; n after age 40 = 613,842)Women (n before 40 and all ages = 608,394; n after age 40 = 586,677)All (n before 40 and all ages = 1,247,867; n after age 40 = 1,200,519)
    Before age 40 (18,496/8,526)1.03 (0.97–1.08)1.02 (0.95–1.10)1.03 (0.98–1.07)
    Age 40 and after (39,867/25,462)0.96 (0.92–1.00)0.95 (0.91–1.00)0.96 (0.93–0.99)
    All ages (58,363/33,988)[0.98 (0.95–1.02)]*0.97 (0.94–1.01)0.98 (0.95–1.01)
    • Boldface represents significant P value (P < 0.05). All models include control for birth cohort and municipality fixed-effects. SEs are clustered at the municipal level. The pooled models (both women and men) include control for sex.

    • ↵*Violation of the proportional hazard assumption.

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    Table 3.

    Effect of the reform on cause-specific mortality after age 40, hazard ratios (95% CI)

    Cause of death (no. of deaths: men/women)Men (n = 613,842)Women (n = 586,677)All (n = 1,200,519)
    Cancer (11,553/13,827)0.94 (0.87–1.01)0.94 (0.88–1.01)0.94(0.90–0.99)
     Of lung/trachea/bronchus/larynx (2,221/2,471)0.93 (0.78–1.10)0.83(0.71–0.98)0.88(0.78–0.99)
     Of breast (17/3,480)0.75 (0.04–15.10)1.01 (0.89–1.15)1.01 (0.89–1.15)
     Of lymphatic/hematopoietic tissue (1,211/762)0.89 (0.70–1.12)0.75 (0.55–1.02)0.83 (0.69–1.01)
     All other cancers (8,104/7,114)0.95 (0.86–1.04)0.97 (0.89–1.06)0.96 (0.90–1.02)
    Circulatory diseases (11,474/3,951)1.04 (0.96–1.13)0.95 (0.84–1.07)1.01 (0.95–1.09)
     Ischemic heart diseases (7,016/1,612)1.07 (0.97–1.19)0.80(0.66–0.97)1.02 (0.92–1.12)
     Cerebrovascular diseases (1,767/1,220)1.03 (0.86–1.22)1.04 (0.84–1.28)1.03 (0.90–1.17)
     All other circulatory diseases (2,691/1,119)0.96 (0.84–1.11)1.08 (0.86–1.36)1.00 (0.88–1.13)
    External causes (7,676/2,845)0.90(0.83–0.98)0.97 (0.83–1.12)[0.92(0.85–0.99)]†
     Accidents (3,190/962)0.85(0.75–0.97)0.91 (0.72–1.15)0.87(0.77–0.98)
     Suicide and intentional self harm (3,180/1,288)0.89 (0.78–1.01)0.98 (0.78–1.22)[0.91 (0.82–1.02)]†
     All other external causes (1,306/595)1.06 (0.86–1.30)1.06 (0.79–1.42)1.06 (0.89–1.25)
    All other causes (9,164/4,839)0.95 (0.88–1.03)0.99 (0.88–1.10)0.96 (0.90–1.03)
    • Boldface represents significant P value (P < 0.05). All models include control for birth cohort and municipality fixed-effects. SEs are clustered at the municipal level. The pooled models (both women and men) include control for sex.

    • ↵†Significant interaction sex*reform.

    • View popup
    Table 4.

    Effect of the reform on all-cause mortality for individuals with different levels of highest attained educational level at the end of 1985, hazard ratios (95% CI)

    AllCompulsoryVocationalSenior secondaryTertiary less than 3 yTertiary 3 y or more
    Men0.96 (0.92–1.00)0.95 (0.89–1.01)0.93(0.87–0.99)0.96 (0.86–1.08)1.07 (0.91–1.26)1.06 (0.94–1.20)
     Dead/n40,260/596,76914,856/173,89612,071/162,7025,062/89,6272,275/53,5373,140/83,695
    Women0.96 (0.92–1.00)0.92 (0.84–1.01)0.92(0.85–0.99)1.16 (0.97–1.39)1.01 (0.86–1.19)0.93 (0.78–1.09)
     Dead/n25,647/574,6297,961/133,7359,231/205,2711,631/47,5012,246/74,4682,339/73,356
    All0.96(0.93–0.99)0.94(0.89–0.99)0.92(0.88–0.97)1.01 (0.92–1.12)1.03 (0.92–1.15)1.00 (0.90–1.12)
     Dead/n65,907/1,171,39822,817/307,63121,302/367,9736,693/137,1284,521/128,0055,479/157,051
    • Boldface represents significant P value (P < 0.05). The pooled models (both women and men) include control for sex. Follow-up between January 1986 and December 2007.

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Causal effect of education on mortality
Anton Carl Jonas Lager, Jenny Torssander
Proceedings of the National Academy of Sciences May 2012, 109 (22) 8461-8466; DOI: 10.1073/pnas.1105839109

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Causal effect of education on mortality
Anton Carl Jonas Lager, Jenny Torssander
Proceedings of the National Academy of Sciences May 2012, 109 (22) 8461-8466; DOI: 10.1073/pnas.1105839109
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