Material, psychosocial, and behavioural factors in the explanation of educational inequalities in mortality in the Netherlands
Open accessAbstract
Study objectives: To assess the direct and indirect contributions of material, behavioural, and psychosocial factors to the explanation of educational inequalities in mortality simultaneously. Design: Prospective observational study (1991–1998). Setting: General population from south east Netherlands. Participants: 3979 men and women aged 15–74 years without severe chronic disease at baseline (1991). Main results: Material factors (type of health insurance, financial problems, and housing tenure), psychosocial factors (life events and external locus of control), and behavioural factors (smoking habits and physical activity) together reduced the relative risk of mortality of the lowest educated group from 2.57 (95%CI 1.43 to 4.64) to 1.01 (95%CI 0.50 to 2.03). Of these three groups of factors, material factors contributed most to the educational inequalities. Part of the contribution of material factors was via psychosocial factors and part via behavioural factors. Psychosocial factors contributed to educational inequalities, partly via behavioural factors. Behavioural and psychosocial factors contributed only marginally to the explanation independent of material factors. Conclusion: Educational inequalities in mortality were explained by material, psychosocial, and behavioural factors. Material factors contributed most to the explanation, partly via psychosocial and behavioural factors. Improving the material situation of lower educated people may substantially reduce educational inequalities in mortality, partly via the psychosocial and behavioural consequences of improved material circumstances.
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Similar findings for all-cause mortality have been reported in Finnish cohorts.
“Similar findings for all-cause mortality have been reported in a Finnish cohorts [129]”
From Personality and Longevity: Knowns, Unknowns, and Implications for Public Health and Personalized Medicine (2011) · cites this paper as [129]
Limited studies on personality, SES, and longevity to date suggest a mild degree of confounding between mortality risk related to Neuroticism and low control, and mortality risk related to low social position (supporting indirect selection).
“Limited studies on personality, SES, and longevity to date suggest a mild degree of confounding between mortality risk related to Neuroticism and low control, and mortality risk related to low social position (supporting indirect selection).”
From Personality and Longevity: Knowns, Unknowns, and Implications for Public Health and Personalized Medicine (2011) · cites this paper as [129]
These traits thus far explain less than 20% of the associations between low-SES and mortality.
“These traits thus far explain less than 20% of the associations between low-SES and mortality [62, 129, 204].”
From Personality and Longevity: Knowns, Unknowns, and Implications for Public Health and Personalized Medicine (2011) · cites this paper as [129]
In these studies, both personality and SES still exert independent mortality risks when confounding is controlled.
“In these studies, both personality and SES still exert independent mortality risks when confounding is controlled.”
From Personality and Longevity: Knowns, Unknowns, and Implications for Public Health and Personalized Medicine (2011) · cites this paper as [129]
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Cites
Regression Models and Life-Tables
Cox, D. R. (1972) · Journal of the Royal Statistical Society Series B: Statistical Methodology · doi:10.1111/j.2517-6161.1972.tb00899.x · Cited by 39,793 · see citing works
Regression Models and Life-Tables
Cox, D. R. (1992) · Springer Series in Statistics · doi:10.1007/978-1-4612-4380-9_37 · Cited by 26,297 · see citing works
Generalized expectancies for internal versus external control of reinforcement.
Rotter, J. B. (1966) · Psychological Monographs: General and Applied · doi:10.1037/h0092976 · Cited by 21,937 · see citing works
Actual causes of death in the United States
McGinnis, J. M. (1993) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1993.03510180077038 · Cited by 5,480 · see citing works
Lantz, P. M., House, J. S., Lepkowski, J. M., Williams, D. R., Mero, R. P., & Chen, J. (1998) · JAMA · doi:10.1001/jama.279.21.1703 · Cited by 1,514 · see citing works
Lynch, J. W. (2000) · BMJ · doi:10.1136/bmj.320.7243.1200 · Cited by 1,511 · see citing works
Socioeconomic inequalities in morbidity and mortality in western Europe
Mackenbach, J. P., Kunst, A. E., Cavelaars, A. E. J. M., Groenhof, F., & Geurts, J. J. (1997) · The Lancet · doi:10.1016/s0140-6736(96)07226-1 · Cited by 1,038 · see citing works
Self-citationThe independent inquiry into inequalities in health
Smith, G. D., Morris, J. N., & Shaw, M. (1998) · BMJ · doi:10.1136/bmj.317.7171.1465 · Cited by 963 · see citing works
Socioeconomic inequalities in morbidity and mortality in western Europe
Vågerö, D. H., & Erikson, R. S. (1997) · The Lancet · doi:10.1016/s0140-6736(97)26033-2 · Cited by 894 · see citing works
Socioeconomic determinants of health: Health inequalities: relative or absolute material standards?
Wilkinson, R. G. (1997) · BMJ · doi:10.1136/bmj.314.7080.591 · Cited by 888 · see citing works
Marmot, M. G., & Wilkinson, R. G. (2001) · BMJ · doi:10.1136/bmj.322.7296.1233 · Cited by 776 · see citing works
Actual causes of death in the United States
McGinnis, J. M. (1993) · JAMA · doi:10.1001/jama.270.18.2207 · Cited by 579 · see citing works
GENERALIZED EXPECTANCIES FOR INTERNAL VERSUS EXTERNAL CONTROL OF REINFORCEMENT
Router, J. B. (1966) · Cited by 578 · see citing works
Lynch, J. W., Kaplan, G. A., Cohen, R. D., Tuomilehto, J., & Salonen, J. T. (1996) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a008863 · Cited by 547 · see citing works
Psychosocial Resources and the SES‐Health Relationship
Taylor, S. E., & Seeman, T. E. (1999) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1999.tb08117.x · Cited by 473 · see citing works
Kunst, A. E., & Mackenbach, J. P. (1994) · American Journal of Public Health · doi:10.2105/ajph.84.6.932 · Cited by 449 · see citing works
Self-citationNeighborhood Social Environment and Risk of Death: Multilevel Evidence from the Alameda County Study
Yen, I. H., & Kaplan, G. A. (1999) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a009733 · Cited by 447 · see citing works
Social inequalities in health disentangling the underlying mechanisms.
Goldman, N. (2001) · PubMed · Cited by 401 · see citing works
Steptoe, A., Wardle, J., Pollard, T. M., Canaan, L., & Davies, G. J. (1996) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(96)00095-5 · Cited by 382 · see citing works
Is Social Capital the Key to Inequalities in Health?
Pearce, N. E., & Smith, G. D. (2003) · American Journal of Public Health · doi:10.2105/ajph.93.1.122 · Cited by 368 · see citing works
Borg, V., & Kristensen, T. S. (2000) · Social Science & Medicine · doi:10.1016/s0277-9536(00)00011-3 · Cited by 348 · see citing works
Explanations for socio-economic differentials in mortality
Smith, G. D., Blane, D., & Bartley, M. (1994) · European Journal of Public Health · doi:10.1093/eurpub/4.2.131 · Cited by 292 · see citing works
Explaining educational differences in mortality: the role of behavioral and material factors.
Schrijvers, C., Stronks, K., van de Mheen, H., & Mackenbach, J. (1999) · American Journal of Public Health · doi:10.2105/ajph.89.4.535 · Cited by 264 · see citing works
Self-citationNeighborhood Socioeconomic Status and All-Cause Mortality
Bosma, H., van de Mheen, H., Borsboom, G., & Mackenbach, J. P. (2001) · American Journal of Epidemiology · doi:10.1093/aje/153.4.363 · Cited by 259 · see citing works
Self-citationSchrijvers, C., van de Mheen, H., Stronks, K., & Mackenbach, J. (1998) · International Journal of Epidemiology · doi:10.1093/ije/27.6.1011 · Cited by 239 · see citing works
Self-citationPsychosocial factors and public health: a suitable case for treatment?
Macleod, J., & Smith, G. D. (2003) · Journal of Epidemiology & Community Health · doi:10.1136/jech.57.8.565 · Cited by 231 · see citing works
A strategy for tackling health inequalities in the Netherlands
Mackenbach, J. P., & Stronks, K. (2002) · BMJ · doi:10.1136/bmj.325.7371.1029 · Cited by 196 · see citing works
Self-citationMackenbach, J. P., van de Mheen, H., & Stronks, K. (1994) · Social Science & Medicine · doi:10.1016/0277-9536(94)90399-9 · Cited by 195 · see citing works
Self-citationSocial class, health behaviour, and mortality among men and women in eastern Finland
Pekkanen, J., Tuomilehto, J., Uutela, A. K., Vartiainen, E. A., & Nissinen, A. M. (1995) · BMJ · doi:10.1136/bmj.311.7005.589 · Cited by 185 · see citing works
Stronks, K., van de Mheen, H., Looman, C. W., & Mackenbach, J. (1996) · Sociology of Health & Illness · doi:10.1111/1467-9566.ep10934524 · Cited by 152 · see citing works
Self-citationDisease aetiology and materialist explanations of socioeconomic mortality differentials
Blane, D. (1997) · European Journal of Public Health · doi:10.1093/eurpub/7.4.385 · Cited by 110 · see citing works
Sacker, A., Bartley, M., Firth, D., & Fitzpatrick, R. M. (2001) · Social Science & Medicine · doi:10.1016/s0277-9536(00)00176-3 · Cited by 99 · see citing works
Socio-economic Differentials in Health
Marmot, M., & Smith, G. (1997) · Journal of Health Psychology · doi:10.1177/135910539700200302 · Cited by 64 · see citing works
Health on equal terms--national goals for public health.
(2001) · PubMed · Cited by 27 · see citing works
van der Meer, J. (1998) · EUR Research Repository (Erasmus University Rotterdam) · Cited by 19 · see citing works
Flagged first, then by citations
Research works printed but not linked: 6
- Stronks K, Mheen van de H, Mackenbach JP. Achtergronden van sociaal- economische gezondheidsverschillen. Een overzicht van literatuur en een onderzoeksmodel. T Soc Gezondheidsz 1993;71:2-10.
- Garretsen HFL. Problem drinking. Determination of prevalence, influencing factors and possibilities for prevention. [In Dutch]. [Thesis]. Lisse: Swets and Zeitlinger BV, 1983.
- Ormel J. Difficulties with living or difficult life. [In Dutch]. [Thesis]. Groningen: Rijksuniversiteit Groningen, 1980.
- Hendriks AAJ, Ormel J, van de Willige G. Long lasting difficulties measured with a self-assessment questionnaire and semi structured interview: a theoretical and empirical comparison. [In Dutch]. Gedrag Gezondh 1990;18:273-83.
- van Tilburg TG. Received and desired support in the light of experiences with loneliness. [In Dutch]. [Thesis]. Amsterdam: Vrije Universiteit Amsterdam, 1988.
- Schreurs P, Tellegen B, Vromans ISY, et al. The development of the Utrecht coping list. [In Dutch]. [Thesis]. Utrecht: Vakgroep Klinische Psychologie, Rijksuniversiteit Utrecht, 1983.
Cited by
Sorted by citations
Havranek, E. P., Mujahid, M. S., Barr, D. A., Blair, I. V., Cohen, M. S., Cruz-Flores, S., Davey-Smith, G., Dennison-Himmelfarb, C. R., Lauer, M. S., Lockwood, D. W., et al. (2015) · Circulation · doi:10.1161/cir.0000000000000228 · Cited by 1,472 · see citing works
Association of socioeconomic position with health behaviors and mortality
Stringhini, S. (2010) · JAMA · doi:10.1001/jama.2010.297 · Cited by 1,065 · see citing works
Good intentions are not enough: how informatics interventions can worsen inequality
Veinot, T. C., Mitchell, H., & Ancker, J. S. (2018) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocy052 · Cited by 704 · see citing works
Chapman, B. P., Roberts, B., & Duberstein, P. (2011) · Journal of Aging Research · doi:10.4061/2011/759170 · Cited by 283 · see citing works
“Each class contains several diseases unified by a common set of etiologies, and in some cases the personality traits have been implicated more in one set of etiologic processes than another.”
BackgroundNandi, A., Glymour, M. M., & Subramanian, S. V. (2014) · Epidemiology · doi:10.1097/ede.0000000000000038 · Cited by 237 · see citing works
Wu, Y.-T., Daskalopoulou, C., Muniz Terrera, G., Sanchez Niubo, A., Rodríguez-Artalejo, F., Ayuso-Mateos, J. L., Bobak, M., Caballero, F. F., de la Fuente, J., de la Torre-Luque, A., et al. (2020) · The Lancet Public Health · doi:10.1016/s2468-2667(20)30077-3 · Cited by 161 · see citing works
Does personality explain social inequalities in mortality? The French GAZEL cohort study
Nabi, H., Kivimaki, M., Marmot, M. G., Ferrie, J., Zins, M., Ducimetiere, P., Consoli, S. M., & Singh-Manoux, A. (2008) · International Journal of Epidemiology · doi:10.1093/ije/dyn021 · Cited by 63 · see citing works
Financial fraud and health: the case of Spain
Zunzunegui, M. V., Belanger, E., Benmarhnia, T., Gobbo, M., Otero, A., Béland, F., Zunzunegui, F., & Ribera-Casado, J. M. (2017) · Gaceta Sanitaria · doi:10.1016/j.gaceta.2016.12.012 · Cited by 25 · see citing works
- Authors
- van Oort, F. V. A., van Lenthe, F. J., & Mackenbach, J. P.
- Affiliations
- Erasmus MC (NL)
- Venue
- Journal of Epidemiology and Community Health
- Publisher
- BMJ
- Published
- 2005-02-11
- Volume
- 59
- Issue
- 3
- Pages
- 214-220
- ISSN
- 0141-7681 (ISSN-L)
- 0143-005X
- 1470-2738
- PMC
- PMC1733027
- OpenAlex
- W2159201362
- Cited by
- 263
- References
- 35
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 1 · 2023: 6 · 2022: 7 · 2021: 14 · 2020: 12 · 2019: 22 · 2018: 11 · 2017: 18 · 2016: 13 · 2015: 21 · 2014: 19 · 2013: 11 · 2012: 13
- FWCI
- 10.15
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Epidemiology & Community Health (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Health › Public Health and Social Inequalities
- Social Sciences › Sociology and Political Science › Intergenerational and Educational Inequality Studies
- Keywords
- socioeconomic inequalities in health, material factors, psychosocial factors, behavioral factors, health insurance, financial problems, housing tenure, life events, locus of control, smoking, physical activity, social class
- MeSH terms
- Adult, Educational Status, Female, Humans, Health Knowledge, Attitudes, Practice, Life Style, Male, Middle Aged, Mortality, Netherlands, Poverty, Prospective Studies, Risk Factors, Socioeconomic Factors, Health Behavior
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