Combined Effect of Marriage and Education on Mortality: A Cross-national Study of Older Japanese and Finnish Men and Women
Combined Effect of Marriage and Education on Mortality: A Cross-national Study of Older Japanese and Finnish Men and Women
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DOI：
10.2188/jea.je20190061
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发表时间：
2020-10-01
影响因子：
4.7
通讯作者：
Vahtera, Jussi
中科院分区：
文献类型：
--
作者：
Saito, Tami;Oksanen, Tuula;Vahtera, Jussi
背景：虽然婚姻和教育有助于维持老年人的健康，但它们与死亡率的联合关系仍不清楚。这项跨国研究考察了婚姻和教育对日本和芬兰老年人死亡率的综合影响。方法：2010-2012 年日本老年学评估研究以及 2008-2009 年和 2012-2013 年芬兰公共部门研究获得了 22,415 名日本和 11,993 名 65-74 岁芬兰成年人的数据。我们利用公共记录对受访者的生存状况进行了长达 5 年的追踪。结果：Cox 比例风险模型显示，两国未婚男性的死亡风险高于已婚男性（风险比 [HR] 1.47；95% 置信区间 [CI]，日本为 1.21-1.79，芬兰 HR 为 1.94；95% CI，1.29-2.91）；在女性中没有观察到这种差异。根据基线年龄、健康相关行为和疾病进行调整后，在日本（HR 1.85；95% CI，1.21-2.83）和芬兰（HR 2.21；95% CI，1.26 - 3.89）中，受过高等教育的未婚男性死亡风险最高。更明显的社会经济健康差异。进一步的研究应该探讨两国受过高等教育的未婚男性死亡率过高的原因，并考虑选择偏差是否导致低估了受教育程度较低的未婚老年人的真实风险。
Background: While marriage and education help maintain older adults' health, their joint association with mortality remains unclear. This cross-national study examined the combined effect of marriage and education on the mortality of older Japanese and Finnish adults.Methods: Data on 22,415 Japanese and 11,993 Finnish adults, aged 65-74 years, were obtained from the Japan Gerontological Evaluation Study of 2010-2012 and the Finnish Public Sector Study of 2008-2009 and 2012-2013. We followed up on respondents' survival status for 5 years using public records. Marital status, educational level, and other variables in both datasets were harmonized.Results: The Cox proportional hazards model showed that unmarried men had a higher mortality risk than married men in both countries (hazard ratio [HR] 1.47; 95% confidence interval [CI], 1.21-1.79 for Japanese and HR 1.94; 95% CI, 1.29-2.91 for Finnish); no such difference was observed in women. The highest mortality risk was observed in unmarried men with tertiary education in both Japan (HR 1.85; 95% CI, 1.21-2.83) and Finland (HR 2.21; 95% CI, 1.26 3.89), when adjusted for baseline age, health-related behaviors, and illnesses.Conclusions: Our findings showed similarity in the combined effect of marriage and education between Japan and Finland, differing from observations in countries with more apparent socioeconomic health disparities. Further studies should examine the reasons for the excessive mortality risk in highly educated, unmarried men in both countries and consider whether selection bias led to underestimation of the true risk in unmarried older adults with lower education.