title: Material, psychosocial, and behavioural factors in the explanation of educational inequalities in mortality in The Netherlands.
abstract: OBJECTIVE
  To assess the direct and indirect contributions of material, behavioural, and psychosocial factors to the explanation of educational inequalities in mortality simultaneously.
  
  
  METHODS
  Prospective observational study (1991-1998).
  
  
  METHODS
  General population from south east Netherlands.
  
  
  METHODS
  3979 men and women aged 15-74 years without severe chronic disease at baseline (1991).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands. f.vanoort@erasmusmc.nl
authors.forename: Floor V A
authors.initials: FV
authors.lastname: van Oort
authors.forename: Frank J
authors.initials: FJ
authors.lastname: van Lenthe
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
mesh_terms: D000328:Adult; D004522:Educational Status; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009426:Netherlands / Q000453:epidemiology; D011203:Poverty / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors