title: The modifying influence of country development on the effect of individual educational attainment on self-rated health.
abstract: OBJECTIVE
  We investigated how much the Human Development Index (HDI), a global measure of development, modifies the effect of education on self-reported health.
  
  
  METHODS
  We analyzed cross-sectional World Health Survey data on 217,642 individuals from 49 countries, collected in 2002 to 2005, with random-intercept multilevel linear regression models.
  
  
  RESULTS
  We observed greater positive associations between educational levels and self-reported good health with increasing HDI. The magnitude of this effect modification of the education-health relation tended to increase with educational attainment. For example, before adjustment for effect modification, at comparable HDI, on average, finishing primary school was associated with better general health (b = 1.49; 95% confidence interval [CI] = 1.18, 1.80). With adjustment for effect modification by HDI, the impact became 4.63 (95% CI = 3.63, 5.62) for every 0.1 increase in HDI. Among those who completed high school, these associations were, respectively, 5.59 (95% CI = 5.20, 5.98) and 9.95 (95% CI = 8.89, 11.00).
  
  
  CONCLUSIONS
  The health benefits of educational attainment are greater in countries with greater human development. Health inequalities attributable to education are, therefore, larger in more developed countries.
authors.affiliation: Anne L. F. van der Kooi, Caroline A. Thompson, Maral DerSarkissian, and Onyebuchi A. Arah are with the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles. Anne-Lotte van der Kooi and Onyebuchi A. Arah are also with and Karien Stronks is with the Department of Public Health, Academic Medical Center, University of Amsterdam, Netherlands.
authors.forename: Anne L F
authors.initials: AL
authors.lastname: van der Kooi
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Thompson
authors.forename: Maral
authors.initials: M
authors.lastname: DerSarkissian
authors.forename: Onyebuchi A
authors.initials: OA
authors.lastname: Arah
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D019049:Developed Countries / Q000706:statistics & numerical data*; D003906:Developing Countries / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D006304:Health Status; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D057566:Self Report; D055815:Young Adult
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