Individual and spousal education, mortality and life expectancy in Switzerland: a national cohort study.
BACKGROUND
Household measures of socioeconomic position may better account for the shared nature of material resources, lifestyle, and social position of cohabiting persons, but household measures of education are rarely used. We aimed to evaluate the association of combined educational attainment of married couples on mortality and life expectancy in Switzerland.


METHODS
The study included 3,496,163 ever-married persons aged ≥30 years. The 2000 census was linked to mortality records through 2008. Mortality by combined educational attainment was assessed by gender-age-specific HRs, with 95% CIs from adjusted models, life expectancy was derived using abridged life tables.


RESULTS
Having a less educated partner was associated with increased mortality. For example, the HR comparing men aged 50-64 years with tertiary education married to women with tertiary education to men with compulsory education married to women with compulsory education was 2.05 (1.92-2.18). The estimated remaining life expectancy in tertiary educated men aged 30 years married to women with tertiary education was 4.6 years longer than in men with compulsory education married to women with compulsory education. The gradient based on individual education was less steep: the HR comparing men aged 50-64 years with tertiary education with men with compulsory education was 1.74 (1.67-1.81).


CONCLUSIONS
Using individual educational attainment of married persons is common in epidemiological research, but may underestimate the combined effect of education on mortality and life expectancy. These findings are relevant to epidemiologic studies examining socio-demographic characteristics or aiming to adjust results for these characteristics.
Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
Adrian
A
Spoerri
Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
Kurt
K
Schmidlin
Institute of Medical Sociology (IMS), Martin-Luther University, Halle, Germany.
Matthias
M
Richter
Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
Matthias
M
Egger
Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland Section of Geriatrics, Boston University School of Medicine, Boston Medical Center, Boston, USA.
Kerri M
KM
Clough-Gorr
D000328:Adult; D000368:Aged; D004522:Educational Status; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D018454:Spouses; D013557:Switzerland / Q000453:epidemiology
Education; Epidemiology; Mortality; Research Methods; Social Factors in