title: Exploring trends in and determinants of educational inequalities in self-rated health.
abstract: OBJECTIVE
  Educational inequalities in self-rated health (SRH) in European welfare countries are documented, but recent trends in these inequalities are less well understood. We examined educational inequalities in SRH in different age groups, and the contribution of selected material, behavioural and psychosocial determinants from 2000 to 2008.
  
  
  METHODS
  Data were derived from cross-sectional surveys conducted in 2000, 2004 and 2008 including 37,478, 34,876 and 32,982 respondents, respectively, aged 25-75 in mid-Sweden. Inequalities were analysed by age-standardized and age-stratified rate ratios of poor SRH and age-standardized prevalence of determinants, and contribution of determinants by age-adjusted logistic regression.
  
  
  RESULTS
  Relative educational inequalities in SRH increased among women from 2000 (rate ratio (RR) 1.70, 95% CI 1.55-1.85) to 2008 (RR 2.07, 95% CI 1.90-2.26), but were unchanged among men (RR 1.91-2.01). The increase among women was mainly due to growing inequalities in the age group 25-34 years. In 2008, significant age differences emerged with larger inequalities in the youngest compared with the oldest age group in both genders. All determinants were more prevalent in low educational groups; the most prominent were lack of a financial buffer, smoking and low optimism. Educational differences were unchanged over the years for most determinants. In all three surveys, examined determinants together explained a substantial part of the educational inequalities in SRH.
  
  
  CONCLUSIONS
  Increased relative educational health inequalities among women, and persisting inequalities among men, were paralleled by unchanged, large differences in material/structural, behavioural and psychosocial factors. Interventions to reduce these inequalities need to focus on early mid-life.
authors.affiliation: Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden fredrik.granstrom@dll.se.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Granström
authors.affiliation: Västmanland County Council, Competence Centre for Health, Västerås, Sweden.
authors.forename: Anu
authors.initials: A
authors.lastname: Molarius
authors.affiliation: Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Unit of Research and Development in Local Health Care, County of Östergötland, Linköping, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Garvin
authors.affiliation: Örebro County Council, Department of Community Medicine and Public Health, Örebro, Sweden.
authors.forename: Sirkka
authors.initials: S
authors.lastname: Elo
authors.affiliation: Uppsala County Council, Department of Development, Uppsala, Sweden Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: Inna
authors.initials: I
authors.lastname: Feldman
authors.affiliation: Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Kristenson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D059026:Diagnostic Self Evaluation; D004522:Educational Status; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D013548:Sweden
keywords: Health status disparities; educational status; social medicine; socioeconomic factors