observations & questions week 4

observations & questions week 4

by Charles Fleischmann -

Confounding factors in Mackenbach et al:

The causes of death with the highest relative risk between the educated and non-educated are those that can be prevented by behavioral changes. This is true for both men and women.

The authors conclude:

It is quite likely that these inequalities in health-related behaviors are indeed a reflection of differences between low and high educated people in “an array of resources, such as money, knowledge, prestige, power, and beneficial social connections”

I’m sure that these differences must contribute to the observed relative risks to an extent. However, it seems far more likely to me that a greater contribution would be from individual differences in biological susceptibility to addiction and cognitive ability, which in turn also effect educational attainment. I basis this on observations of my own friends and family.

 

 

Cohort vs Period effects in Ouellette et al:

The authors conclude that turning-point declines in mortality are due to period effects for most of the causes of death, with the notable exception being cancers that are due to smoking, which they conclude might “be at least partly cohort-driven” (page 97). I wonder if a similar observation would have been made if the authors had also looked at data on deaths due to diseases related to alcoholism.


Re: observations & questions week 4

by Kate Chirikova -
Hi Charles,

To your first point, given that level of education is used in this article as a proxy of socioeconomic differences, I would actually expect it to play a meaningful role in differential health-related behavior, and thus in the observed increased risk of cause-specific mortality among less educated (~ less socioeconically advantaged). There's a large body of research demonstrating the effect of SES, education, place of residence, neighborhood factors etc. -- all contributing to the availability of so-called "flexible resources" -- on various health-related behaviors (e.g. vaccination, cancer screening) and disease outcomes (e.g. cancer deaths). And this effect is not just marginal. So, to me authors' conclusion that you cite looks quite compelling.
 
However, I think that it is fare to be concerned about reverse causation. Authors touch upon that when discussing limitations of their study. They note that since level of education doesn't usually change in the adult life, it is less sensitive to reverse causation than, for example, SES. Also, they note that "quasi-experimental approaches using compulsory schooling reforms have generally supported the claim that at least part of the association between education and mortality is causal (Lleras-Muney, 2005)."