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Soc Sci Med. 2017 Jul;184:49-56. doi: 10.1016/j.socscimed.2017.05.019. Epub 2017 May 8.

Educational gains in cause-specific mortality: Accounting for cognitive ability and family-level confounders using propensity score weighting.

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Netherlands Interdisciplinary Demographic Institute (NIDI-KNAW/University of Groningen), PO Box 11650, 2502 AR, The Hague, The Netherlands. Electronic address:
Max Planck Institute for Demographic Research, Rostock, Germany; Department of Social Policy, London School of Economics and Political Science, London, UK; Department of Social Research, University of Helsinki, Helsinki, Finland. Electronic address:
Department of Public Health Sciences, Karolinska Institute, Tomtebodavägen 18A; Widerströmska huset, 171 77 Stockholm, Sweden. Electronic address:
Department of Health Sciences, Lund University, Box 117, 221 00 Lund, Sweden. Electronic address:


A negative educational gradient has been found for many causes of death. This association may be partly explained by confounding factors that affect both educational attainment and mortality. We correct the cause-specific educational gradient for observed individual background and unobserved family factors using an innovative method based on months lost due to a specific cause of death re-weighted by the probability of attaining a higher educational level. We use data on men with brothers from the Swedish Military Conscription Registry (1951-1983), linked to administrative registers. This dataset of some 700,000 men allows us to distinguish between five education levels and many causes of death. The empirical results reveal that raising the educational level from primary to tertiary would result in an additional 20 months of survival between ages 18 and 63. This improvement in mortality is mainly attributable to fewer deaths from external causes. The highly educated gain more than nine months due to the reduction in deaths from external causes, but gain only two months due to the reduction in cancer mortality and four months due to the reduction in cardiovascular mortality. Ignoring confounding would lead to an underestimation of the gains by educational attainment, especially for the less educated. Our results imply that if the education distribution of 50,000 Swedish men from the 1951 cohort were replaced with that of the corresponding 1983 cohort, 22% of the person-years that were lost to death between ages 18 and 63 would have been saved for this cohort.


Causal effect of education; Cause-specific mortality; Fixed effects; Inverse probability weighting; Months lost analysis; Sweden

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