Does household income mediate the association between education and health in Canada?

Abstract

Objectives: The study aim was to investigate whether household income mediates the association between education and health in a nationally representative sample of Canadian adults. Methods: The data came from the Longitudinal and International Study of Adults linked to income data from the Canada Revenue Agency. Odds ratios and predicted probabilities from binary logistic regression models were used to describe associations between education and (a) self-rated health, (b) longstanding illness or health problem, (c) emotional, psychological or mental health problem and (d) symptoms of psychological distress. The Karlson–Holm–Breen decomposition method was used to investigate the potentially mediating role of household income in these associations. The analyses were conducted separately for women and men. Results: Education was significantly associated with all four health indicators for both women and men. Of the four health indicators, education was most strongly associated with self-rated health for both women and men. Education was more strongly associated with self-rated health and the presence of an emotional, psychological or mental health problem for women than for men. Curiously, men with a postgraduate degree were significantly more likely than men with a bachelor degree to report symptoms of psychological distress. Only modest proportions of the associations between education and health could be attributed to differences in household income. Education and household income manifested independent associations with all four health indicators among women and with three of four health indicators among men. Conclusions: Education and household income are joint and independent predictors of health in Canada. Accordingly, both should be included in research on socioeconomic health inequalities in this context.

Intergenerational reproduction and self‐rated health in Canada

“…After controlling for parental socioeconomic resources, personal education manifested a significant association with self-rated health among women and personal family income was significantly associated with self-rated health among both women and men. The presence of strong associations between indicators of personal socioeconomic status and self-rated health is consistent with previous research from Canada (Dunn, Veenstra & Ross, 2006;Hay, 1988;Humphries & van Doorslaer, 2000;McLeod et al, 2003;Orpana, Lemyre & Kelly, 2007;Prus, 2011;Veenstra & Vanzella-Yang, 2021;Willson, 2009).…”

Are stress‐related pathways of social status differentiation more important determinants of health inequities in countries with higher levels of income inequality?

“…Contrary to expectations, a higher educational attainment was associated with higher psychosocial stress, which was associated with poorer SROH. Similar ‘glitches’ in the education–health gradient have been reported in the United States, the UK and Canada (Singh‐Manoux et al, 2003; Veenstra, 2005; Veenstra & Vanzella‐Yang, 2020; Zajacova et al, 2012). It was also unexpected that psychosocial stress proved to be a more important mediator of associations between perceived income adequacy and SROH than it was for SSS.…”

Income, education, and hospitalization in Canada: results from linked census and administrative data

“…The association of education and income with hospitalization that we saw in the bivariate age-standardized hospitalization rates is still present in the multivariate models. Recent work using linked survey and Canada Revenue data which examined the joint effects of education and income on self-rated health and physical and mental illness concluded that a proportion of the association between education and self-reported health outcomes was attributed to income [77]. Our results suggest education and income have independent associations with hospitalization.…”