Effects of education and other socioeconomic factors on middle age mortality in rural Bangladesh

Abstract

Study objective: To examine socioeconomic gradients in mortality in adult women and their husbands in Bangladesh, paying particular attention to the independent effects of the educational status of each spouse. Design: Historical cohort study. Setting: Matlab, a rural area 60 km south east of Dhaka, the capital of Bangladesh. Participants: 14 803 married women aged 45 or over and their husbands who were resident in the Matlab Demographic Surveillance area between 30 June 1982 and 31 December 1998. Main results: Mortality was lower in women with formal or Koranic education compared with those with none (adjusted rate ratio for formal education = 0.68, 95% CI 0.53 to 0.86; adjusted rate ratio for Koranic schooling = 0.82, 95% CI 0.66 to 1.00). After adjusting for her own education, the husband's level of education or occupation did not have an independent effect on a woman's survival. Men who had attended formal education had lower mortality than those without any education (adjusted rate ratio = 0.84, 95% CI 0.75 to 0.93), but men whose wives had been educated had an additional survival advantage independent of their own education and occupation (adjusted rate ratio = 0.76, 95% CI 0.67 to 0.87). Mortality in both sexes was also significantly associated with marital status and the percentage of surviving children, and in men was associated with the man's occupation, religion, area of residence. Conclusions: The data suggest that socioeconomic status has a strong influence on mortality in adults in Bangladesh. They also illustrate how important the continued promotion of education, particularly for women, may be for the survival of both women and men in rural Bangladesh. I t has long been recognised that people who are socially disadvantaged have higher mortality. Social or economic gradients in adult mortality have consistently been observed in affluent societies 1 2 and studies in the developing world have also found substantial inequalities.3-9 Increasing attention is now being paid to understanding the nature of such inequalities and the pathways through which they exert their effects. 10One of the critical factors in this pathway is adult education. In affluent societies, a consistent association between the educational status of adults and their mortality has been shown, independent of other social or economic factors.11-14 Effects are seen in both women and men, although they might be slightly weaker in women than in men.15 16 Factors thought to contribute to the lower mortality of educated people are improvements in their employment opportunities and material circumstances, and an increased knowledge about health matters with consequent reductions in risky health behaviours.11 13 [17][18][19][20] Evidence is also accruing that educated men and women in the developing world have lower mortality, but the mechanisms underlying this association are not fully understood. [7][8][9] Understanding social inequalities in developing countries may require looking into the independent effects of individuals within hous...

Correlation and causation between the UN Human Development Index and national and personal wealth and resource exploitation

“…This link between personal wealth and life expectancy is particularly apparent in the HDI at the higher personal wealth values (log 10 [GDP-per-capita] > 4, Figure 3b, indicated by a lower degree of scatter around the trend), backing up these previous claims. However, reflecting the tight bi-directional causality implied by the multi-spatial CCM analysis (Figures 6a and 7a-d), the opposite may also be stated: better levels of education and prolonged periods of good health may lead to more time in higher paid jobs, increasing both national and personal income (Case & Deaton, 2003;Hurt, Ronsmans, & Saha, 2004), thus helping to drive up the HDI. The dominant causality is unclear, agreeing with the findings of Cutler et al (2006).…”

Religiosity/Spirituality and Mortality

“…Tables summarizing the 36 articles that were included are available from the first author [23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59]. Articles were excluded because they overlapped in their study samples with articles that were included [60,61,62,63,64,65,66,67], because they did not include a relevant spirituality/religiosity predictor variable [68,69,70,71,72,73,74,75,76,77,78], or because the outcome was not assessed in terms of mortality [79,80,81]. Table 1 summarizes the detailed characteristics of the 69 studies investigating the effect of religiosity/spirituality on mortality in initially healthy populations that were included in the analysis, and the 22 studies investigating the effect of religiosity/spirituality on mortality in diseased populations.…”

Social determinants of health inequalities

“…Figure 3 shows that in Bangladesh, adult mortality rates vary inversely with level of education. 11 This gradient in mortality is quite remarkable. Within rich countries, with strikingly different material conditions from Bangladesh, there is a social gradient in mortality prompting consideration of the causal links between status and health.…”