In 1949-1962, Sweden implemented a 1-y increase in compulsory schooling as a quasi-experiment. Each year, children in a number of municipalities were exposed to the reform and others were kept as controls, allowing us to test the hypothesis that education is causally related to mortality. We studied all children born between 1943 and 1955, in 900 Swedish municipalities, with control for birth-cohort and area differences. Primary outcome measures are all-cause and cause-specific mortality until the end of 2007. The analyses include 1,247,867 individuals, of whom 92,351 died. We found lower all-cause mortality risk in the experimental group after age 40 [hazard ratio (HR) = 0.96, 95% confidence interval (CI) 0.93-0.99] but not before (HR = 1.03, 95% CI 0.98-1.07) or during the whole follow-up (HR = 0.98, 95% CI 0.95-1.01). After age 40, the experimental group had lower mortality from overall cancer, lung cancer, and accidents. In addition, exposed women had lower mortality from ischemic heart disease, and exposed men lower mortality from overall external causes. In analyses stratified for final educational level, we found lower mortality in the experimental group within the strata that settled for compulsory schooling only (HR = 0.94, 95% CI 0.89-0.99) and compulsory schooling plus vocational training (HR = 0.92, 95% CI 0.88-0.97). Thus, the experimental group had lower mortality from causes known to be related to education. Lower mortality in the experimental group was also found among the least educated, a group that clearly benefited from the reform in terms of educational length. However, all estimates are small and there was no evident impact of the reform on all-cause mortality in all ages.
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Cites: BMJ. 2002 Jan 5;324(7328):23-511777800
Cites: Epidemiol Rev. 2004;26:7-2115234944
Cites: Am J Public Health. 1993 Jun;83(6):830-78498620
Cites: Addiction. 1998 Feb;93(2):183-2039624721
Cites: Ann Emerg Med. 1999 Jun;33(6):659-6810339681
Cites: J Health Econ. 2004 Jul;23(4):629-3615587689
Cites: Soc Sci Med. 2011 Feb;72(4):608-1621211874
Cites: N Engl J Med. 2008 Jun 5;358(23):2468-8118525043
Cites: Soc Sci Med. 2009 Apr;68(7):1271-819195749
Cites: Scand J Public Health. 2009 May;37(3):227-3119286749
Cites: Tob Control. 2009 Aug;18(4):262-719509003
Cites: BMJ. 2009;339:b528220008007
Cites: Drug Alcohol Depend. 2006 Mar 15;82(1):61-7616150555