Citation
van der Kooi, Anne L. F.; Stronks, Karien; Thompson, Caroline A.; DerSarkissian, Maral; & Arah, Onyebuchi A. (2013). The Modifying Influence of Country Development on the Effect of Individual Educational Attainment on Self-Rated Health. American Journal of Public Health, 103(11), e49-54. PMCID: PMC3828725Abstract
OBJECTIVES: We investigated how much the Human Development Index (HDI), a global measure of development, modifies the effect of education on self-reported health.METHODS: We analyzed cross-sectional World Health Survey data on 217,642 individuals from 49 countries, collected in 2002 to 2005, with random-intercept multilevel linear regression models.
RESULTS: We observed greater positive associations between educational levels and self-reported good health with increasing HDI. The magnitude of this effect modification of the education-health relation tended to increase with educational attainment. For example, before adjustment for effect modification, at comparable HDI, on average, finishing primary school was associated with better general health (b = 1.49; 95% confidence interval [CI] = 1.18, 1.80). With adjustment for effect modification by HDI, the impact became 4.63 (95% CI = 3.63, 5.62) for every 0.1 increase in HDI. Among those who completed high school, these associations were, respectively, 5.59 (95% CI = 5.20, 5.98) and 9.95 (95% CI = 8.89, 11.00).
CONCLUSIONS: The health benefits of educational attainment are greater in countries with greater human development. Health inequalities attributable to education are, therefore, larger in more developed countries.
URL
http://dx.doi.org/10.2105/AJPH.2013.301593Reference Type
Journal ArticleYear Published
2013Journal Title
American Journal of Public HealthAuthor(s)
van der Kooi, Anne L. F.Stronks, Karien
Thompson, Caroline A.
DerSarkissian, Maral
Arah, Onyebuchi A.