Adult children's socioeconomic positions and their parents' mortality: A comparison of education, occupational class, and income
Introduction
In health inequality research, family members' socioeconomic resources have primarily been defined as the resources in the family of origin or the overall resources within a household. The family as a producer of health refers primarily to how partners influence each other (e.g., Monden et al., 2003) or to early life circumstances and how the resources of the older generation influence the health of the younger generation (e.g., Davey Smith, 2003). However, a few studies have recently examined intergenerational transmissions in the opposite direction, i.e., from children to parents. These studies have shown that adult children's education is associated with their parents' survival in Taiwan (Zimmer et al., 2007), Sweden (Torssander, 2013), and the U.S. (Friedman and Mare, 2014).
The reason that parents of well-educated children live longer than do parents of less well-educated children is not yet established. However, suggested explanations include access to health-related advice, direct and indirect influences on health behaviors, and support in contact with health care professionals (Torssander, 2013). The association between adult children's education and their parents' mortality persisted after adjusting for the parents' own education and other socioeconomic resources in the household (Zimmer et al., 2007, Torssander, 2013, Friedman and Mare, 2014). Furthermore, in a fixed effects model in which the characteristics that were shared between siblings were held constant, this association remained (Torssander, 2013). Nonetheless, the association between children's resources and parents' mortality may reflect unmeasured third variables that affect children's opportunities for higher education and the parents' health. If a causal effect from children's resources to parents' health is present, however, this effect may apply to specific aspects of the socioeconomic position because education, occupation and income reflect different health mechanisms.
Previous studies on the association between the socioeconomic position of the younger generation and the mortality of the older generation have only considered children's educational levels (Zimmer et al., 2007, Torssander, 2013, Friedman and Mare, 2014). The aim of the current study is to include a wider range of socioeconomic resources of the younger generation, i.e., educational level, occupational class, and disposable income. The association with parental survival may vary across the indicators because these indicators capture material and non-material mechanisms to various degrees. Although measures of education, occupation, and income are interrelated and show a similar social gradient in mortality, indicator-specific mechanisms have been suggested (e.g., Geyer et al., 2006). At the individual level, examples of these mechanisms include knowledge (education-specific), working conditions (occupation-specific), and material conditions (income-specific).
A ‘spillover effect’ of education between people has been suggested for partners (Monden et al., 2003) and relatives such as siblings (Kravdal, 2008). One hypothesis is that a spillover effect exerts an impact through lifestyle, the use of health care, and adherence to medical treatment. The active or passive imitation of behavior – which is more likely to be health-enhancing among well-educated individuals – is an additional possibility. It has also been shown that children's education is associated with smoking and physical activity in their parents' generation, regardless of the parents' own education and income levels (Friedman and Mare, 2014).
Children's income is the socioeconomic indicator that most directly reflects the younger generation's economic resources. Therefore, income may be the indicator with the closest link to material explanations and consumption potential. Because low income is also a consequence of ill-health, a relationship between children's income and parents' mortality risk might reflect family health problems. There may also be psychosocial reasons for the association between children's income and parents' health. For example, children's financial problems predict poorer parental well-being, whereas children's success is associated with greater parental well-being (Fingerman et al., 2012).
Social class – with roots in employment relationships – has been suggested to be associated with health and mortality because of differences in working conditions (Schrijvers et al., 1998), for example, physical workload (Lahelma et al., 2009). However, we may need to consider other explanations for the association between one person's occupational class and a second person's health. A stable and privileged labor market position might involve advantages that benefit others, particularly family members. Some occupational positions may provide access to knowledge and contacts that increase the health of kin. Connections with doctors and assistance in navigating the health care system may be examples of this, although such possibilities may be more related to the type of industry than the class position. However, the likelihood of knowing a person who knows how the system operates may be greater in the service class. It is also possible that flexibility in professional occupations, e.g., flexible work schedules (Golden, 2001), allows adult children to be present during their parents' contacts with health and elderly care services.
However, the above suggestions of indicator-specific mechanisms are not clear-cut, and some of the explanations are most likely linked to several socioeconomic dimensions. For example, lifestyles are social practices (Cockerham et al., 1997) that differ not only between individuals with different levels of education but also across income groups and occupational classes. In addition, “flexible resources” (Phelan et al., 2010), which influence the potential to avoid or prevent diseases regardless of the cause, may be connected to many socioeconomic indicators.
Because little is known about the causes of the relationship between children's socioeconomic position and their parents' chances of survival, an examination of cause-specific mortality is useful. Such analyses have been conducted on U.S. data mainly for causes of death that typically demonstrate large social inequalities, such as diabetes and lower respiratory diseases (Friedman and Mare, 2014). Following the comparison of the socioeconomic indicators, the second portion of the current paper analyzes cause-specific mortality. Some of the causes that typically demonstrate large social inequalities in mortality risk, such as lung cancer and circulatory diseases, and the diseases in which the risk of dying is more evenly distributed across socioeconomic groups, such as prostate and breast cancer, are distinguished. These analyses may indicate whether the association with offspring's socioeconomic position largely resembles the association with the parent's own position or whether the socioeconomic resources in the younger generation partly relates to other underlying explanations of differential mortality risks.
Section snippets
Study population
The Multi-generation Register (Statistics Sweden, 2008), which connects parents to children throughout the Swedish population, was used as the basis for including individuals in the study sample. The initial population consisted of all mothers and fathers who were born between 1926 and 1940 and were alive and residing in Sweden in 2001 (N = 978,434). Parents who bore their first child in 1967 or later were excluded (N = 124,077; 12.7%) because their children were too young (<35 years old) to
Independent variables and mortality – unadjusted associations
The unadjusted mortality rates (number of deaths per 1000 person-years) across independent variables are shown in Table 3. Most of these associations are well known from previous research. For example, men and singles had higher death risks than females and married/cohabiting individuals. The parents with one child had higher death rates than those with two or three children.
For the parents' socioeconomic indicators, the gradients were mostly clear, with lower survival for the individuals with
Summary and discussion
Compared with research on the importance of parents' socioeconomic position for children's later-life health, the transmission of resources from children to parents is an understudied topic in health inequality research. The few studies that have been carried out have focused on the significance of children's education for their parents' survival (Zimmer et al., 2007, Torssander, 2013, Friedman and Mare, 2014). The present study compared the associations between children's various socioeconomic
Acknowledgment
For valuable comments and advice, I thank Robert Erikson, Michael Gähler, Sara Kjellsson, Pekka Martikainen, Denny Vågerö, Viveca Östberg and three anonymous Social Science and Medicine reviewers. The study was financially supported by the Swedish Research Council for Health, Working Life and Welfare (Nr. 2010-0101).
References (32)
- et al.
The importance of marital and socioeconomic status in incidence and survival of prostate cancer
Prev. Med.
(1997) - et al.
Epidemiology of breast cancer
lancet Oncol.
(2001) A broader perspective on education and mortality: are we influenced by other people's education?
Soc. Sci. Med.
(2008)- et al.
Marital status and mortality in the elderly: a systematic review and meta-analysis
Soc. Sci. Med.
(2007) - et al.
Partner's and own education: does who you live with matter for self-assessed health, smoking and excessive alcohol consumption?
Soc. Sci. Med.
(2003) - et al.
Effects of spouses' socioeconomic characteristics on mortality among men and women in a Norwegian longitudinal study
Soc. Sci. Med.
(2008) Bringing intergenerational social mobility research into the twenty-first century: why mothers matter
Am. Sociol. Rev.
(2009)- et al.
Conceptualizing contemporary health lifestyles
Sociol. Q.
(1997) Social class of men, women and families
Sociology
(1984)
The Constant Flux: A Study of Class Mobility in Industrial Societies
Social class and cause of death
Eur. J. Public Health
Family matters: impacts of family background on educational attainments
Economica
Only as happy as the least happy child: multiple grown children's problems and successes and middle-aged parents' well-being
J. Gerontol. Ser. B: Psychol. Sci. Soc. Sci.
The schooling of offspring and the survival of parents
Demography
Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice
J. Epidemiol. Community Health
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