Does compulsory schooling affect health? Evidence from ambulatory claims data.
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ABSTRACT:
SUBMITTER: Begerow T
PROVIDER: S-EPMC9304067 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundIn 1999, an education reform was implemented in Poland, which added 1 year to the shortest available educational path-that of basic vocational education. Under the new system, students choosing this path receive one additional year of general education. According to the authors of the reform, this should improve the students' position in the labor market, as a shortage of general skills was identified as the main deficit of basic vocational school leavers prior to the reform.PurposeThe study assesses the impact of the 1999 reform on the hourly wage of individuals who completed formal education after obtaining a basic vocational school certificate.MethodsThe analysis is based on individual data from the Polish Labor Force Survey for the years 2001-2016. As the education reform was implemented simultaneously across the country, a regression discontinuity design is used to assess its impact.Results and conclusionsThe study finds that one additional year of general education has led to a 13% increase in the hourly wages of individuals who completed basic vocational schools. This effect is higher than those reported in studies for other countries where the wage premium is typically found to be under 10%. This may be because the extension of compulsory schooling in Poland affected individuals with relatively low general skills and abilities.
| S-EPMC7900822 | biostudies-literature
Project description:Both the industrialization thesis and institutional theories of education hypothesize that early educational expansion increased internal migration. We take advantage of state variation in early U.S. compulsory schooling laws and use a regression discontinuity approach to test this hypothesis in 1860-1950 Census data. Results indicate that those required to attend school were more likely to leave their state of birth than others. Effects were stronger among men in states with low occupational status scores, suggesting education encouraged migration out of states with fewer occupational opportunities. Potential contemporary implications for the U.S. and developing countries are discussed.
| S-EPMC8871595 | biostudies-literature
Project description:Adult health outcomes and health behaviors are often associated with schooling. However, such associations do not necessarily imply that schooling has causal effects on health with the signs or magnitudes found in the cross-sectional associations. Schooling may be proxying for unobserved factors related to genetics and family background that directly affect both health and schooling. Recently several studies have used within-monozygotic (MZ) twins methods to control for unobserved factors shared by identical twins. Within-MZ estimates for developed countries are generally smaller than suggested by cross-sectional associations, consistent with positive correlations between unobserved factors that determine schooling and those that determine health. This study contributes new estimates of cross-sectional associations and within-MZ causal effects using the Chinese Adults Twins Survey, the first study of its type for developing countries. The cross-sectional estimates suggest that schooling is significantly associated with adult health-related behaviors (smoking, drinking, exercising) but not with own or spouse health outcomes (general health, mental health, overweight, chronic diseases). However, within-MZ-twins estimators change the estimates for approximately half of these health indicators, in one case declining in absolute magnitudes and becoming insignificant and in the other cases increasing in absolute magnitudes. Within-MZ estimates indicate significant pro-health effects for at least one of the indicators for own health (better mental health), own health-related behaviors (less smoking) and spouse health (less overweight).
| S-EPMC4323945 | biostudies-literature
Project description:BackgroundMedical treatment quality has been shown to be better in high volume than in low volume hospitals. However, this relationship has not yet been confirmed in abdominal cancer in Switzerland and is relevant for referral of patients and healthcare planning. Thus, the present study investigates the association between hospital volumes for surgical resections of colon, gastric, rectal, and pancreatic carcinomas and outcomes.MethodsThis retrospective analysis is based on anonymized claims data of patients with mandatory health insurance at Helsana Group, a leading health insurance in Switzerland. Outcome parameters were length of hospital stay, mortality and cost during the inpatient stay as well as at 1-year follow-up. Hospital volume information was derived from the Quality Indicators dataset provided by the Swiss Federal Office of Public Health. The impact of hospital volume on the different treatment outcomes was statistically tested using generalized estimating equations (GEE) models, taking into account the non-independence of observations from the same hospital.ResultsThe studies included 2'859 resections in patients aged 18 years and older who were hospitalized for abdominal cancer surgery between 2014 and 2018. Colon resections were the most common procedures (n = 1'690), followed by rectal resections (n = 709). For rectal, colon and pancreatic resections, an increase in the mean number of interventions per hospital and a reduction of low volume hospitals could be observed. For the relationship between hospital volume and outcomes, we did not observe a clear dose-response relationship, as no significantly better outcomes were observed in the higher-volume category than in the lower-volume category. Even though a positive "routine effect" cannot be excluded, our results suggest that even hospitals with low volumes are able to achieve comparable treatment outcomes to larger hospitals.ConclusionIn summary, this study increases transparency on the relationship between hospital volume and treatment success. It shows that simple measures such as defining a minimum number of procedures only might not lead to the intended effects if other factors such as infrastructure, the operating team or aggregation level of the available data are not taken into account.
| S-EPMC8881861 | biostudies-literature
Project description:Several recent studies using instrumental variables based on changes in compulsory schoolleaving age laws have estimated the causal effect of schooling on health outcomes and health-related behaviors in the U.K. Despite using the same identification strategy and similar datasets, no consensus has been reached. We contribute to the literature by providing results for the U.K. using a different research design and a different dataset. Specifically, we estimate the effect of schooling on health outcomes (obesity and physical health) and health-related behaviors (smoking, alcohol consumption and exercise) for women through within-MZ twins estimates using the TwinsUK database. For physical health, alcohol consumption and exercise, the within-MZ twins estimates are uninformative about whether there is a causal effect. However, we find (1) that the significant association between schooling and smoking status is due to unobserved endowments that are correlated with schooling and smoking (2) there is some indication that more schooling reduces the body mass index for women, even once these unobserved endowments have been controlled for.
| S-EPMC3885175 | biostudies-literature
Project description:Objectives: Evidence on social stimuli associated with mental health is based mostly on self-reported health measures. We aimed to examine prospective associations between social connectedness and clinical diagnosis of depression and of anxiety. Methods: Longitudinal observational data merged with health insurance data comprising medical information on diagnosis of depression and anxiety were used. 1,209 randomly sampled employees of a US employer provided data for the analysis. Robust Poisson regression models were used. Multiple imputation was conducted to handle missing data on covariates. Results: Better social connectedness was associated with lower risks of subsequently diagnosed depression and anxiety, over a one-year follow-up period. Reports of feeling lonely were associated with increased risks of depression and anxiety. Association between community-related social connectedness and subsequent diagnosis of depression, but not of anxiety, was found. The associations were independent of demographics, socioeconomic status, lifestyle, and work characteristics. They were also robust to unmeasured confounding, missing data patterns, and prior health conditions. Conclusion: Social connectedness may be an important factor for reducing risks of depression and anxiety. Loneliness should be perceived as a risk factor for depression and anxiety.
| S-EPMC9218058 | biostudies-literature
Project description:Rich literatures across multiple disciplines document the association between increased educational attainment and improved health. While quasi-experimental studies have exploited variation in educational policies to more rigorously estimate the health effects of education, there remains disagreement about whether education and health are causally linked. The aim of this study was to conduct a systematic review and meta-analysis to characterize this literature, with a focus on quasi-experimental studies of compulsory schooling laws (CSLs). Articles from 1990 to 2015 were obtained through electronic searches and manual searches of reference lists. We searched for English-language studies and included manuscripts if: (1) they involved original data analysis; (2) outcomes were health-related; and (3) the primary predictor utilized variation in CSLs. We identified 89 articles in 25 countries examining over 25 health outcomes, with over 600 individual point estimates. We systematically characterized heterogeneity on key study design features and conducted a meta-analysis of studies with comparable health outcome and exposure variables. Within countries, studies differed in terms of birth cohorts included, the measurement of health outcomes within a given category, and the type of CSL variation examined. Over 90% of manuscripts included multiple analytic techniques, such as econometric and standard regression methods, with as many as 31 "primary" models in a single study. A qualitative synthesis of study findings indicated that educational attainment has an effect on the majority of health outcomes-most beneficial, some negative-while the meta-analysis demonstrated small beneficial effects for mortality, smoking, and obesity. Future work could focus on inconsistent findings identified by this study, or review the health effects of other types of educational policies.
| S-EPMC6209316 | biostudies-literature
Project description:Prior research has identified that school absences harm children's academic achievement. However, this literature is focused on brief periods or single school years and does not consistently account for the dynamic nature of absences across multiple school years. This study examined dynamic trajectories of children's authorised and unauthorised absences throughout their compulsory school career in England. It investigated the consequences of these absence trajectories for children's achievement at the end of compulsory schooling. We analyse linked administrative data on children's absences and achievement from the National Pupil Database and survey data from the Millennium Cohort Study for a representative sample of children born in 2000/2001 in England (N = 7218). We used k-means clustering for longitudinal data to identify joint authorised-unauthorised absence trajectories throughout compulsory schooling and a regression-with-residuals approach to examine the link between absence trajectories and achievement. We identified five distinct absence trajectories: (1) 'Consistently Low Absences', (2) 'Consistently Moderate Authorised Absences', (3) 'Moderately Increasing Unauthorised Absences', (4) 'Strongly Increasing Unauthorised Absences', and (5) 'Strongly Increasing Authorised Absences'. We found substantial differences between trajectory groups in GCSE achievement, even when accounting for significant risk factors of school absences. Compared to 'Consistently Low Absences', 'Strongly Increasing Unauthorised Absences' reduced achievement by -1.23 to -1.48 standard deviations, while 'Strongly Increasing Authorised Absences' reduced achievement by -0.72 to -1.00 SD for our continuous outcomes. 'Moderately Increasing Unauthorised Absences' (-0.61 to -0.70 SD) and 'Consistently Moderate Authorised Absences' (-0.13 to -0.21 SD) also negatively affected achievement compared to 'Consistently Low Absences'. Our research underscores the critical importance of examining entire trajectories of absenteeism and differentiating between types of absences to fully grasp their associations with academic outcomes and design targeted interventions accordingly.
| S-EPMC11318909 | biostudies-literature
Project description:PurposeExcellent character, reflected in adherence to high standards of moral behavior, has been argued to contribute to well-being. The study goes beyond this claim and provides insights into the role of strengths of moral character (SMC) for physical and mental health.MethodsThis study used longitudinal observational data merged with medical insurance claims data collected from 1209 working adults of a large services organization in the US. Self-reported physical and mental health as well as diagnostic information on depression, anxiety, and cardiovascular disease were used as outcomes. The prospective associations between SMC (7 indicators and a composite measure) and physical and mental health outcomes were examined using lagged linear and logistic regression models. A series of sensitivity analyses provided evidence for the robustness of results.ResultsThe results suggest that persons who live their life according to high moral standards have substantially lower odds of depression (by 21-51%). The results were also indicative of positive associations between SMC and self-reports of mental health (β = 0.048-0.118) and physical health (β = 0.048-0.096). Weaker indications were found for a protective role of SMC in mitigating anxiety (OR = 0.797 for the indicator of delayed gratification) and cardiovascular disease (OR = 0.389 for the indicator of use of SMC for helping others).ConclusionsSMC may be considered relevant for population mental health and physical health. Public health policies promoting SMC are likely to receive positive reception from the general public because character is both malleable and aligned with the nearly universal human desire to become a better person.
| S-EPMC9344441 | biostudies-literature
Project description:The association between schooling and old age cognitive outcomes such as memory disorders is well documented but, because of the threat of reverse causation, controversy persists over whether education affects old age cognition. Changes in state compulsory schooling laws (CSL) are treated as natural experiments (instruments) for estimating the effect of education on memory and mental status among the elderly. Changes in CSL predict changes in average years of schooling completed by children who are affected by the new laws. These educational differences are presumably independent of innate individual characteristics such as IQ.CSL-induced changes in education were used to obtain instrumental variable (IV) estimates of education's effect on memory (n = 10,694) and mental status (n = 9751) for white, non-Hispanic US-born Health and Retirement Survey participants born between 1900 and 1947 who did not attend college.After adjustment for sex, birth year, state of birth and state characteristics, IV estimates of education's effect on memory were large and statistically significant. IV estimates for mental status had very wide confidence intervals, so it was not possible to draw meaningful conclusions about the effect of education on this outcome.Increases in mandatory schooling lead to improvements in performance on memory tests many decades after school completion. These analyses condition on individual states, so differences in memory outcomes associated with CSL changes cannot be attributed to differences between states. Although unmeasured state characteristics that changed contemporaneously with CSL might account for these results, unobserved genetic variation is unlikely to do so.
| S-EPMC2796854 | biostudies-literature