Educational level as a contextual and proximate determinant of all cause mortality in Danish adults

Study objective: To examine the educational level in the area of living as a determinant of all cause mortality, controlling for individual and other correlated contextual factors. Design: Pooled data from two population based cohort studies were linked to social registers to obtain selected socioeconomic information at parish and individual level. A total of 18 344 men and women were followed up from 1980 until October 1999. Setting: Copenhagen, Denmark Main outcome measure: All cause mortality. Results: During follow up 2614 men and women died. Educational status both at parish (hazard ratio (HR): 0.87 (95% Cl 0.77 to 0.98) and individual level (HR: 0.76 (95% Cl 0.64 to 0.88) were inversely associated with mortality, when comparing the higest educated groups with the least educated. However, at parish level the effect was only present, when information on subject's income, behaviour (smoking, exercise, alcohol use, and body mass index) and contextual factors (local area unemployment, income share, and household composition) were included in the Cox model. Conclusion: In this study the educational level of an area influenced subject's mortality, but first after adjustment for behavioural and other contextual risk factors. Neighbourhood education is one of different characteristics of adverse social conditions in an area increasing mortality.