Long-term effects of compulsory schooling on physical, mental and cognitive ageing: a natural experiment.
depression
education
health inequalities
policy
social epidemiology
Journal
Journal of epidemiology and community health
ISSN: 1470-2738
Titre abrégé: J Epidemiol Community Health
Pays: England
ID NLM: 7909766
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
received:
16
10
2018
revised:
12
12
2018
accepted:
14
12
2018
pubmed:
13
1
2019
medline:
22
5
2020
entrez:
13
1
2019
Statut:
ppublish
Résumé
Longer schooling is associated with better physical, mental and cognitive functioning, but there is controversy as to whether these associations are causal. We examine the long-term health impact of a policy that increased compulsory schooling by 2 years in France for cohorts born on or after January 1953, offering a natural experiment. Data came from Constances, a randomly selected cohort of the French population assessed for cognition, depressive symptoms and physical functioning at ages 45 and older (n=18 929). We use a Regression Discontinuity Design to estimate the impact of increased schooling duration on health. Cognition was measured based on five validated neuropsychological tests and combined into an overall score. The Center for Epidemiological Studies Depression scale was used to assess depressive symptoms levels. Physical functioning was included as finger tapping, hand grip strength and walking speed. The reform increased average schooling, particularly among participants from disadvantaged families. Estimates suggest that for men, this reform improved cognitive scores (β=0.15, 95% CI 0.02 to 0.27), but had no impact on physical functioning. Among women, the reform did not increase cognitive scores or physical functioning but led to higher levels of depressive symptoms (β=1.52, 95% CI 0.32 to 2.72). Results were robust to a range of sensitivity analyses. These findings highlight the need to carefully consider the potential limits of policies that increase the length of compulsory schooling as strategies to improve population health.
Sections du résumé
BACKGROUND
Longer schooling is associated with better physical, mental and cognitive functioning, but there is controversy as to whether these associations are causal. We examine the long-term health impact of a policy that increased compulsory schooling by 2 years in France for cohorts born on or after January 1953, offering a natural experiment.
METHODS
Data came from Constances, a randomly selected cohort of the French population assessed for cognition, depressive symptoms and physical functioning at ages 45 and older (n=18 929). We use a Regression Discontinuity Design to estimate the impact of increased schooling duration on health. Cognition was measured based on five validated neuropsychological tests and combined into an overall score. The Center for Epidemiological Studies Depression scale was used to assess depressive symptoms levels. Physical functioning was included as finger tapping, hand grip strength and walking speed.
RESULTS
The reform increased average schooling, particularly among participants from disadvantaged families. Estimates suggest that for men, this reform improved cognitive scores (β=0.15, 95% CI 0.02 to 0.27), but had no impact on physical functioning. Among women, the reform did not increase cognitive scores or physical functioning but led to higher levels of depressive symptoms (β=1.52, 95% CI 0.32 to 2.72). Results were robust to a range of sensitivity analyses.
CONCLUSION
These findings highlight the need to carefully consider the potential limits of policies that increase the length of compulsory schooling as strategies to improve population health.
Identifiants
pubmed: 30635439
pii: jech-2018-211746
doi: 10.1136/jech-2018-211746
pmc: PMC6581102
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
370-376Subventions
Organisme : NIA NIH HHS
ID : R01 AG040248
Pays : United States
Informations de copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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