Although higher education has been associated with lower mortality rates in many studies, the effect of potential improvements in educational distribution on future mortality levels is unknown. We therefore estimated the impact of projected increases in higher education on mortality in European populations. We used mortality and population data according to educational level from 21 European populations and developed counterfactual scenarios. The first scenario represented the improvement in the future distribution of educational attainment as expected on the basis of an assumption of cohort replacement. We estimated the effect of this counterfactual scenario on mortality with a 10-15-year time horizon among men and women aged 30-79 years using a specially developed tool based on population attributable fractions (PAF). We compared this with a second, upward levelling scenario in which everyone has obtained tertiary education. The reduction of mortality in the cohort replacement scenario ranged from 1.9 to 10.1% for men and from 1.7 to 9.0% for women. The reduction of mortality in the upward levelling scenario ranged from 22.0 to 57.0% for men and from 9.6 to 50.0% for women. The cohort replacement scenario was estimated to achieve only part (4-25% (men) and 10-31% (women)) of the potential mortality decrease seen in the upward levelling scenario. We concluded that the effect of on-going improvements in educational attainment on average mortality in the population differs across Europe, and can be substantial. Further investments in education may have important positive side-effects on population health.

Department Centre for Monitoring and Analyses of Population Health Status and Health Care System National Institute of Public Health National Institute of Hygiene Warsaw Poland

Department for Health Faculty of Humanities and Social Sciences University of Bath Bath United Kingdom

Department of Demography and Geodemography Faculty of Science Charles University Prague Prague Czech Republic

Department of Epidemiology and Biostatistics National Institute for Health Development Tallinn Estonia

Department of Public Health Erasmus Medical Center Rotterdam The Netherlands

Department of Sociology and Political Science Norwegian University of Science and Technology Trondheim Norway

Department of Sociology University of Helsinki Helsinki Finland

Department of Sociology Vrije Universiteit Brussel Brussels Belgium

INSERM UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health 75013 Paris France

Institute of Social and Preventive Medicine University of Zürich Zürich Switzerland

Sorbonne Universités UPMC Univ Paris 06 UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health 75013 Paris France

Stockholm Centre on Health of Societies in Transition Södertörn University Huddinge Sweden

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$a Kulhánová, Ivana $u Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: i.kulhanova@erasmusmc.nl.

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$a Assessing the potential impact of increased participation in higher education on mortality: evidence from 21 European populations / $c I. Kulhánová, R. Hoffmann, K. Judge, CW. Looman, TA. Eikemo, M. Bopp, P. Deboosere, M. Leinsalu, P. Martikainen, J. Rychtaříková, B. Wojtyniak, G. Menvielle, JP. Mackenbach, . ,

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$a Although higher education has been associated with lower mortality rates in many studies, the effect of potential improvements in educational distribution on future mortality levels is unknown. We therefore estimated the impact of projected increases in higher education on mortality in European populations. We used mortality and population data according to educational level from 21 European populations and developed counterfactual scenarios. The first scenario represented the improvement in the future distribution of educational attainment as expected on the basis of an assumption of cohort replacement. We estimated the effect of this counterfactual scenario on mortality with a 10-15-year time horizon among men and women aged 30-79 years using a specially developed tool based on population attributable fractions (PAF). We compared this with a second, upward levelling scenario in which everyone has obtained tertiary education. The reduction of mortality in the cohort replacement scenario ranged from 1.9 to 10.1% for men and from 1.7 to 9.0% for women. The reduction of mortality in the upward levelling scenario ranged from 22.0 to 57.0% for men and from 9.6 to 50.0% for women. The cohort replacement scenario was estimated to achieve only part (4-25% (men) and 10-31% (women)) of the potential mortality decrease seen in the upward levelling scenario. We concluded that the effect of on-going improvements in educational attainment on average mortality in the population differs across Europe, and can be substantial. Further investments in education may have important positive side-effects on population health.

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$a Hoffmann, Rasmus $u Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.

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$a Judge, Ken $u Department for Health, Faculty of Humanities & Social Sciences, University of Bath, Bath, United Kingdom.

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$a Looman, Caspar W N $u Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.

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$a Eikemo, Terje A $u Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway.

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$a Bopp, Matthias $u Institute of Social and Preventive Medicine, University of Zürich, Zürich, Switzerland.

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$a Deboosere, Patrick $u Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium.

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$a Leinsalu, Mall $u Stockholm Centre on Health of Societies in Transition, Södertörn University, Huddinge, Sweden; Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia.

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$a Martikainen, Pekka $u Department of Sociology, University of Helsinki, Helsinki, Finland.

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$a Rychtaříková, Jitka $u Department of Demography and Geodemography, Faculty of Science, Charles University in Prague, Prague, Czech Republic.

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$a Wojtyniak, Bogdan $u Department-Centre for Monitoring and Analyses of Population Health Status and Health Care System, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland.

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$a Menvielle, Gwenn $u INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, 75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, 75013 Paris, France.

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$a Mackenbach, Johan P $u Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.

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