Parental education and adult health outcomes: a cohort study examining disease-specific effects of education levels using Swedish nationwide registries across two generations


  • Hendrik Koffijberg University Medical Center Utrecht
  • Johanna Adami Clinical Epidemiology Unit, Department of Medicine at the Karolinska University Hospital
  • Erik Buskens Department of Epidemiology, University Medical Centre Groningen
  • Mårten Palme Department of Economics, Stockholm University



Intergenerational, Education, Life Course Study, Pathway hypothesis,


It is well known that children with less educated parents have inferior health status in later life. There are two competing hypotheses explaining the association found: the pathway hypothesis – suggesting that children from low educated households are more likely to obtain less education themselves, which, in turn, is associated with inferior health outcomes – and the life course hypothesis – suggesting that living conditions during childhood, as such affected by parental education level, is important for the formation of adult health status. We obtained data from National Swedish registries comprising health outcomes of individuals born between 1940 and 1949, and the Swedish Multi-generation Register. We assessed the differences in risk of hospital admission for individuals with low and high parental education as well as low and high own education. We found that for higher educated individuals, high parental education is associated with even better health outcomes: having a high versus low educated mother or high versus low educated father was associated with an overall decrease in the risk (hazard rate) of hospital admission by 5% (95% CI 0.91-0.98) and 3% (95% CI 0.95-0.99), respectively. This indicates that children from a relatively disadvantaged background, signaled by lower parental educational attainment, are more likely to continue accumulating risk throughout life. Even if they have higher qualifications they may still have a greater accumulation of risk, compared with other highly qualified children from a less disadvantaged background. We found that this effect is primarily attributed to circulatory diseases, and would appear to support the life course hypothesis. We conclude that parental education and ensuing early childhood or even fetal living conditions have a persistent effect on adult health.