Aim: The mechanisms behind the association between adult offspring’s socioeconomic position and their parents’ mortality are not well understood. This study investigates lifestyle-related diseases as a potential mediating pathway between adult offspring’s education and parental mortality. Methods: This nationwide register-based cohort study consists of 963,742 older adults aged 65 years between 2000 and 2018. Lifestyle-related diseases were measured between 60 and 65 years and those with prior lifestyle-related diseases were excluded. Natural Effect Models were performed to assess potential mediation through lifestyle-related diseases of the association between offspring’s education and parental mortality measured by additive hazard estimates with 95% confidence intervals (CIs). Results: Between 60 and 65 years, 150,501 (15.6%) older adults were diagnosed with lifestyle-related diseases and 149,647 (15.5%) died during follow-up. Compared with having offspring with long education, short education was associated with 631 (95% CI: 555; 707) and 581 (95% CI: 525; 638) additional deaths per 100,000 person-years for women and men, respectively, of which 15.4% (95% CI: 9.0; 21.6) and 16.8% (95% CI: 14.6; 18.9) were mediated by lifestyle-related diseases. The corresponding numbers for medium education were 276 (95% CI: 205; 347) and 299 (95% CI: 255; 343) with 26.2% (95% CI: 12.0; 40.6) and 27.6% (95% CI: 25.1; 31.8) mediated by lifestyle-related diseases. Conclusions: Lifestyle-related diseases accounted for 15–28% of the association between offspring’s education and parental mortality for both men and women.

中文翻译：

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成年后代的教育与父母死亡率：生活方式相关疾病中介作用的全国队列研究

目的：成年后代的社会经济地位与其父母死亡率之间关联背后的机制尚不清楚。这项研究调查了生活方式相关疾病作为成年后代教育与父母死亡率之间潜在的中介途径。方法：这项基于登记的全国性队列研究由 2000 年至 2018 年间 963,742 名 65 岁老年人组成。测量了 60 至 65 岁之间与生活方式相关的疾病，并排除了既往患有生活方式相关疾病的人。采用自然效应模型来评估生活方式相关疾病对后代教育与父母死亡率之间关联的潜在中介作用，而父母死亡率是通过具有 95% 置信区间 (CI) 的加性风险估计来衡量的。结果：60 至 65 岁之间，150,501 名（15.6%）老年人被诊断患有生活方式相关疾病，149,647 名（15.5%）在随访期间死亡。与受过长期教育的后代相比，受教育时间短的女性和男性每 10 万人年分别增加 631 例（95% CI：555；707）和 581 例（95% CI：525；638）死亡，其中15.4% (95% CI: 9.0; 21.6) 和 16.8% (95% CI: 14.6; 18.9) 是由生活方式相关疾病介导的。中等教育程度的对应数字分别为 276（95% CI：205；347）和 299（95% CI：255；343），其中 26.2%（95% CI：12.0；40.6）和 27.6%（95% CI：25.1；343）。 31.8）由生活方式相关疾病介导。结论：对于男性和女性，与生活方式相关的疾病在后代教育程度与父母死亡率之间的关联中占 15-28%。