Assessing the potential impact of increased participation in higher education on mortality: Evidence from 21 European populations Ivana Kulh  anov  a a, * , Rasmus Hoffmann a , Ken Judge b , Caspar W.N. Looman a , Terje A. Eikemo a, c , Matthias Bopp d , Patrick Deboosere e , Mall Leinsalu f, g , Pekka Martikainen h , Jitka Rychta  ríkov  a i , Bogdan Wojtyniak j , Gwenn Menvielle k, l , Johan P. Mackenbach a , for the EURO-GBD-SE Consortium a Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands b Department for Health, Faculty of Humanities & Social Sciences, University of Bath, Bath, United Kingdom c Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway d Institute of Social and Preventive Medicine, University of Zürich, Zürich, Switzerland e Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium f Stockholm Centre on Health of Societies in Transition, S€ odert€ orn University, Huddinge, Sweden g Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia h Department of Sociology, University of Helsinki, Helsinki, Finland i Department of Demography and Geodemography, Faculty of Science, Charles University in Prague, Prague, Czech Republic j Department-Centre for Monitoring and Analyses of Population Health Status and Health Care System, National Institute of Public Health e National Institute of Hygiene, Warsaw, Poland k INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, 75013 Paris, France l Sorbonne Universit es, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, 75013 Paris, France article info Article history: Received 23 February 2014 Received in revised form 8 July 2014 Accepted 10 July 2014 Available online 11 July 2014 Keywords: Europe Mortality Education Population attributable fraction Counterfactual scenarios abstract 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 distri- bution 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 10e15-year time horizon among men and women aged 30e79 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 esti- mated to achieve only part (4e25% (men) and 10e31% (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. © 2014 Elsevier Ltd. All rights reserved. 1. Introduction Lower education has been associated with many health-related outcomes, including self-reported health, physical functioning, disability, morbidity and mortality (Hoffmann, 2011; Huisman et al., 2005; Kilander et al., 2001; Steenland et al., 2002). Although social selection may partly explain this relationship (ill individuals underperform in school and therefore do not achieve a * Corresponding author. Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail address: i.kulhanova@erasmusmc.nl (I. Kulh anov a). Contents lists available at ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed http://dx.doi.org/10.1016/j.socscimed.2014.07.027 0277-9536/© 2014 Elsevier Ltd. All rights reserved. Social Science & Medicine 117 (2014) 142e149