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The spillover influence of partner’s education on myocardial infarction incidence and survival

Kilpi Fanny; Martikainen, Pekka; Konttinen, Hanna; Silventoinen, Karri; Torssander, Jenny; Kawachi, Ichiro
doi: 10.1097/EDE.0000000000000785
Original Article: PDF Only


Education is believed to have positive spillover effects across network connections. Partner’s education may be an important resource preventing the incidence of disease and helping patients cope with illness. We examined how partner’s education predicted myocardial infarction (MI) incidence and survival net of own education and other socioeconomic resources in Finland.


A sample of adults aged 40-69 at baseline in Finland in 1990 was followed up for MI incidence and mortality during the period 1991-2007 (n=354,100).


Lower own and spousal education both contributed independently to a higher risk of MI incidence and fatality when mutually adjusted. Having a partner with basic education was particularly strongly associated with long-term fatality in women with a hazard ratio of 1.53 (95% confidence interval 1.22, 1.92) compared to women with tertiary level educated partners. There was some evidence that the incidence risk associated with basic spousal education was weaker in those with own basic education. The highest risks of MI incidence and fatality were consistently found in those without a partner, whereas the most favorable outcomes were in households where both partners had a tertiary level of education.


Accounting for spousal education demonstrates how health-enhancing resources accumulate to some households. Marriage between people of similar educational levels may therefore contribute to the widening of educational differences in MI incidence and survival.

Conflicts of Interest and Source of Funding

Conflicts of interest: None declared.

Sources of Funding: This work was supported by the Academy of Finland (grant number 265796); the Emil Aaltonen Foundation; the Doctoral Programme of the Department of Social Research, University of Helsinki; and the Swedish Research Council for Health, Working Life and Welfare (FORTE) (grant number 2014-0445).

Access to data and code: Due to data protection regulations of the national register-holders providing the data, we do not have the permission to make the data available to third parties. Interested researchers have the possibility to obtain the data by contacting the following register-holding public institutions: •Statistics Finland ( Contact by email tutkijapalvelut(at) or by telephone +358 29 551 2758. •The Social Insurance Institution of Finland ( Contact by email toimistopalvelut(at) or by telephone +358 20 634 1364. Computing code available upon request from the corresponding author.

*Correspondence to: Fanny Kilpi, MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, BS8 2BN Bristol, United Kingdom, email:

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