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The Spillover Influence of Partner’s Education on Myocardial Infarction Incidence and Survival

Kilpi, Fannya; Martikainen, Pekkaa,b,c; Konttinen, Hannad; Silventoinen, Karria; Torssander, Jennye; Kawachi, Ichirof

doi: 10.1097/EDE.0000000000000785
Chronic diseases

Background: 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.

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

Results: 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 with 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.

Conclusions: 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.

From the aPopulation Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland; bLaboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany; cCentre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Stockholm, Sweden; dSocial Psychology, Department of Social Research, University of Helsinki, Helsinki, Finland; eSwedish Institute for Social Research, Stockholm University, Stockholm, Sweden; and fDepartment of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA.

Submitted April 6, 2016; accepted November 7, 2017.

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).

The authors report no conflicts of interest.

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 e-mail tutkijapalvelut(at) or by telephone +358 29 551 2758. The Social Insurance Institution of Finland ( Contact by e-mail tutkimus(at) or by telephone +358 20 634 11. Computing code available upon request from the corresponding author.

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Correspondence: Fanny Kilpi, MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, BS8 2BN Bristol, United Kingdom. E-mail:

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