Impact of own vs. parental education on premature mortality: A registry cohort study (1990–2019)

Abstract Background Educational attainment is a key social determinant of health, yet little is known about how parental and personal education jointly shape adult mortality across generations. We investigated the independent, combined, and age-specific effects of parental and personal education on premature mortality (ages 30-70). Methods We used individually linked registry data on 2,849,735 Norwegian residents, followed from 1990 to 2019, with 54.7 million person-years and 162,462 deaths. Cox regression models were used to estimate hazard ratios (HRs) for all-cause mortality, adjusting for birth cohort and age. We examined interaction effects across 9 combinations of personal and parental education and conducted age-stratified analyses. Findings Low parental education was associated with increased premature mortality, especially maternal education (HR: 1.52 for women; 1.58 for men). However, this association attenuated substantially after adjusting for personal education (women: HR 0.99; men: 1.09), suggesting that most of the effect was mediated through personal attainment. Interaction analysis showed that individuals with low personal and high parental education had the highest mortality risks (e.g., HR: 3.16 for women; 3.57 for men). Age-stratified models indicated that among individuals with low personal education, the effect of parental education was strongest in early adulthood. Conclusions While personal education was the dominant predictor of adult mortality, parental education, especially maternal, had an enduring small influence, particularly among men. Intergenerational educational mobility shaped adult survival trajectories, with upward mobility offering protection and downward mobility associated with elevated risk. These findings highlight the need for public health strategies that support educational equity across generations. Key messages • Personal education significantly reduces premature mortality, but parental education still matters - especially for men. • Intergenerational educational inequalities shape adult health outcomes and should inform public health strategies.