Concentration of educational attainment and age-specific risk patterns of preventable avoidable mortality in Hungary, 2007–2023

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Educational attainment is one of the most consequential social determinants of health, fundamentally shaping mortality risks and the patterns of health inequalities. The international literature has extensively documented a close association between socioeconomic disadvantage and poor health-a relationship that is particularly pronounced in post-socialist countries, including Hungary. Hungarian studies likewise show that social deprivation particularly the education is not merely a background determinant but an independent health-shaping factor, producing clearly detectable differences in avoidable mortality even at the settlement-level. The relationship between mortality risk and educational attainment was modelled using negative binomial regression with a log-link function, applying log-transformed population counts as an offset variable. Associations were examined by age, sex, and settlement type, allowing for age-specific analysis of the impact of education on preventable avoidable mortality (PAM) risk. Our results confirm that PAM is most strongly associated with the concentration of low-educated populations, along which a pronounced social gradient emerges. In areas with the highest concentration of low-educated populations, the mortality risk was nearly 40% higher compared to settlements in the lowest quintile of low-educated concentration while a high concentration of tertiary education was associated with a reduction in mortality risk of similar magnitude. The gradient was consistent across all educational levels and was strongest and most linear among the least educated. Age-specific models revealed that the effect of education peaked in the 35-54 age group and gradually weakened in older populations, consistent with the theories of cumulative disadvantage and the survivor effect. While tertiary education was strongly associated with lower mortality risk and low education was associated with substantially higher mortality risk, the association among vocationally trained groups was weak and heterogeneous. Overall, preventable mortality proved highly sensitive to educational inequalities, underscoring that investment in education-particularly the training of disadvantaged groups-remains one of the most effective strategies for improving population health and reducing social disparities.

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