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Unravelling the relationship between parental resources and disability pension in young adulthood
Social Science Research 83 (2019) 102315
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Unravelling the relationship between parental resources and disability pension in young adulthood
T
Salonen Laura∗, Kailaheimo-Lönnqvist Sanna, Pöyliö Heta Sociology, Department of Social Research, University of Turku,Assistentinkatu 7, Publicum, 20014, Turku, Finland
ARTICLE INFO
ABSTRACT
Keywords: Health inequalities Parental resources Disability pension Young adults Discrete-time Event history
A vast literature exists on the relationship between family background and health outcomes. However, there is a shortage of evidence on the relationship between parental resources and offsprings' disability pension, a severe form of general poor health and functionability. This article analyses how parental income and education are associated with offsprings' disability pension in young adulthood (19–27 years) among 1980–1985 birth cohorts using Finnish register data. The results of discrete-time event history analysis demonstrate that parental income and education have contrasting impacts. High parental income is found to decrease, and parental education to increase, the probability of offspring having disability pension, although mainly among offspring with compulsory education. Further, young adults with high parental resources are better off two years after their first disability pension. We conclude that the influence of parental resources operates via offsprings' educational attainment but also has divergent direct impacts on offsprings’ disability pension.
1. Introduction Work disability, especially at a young age, can have long-term consequences on future health, educational attainment and labourmarket positioning (Harkko et al., 2016). The different types of social and environmental exposures during childhood and adolescence influence both health and labour market outcomes later in adulthood (Ben-Shlomo and Kuh, 2002; Erola et al. 2016; Kuh et al., 2003). To prevent work disability particularly among vulnerable young people, it is crucial to understand the ways in which work disability and disability pension in young adulthood may be influenced by social conditions in early life. Previous literature has provided inconsistent findings on this issue, using vague or scattered definitions of the childhood environment. This article contributes to the discussion by providing empirical evidence on how the income and education of one's parents during youth is associated with severe forms of work disability, i.e., disability pension, in young adulthood. The aim of this study is to examine the influences of different parental resources on work disability in young adulthood. Finnish register data provides detailed information on the resources and critical life events of parents and their children. First, we look at how parental income and education predict disability pension between the ages of 19–27. Studying both parental income and education provides us insights into their distinct and combined influence on offsprings' disability pension. Second, we study how the association between parental resources and the probability of disability pension varies according to young adults’ educational attainment. Third, we test whether the labour market status of young adults differs according to the level of parental resources two years after having their first disability pension.
∗
Corresponding author. E-mail addresses: [email protected] (S. Laura), [email protected] (K.-L. Sanna), [email protected] (P. Heta).
https://doi.org/10.1016/j.ssresearch.2019.06.006 Received 16 August 2018; Received in revised form 6 May 2019; Accepted 29 June 2019 Available online 03 July 2019 0049-089X/ © 2019 Elsevier Inc. All rights reserved.
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2. Parental resources and health outcomes Socioeconomic inequalities in health are already established in childhood. The social causation model, also referred to as the pathway model, argues that socioeconomic resources during childhood impact adult socioeconomic resources and health (BenShlomo and Kuh, 2002; Duncan and Brooks-Gunn, 2000; Kuh et al., 2003). The model suggests that children can benefit from their parents' resources, investments and endowments or suffer from the lack thereof. Further, the accumulation of these (dis)advantages influence offsprings’ future outcomes, such as health, throughout their lives (Erola and Kilpi-Jakonen, 2017; Merton, 1988). Previous studies have found diverse relationships between parental resources and health outcomes. A particularly consistent finding is that low parental socioeconomic resources predict poor health (Fahy et al., 2017; Rahkonen et al., 1997; Shuey and Willson, 2017). Additionally, the influence can vary according to the resources of the parents. For example, high parental education can assure better health awareness and health behaviour (Grossman, 2005; Huurre et al., 2003; Kestilä et al., 2006a, 2006b), whereas high parental income can lead to a better use of healthcare and health consumption and can inhibit the stress related to being poor (Case et al., 2002; Marmot, 2004; Reinhold and Jürges, 2012). Further, when studying young adults, measuring parental resources during youth, i.e., those who are 12–18 years of age, best captures parents’ influence, especially in terms of educational attainment. Most children in this age range still live at home and are dependent on and influenced by their parents. Work disability is a measure of extreme poor health, but evidence on the impacts of parental socioeconomic resources on offsprings' work disability pension are scarce. One study discovered that having a father belonging to the class of manual workers increased the probability of receiving a disability pension (Upmark et al., 2001). Another study found that high parental education was associated with a negative probability of receiving a disability pension before adjusting for the offspring's education; however, after the adjustment, high parental education increased the probability (Gravseth et al., 2007). To our knowledge, no studies have been conducted on the impacts of parental income on offsprings' disability pension. A disadvantaged background seems to be a common predictor for both poor health and disability pension. Halonen et al. (2017) found that children with both negative childhood experiences and low parental socioeconomic status have a high probability of receiving disability pension. Moreover, parental disability pension (Boschman et al., 2019; Bratberg et al., 2015; Gravseth et al., 2007), parental mental health problems (Merikukka et al., 2018), parental health-related risk behaviours (Upmark et al., 2001; Upmark and Thundal, 2002) and parents' receipt of income support (Harkko et al., 2016) increase the child's probability of receiving a disability pension during young adulthood. Other negative childhood experiences, such as a history of child welfare involvement or care placement (Brännström et al., 2018; Harkko et al., 2016; Joensuu et al., 2016), have also been found to increase the probability of receiving disability pension during young adulthood. Therefore, we assume that high parental income and education decrease the risk of receiving disability pension (H1). 2.1. Education, parental resources and disability pension Previous studies have demonstrated that the probability of receiving a disability pension at a young age has been found to be higher among those who have low educational attainment or difficulties at school (Halonen et al., 2017; Sumanen et al., 2016; Upmark et al., 2001; Upmark and Thundal, 2002). Vital educational decisions are made during youth in most Western societies, which parents can influence directly through their aspirations and by advising children about educational choices (Breen, 2007). Therefore, the offspring's educational attainment not only reflects the inheritance and accumulation of the (dis)advantaged resources of the family but also entails varying health knowledge, skills and behaviour. Naturally, the educational system significantly affects the educational attainment prospects of youth. In Finland, educational tracking starts at age 15, when students decide whether they want to pursue vocational or general upper secondary education. However, some individuals drop out of the system after either completing basic education, or after participating in it until the age of 17. However, there are multiple support systems in place, and only approximately 10% of young adults do not have at least a secondary level education by the age of 20 (Statistics Finland, 2014). Multiple studies have shown that the offspring's own education mediates the effect of parental resources on their health (Kestilä et al., 2006a, 2006b; Laaksonen et al., 2005; Mäkinen et al., 2006). A similar mechanism has been found in relation to the socioeconomic outcomes of the offspring. Parental resources can have a direct influence on the offspring's outcomes but also an indirect influence that operates through educational attainment (Bernardi and Ballarino, 2014; Pöyliö et al., 2018). In other words, most of the intergenerational transmission of inequality passes through a child's own education. Further, in the Finnish context, the education system is created to alleviate the influence of parental resources on children's educational achievement with free of charge attainment through state-support at all levels. Here, we assume this mechanism to apply also to work disability outcome. There is some evidence to that the effect of parental education is mediated by the young adult's education ((Gravseth et al., 2007). In conclusion, we expect that the link between parental resources and young adults' disability pension vary by young adults’ education levels (H2). 2.2. Parental resources helping through the system In Finland, there are two pension schemes (national and earnings-related pensions) that cover all permanent residents aged 16 to 64. An individual can be entitled to a disability pension if s/he is unable to work or study due to long-term health problems. Disability pension is a monetary compensation for the loss of income – salary or benefit – due to health problems, and can be granted either part or full time and either as fixed-term or permanently. Most under 45-year-olds receive disability pension as fixed-term (e.g., rehabilitation subsidy). Obtaining a disability pension is a long process. After the required 300 days of sickness absence, an individual 2
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must meet with a physician, who will determine if and how much the illness, disease or injury affects the person's ability to work. Finally, The Social Insurance Institution of Finland (SIIF) considers the medical statement and a number of socio-demographic factors when deciding on the admittance and the type of disability pension (SIIF, 2017). While most parents actively seek help for their children's health problems, there seems to be some controversy regarding whether help-seeking, use of healthcare or access to healthcare depends on parents' socioeconomic resources (Zwaanswijk et al., 2003a). In countries with universal healthcare systems, such as Finland, income differences in healthcare use are small because financial constraints do not set a barrier to healthcare access (Sourander et al., 2004; Zwaanswijk et al., 2003a; Zwaanswijk et al., 2003b). However, there is a private healthcare sector in Finland, which is more available to those with high financial resources. Additionally, some research evidence indicates that parental education is linked with offsprings' healthcare use, so that highly educated parents have faster access to specialized care than parents with low education (Halldorsson et al., 2002; Paananen et al., 2013a, 2013b). These findings suggest that parents with higher levels of resources may be able to prevent disability pension by acquiring support and care through other services. As parents have an important role in recognizing problems with offsprings' health and ability to work, they can also support them in using the welfare system. As acquiring disability pension requires an extensive process, receiving them can also reflect having the skills and knowledge necessary to navigate the welfare state system. Acknowledging one's eligibility for assistance and eventually filling out an application for a disability pension requires a multitude of resources. Therefore, the impact of parents' resources can be assumed to extend from healthcare use to social assistance, particularly for young adults. Among young adults in Finland, most disability pensions are fixed-term, and the influence of parental resources and support can be assumed to continue after receiving disability pension. Therefore, we hypothesize that those with high parental resources are better off two years after their first disability pension (H3). 3. Data and methods 3.1. The sample population We use Finnish register data (Finnish Growth Environment Panel), which is a sample of 10% of the Finnish population in 1980 that was extended to cover children, spouses and spouses’ parents of the sample population. In our analytical sample, we analyse the probability of receiving disability pension during young adulthood (age 19–27) among the 1980–1985 birth cohorts. The observation period starts when the young adult turns 19, and they are then followed until the year they receive a disability pension, die or turn 27 years old. Lastly, we follow those young adults who have received a disability pension for two years after their first disability pension to study their labour market status. The labour market status among young adults who received their first disability pension at the age of 26 or 27, was accordingly measured at the age of 28 or 29. We excluded from the sample those who had received disability pension continuously from the age of 16 or 17 (n = 330), since most of these individuals are typically diagnosed with malformations, deformations and chromosomal abnormalities. If both of a young adult's parents died before the young adult turned 19 years old, they were also omitted (n = 82), as their inclusion would prevent us from studying the effect of parental resources. Those who moved abroad during the follow-up and those with missing information for gender, education, parental disability pension, parental death or parental resources (N = 220) were also excluded from the analysis. The missing information was randomly distributed among the population. This resulted in 71,745 young adults being included in the total analytical sample. 3.2. Measurement of outcome variable Our outcome variable is a binary variable indicating whether the first receipt of a disability pension took place between ages 19 and 27. The information on disability pension is measured at the end of each year on an annual basis. In this study, we have not separated between different types of disability pensions. 3.3. Measures of parental resources Parental resources are measured between ages 12 and 18. Parental income is calculated as an average of parents' total gross income (adjusted for the cost-of-living index in 2014). In the main part of the analysis (Table 2 & Fig. 1), parental income is included in the models as a log transformation. In the second part of the analysis, where we focus on young adults’ labour market status after their first disability pension (Fig. 2), centered average parental income is divided into three groups that consist of the lowest 20%, the middle 20–80% and the top 20% of the income distribution and are referred as low, median and high-income groups when represented in figures. Parental education is measured as total years of educational attainment using the dominance theory, i.e., the parent with the most years of completed education is chosen. In the figures, parental education is divided into three categories: those with a maximum of 9 years of education (primary education), those with a maximum of 12 years education (secondary education) and those with more than 12 years of education (tertiary education). 3
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Table 1 Descriptive statistics of the total population and of those who received disability pension during the follow-up in person-years.
Demographic and parental characteristics Men Women Parental DP Parental death Parental resources Parental education a Parental income b Parental income (log) Total N in person-years Total N
Total population (%)
Those with a DP (%)
Chi2
51.0 49.0 11.4 5.3 Mean (sd)
53.1 46.9 21.4 8.0 Mean (sd)
p < 0.001
12.0 (2.9) 30,497.9 (27,479.2) 10.2 (0.5) 638,331 71,113
11.5 (2.9) 25,380.2 (14,498.6) 10.0 (0.5) 13,410 (2.1%) 1490 (2.1%)
p < 0.001 p < 0.001 T-test p < 0.001 p < 0.001
Sd = standard deviation. a Measured in years. b Measured as an average of parents' total gross income. Table 2 Average marginal effects and standard errors on the probability of disability pension.
Gender (ref. Men) Parental DP Parental death
Model 1
Model 2
0.0025 (0.0003) 0.0075∗∗∗ (0.0005) 0.0006 (0.0005)
−0.0009 (0.0003) 0.0109∗∗∗ (0.0006) 0.0033∗∗∗ (0.0006)
∗∗∗
Own education (ref. Primary) Secondary −0.0460∗∗∗ (0.0009) Tertiary −0.0538∗∗∗ (0.0009) Parental income1 Parental education2 N pseudo R2 BIC
638,331 0.116 73,017.9678
Model 3 ∗∗∗
−0.0005∗∗∗ (0.0000) 638,331 0.011 81,709.5136
−0.0010 (0.0003) 0.0085∗∗∗ (0.0005) 0.0024∗∗∗ (0.0006)
∗∗∗
−0.0074∗∗∗ (0.0003) 638,331 0.116 73,017.9678
Model 4
Model 5
Model 6
0.0026 (0.0003) 0.0084∗∗∗ (0.0005) 0.0010 (0.0005)
0.0024 (0.0003) 0.0067∗∗∗ (0.0005) 0.0003 (0.0005)
0.0025∗∗∗ (0.0003) 0.0073∗∗∗ (0.0005) 0.0006 (0.0005)
−0.0494∗∗∗ (0.0010) −0.0577∗∗∗ (0.0010)
−0.0439∗∗∗ (0.0009) −0.0515∗∗∗ (0.0009) −0.0022∗∗∗ (0.0003)
−0.0469∗∗∗ (0.0010) −0.0550∗∗∗ (0.0010) −0.0037∗∗∗ (0.0003) 0.0009∗∗∗ (0.0001) 638,331 0.120 72,712.7175
∗∗∗
0.0006∗∗∗ (0.0001) 638,331 0.118 72,876.8102
∗∗∗
638,331 0.117 72,965.7627
*p < 0.05, **p < 0.01, ***p < 0.001.
3.4. Measures of parental disability pension and death To control for the lack of parental resources and, to a certain degree, a disadvantageous background, we have included information on parental death and disability pension that occur during childhood. The link between parental death and young adults' disability pension has not been previously studied but, according to earlier literature, children with negative childhood experiences have a high probability of receiving disability pension (Halonen et al., 2017). Parental disability pension and death are both included as dummy variables in all the models. Parental disability pension was measured when the child was 7–18 years old, on the last day of the year. The variable takes a value of 1 if one or both parents received disability pension during this age period. Parental death was measured when the child was 0–18 years old, and the dummy variable of parental death indicates whether one of the parents died during the young adult's childhood. 3.5. Individual characteristics in early adulthood The gender (binary) and educational attainment of the respondent are adjusted in all the models. Education is measured as a categorical variable consisting of three categories: completed primary level education, completed secondary level education and enrolled or completed tertiary level education. Educational attainment is included as a time-varying variable in order to avoid measuring educational level after receipt of the disability pension and to get a precise measure of education. The labour market status of the respondent after receiving their first disability pension is derived from the variable “main type of activity”, which describes the nature of the individual's economic activity. We created five categories: employed, unemployed, student, pensioner, and others (those who died, were in civil service or in the army or were outside the labour market). These 4
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Fig. 1. Average marginal effects on the interaction between a child's education and parental log income (on the left) and between child's education and parental education (on the right).
Fig. 2. Young adult's labour market status two years after receiving the first disability pension according to level of parental income and parental education. χ2 Square p < 0.001.1 Low = lowest 20%, Median = 40–80%, High = highest 20% in the income distribution.
categories were measured two years after the first disability pension was granted to ensure a long enough recovery time from the disability. Applying for school or work can take a long time, and it would not be possible to see impacts just one year after receipt of the disability pension (although there were no large differences in the results based on whether the ‘waiting period’ was one or two years). Additionally, due to data limitations (data available from 1980 to 2014), a longer observation period for these cohorts was not feasible. 5
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4. Methods Our analyses consist of three parts. In the first part, we examined the demographic differences between the total population and those who had disability pension with 2-tests and a t-test. In the second part, we examine the probability of ever being granted a disability pension between the ages of 19 and 27 by using a discrete-time event history analysis with average marginal effects (AME). Gender and all parental information, i.e., parental income, education, disability pension and death, are included as time invariant variables, whereas the young adult's education is included as a time-varying variable. To examine how parental resources influence the probability of receiving disability pension, we include parental income and parental education separately in the analysis. Then, to study whether offsprings' own education alters the transmission of parental resources, the time-varying variable of education is included in the models. This enables us to see if and how much of the impact of parental education is explained by introducing the young adult's own education into the model. Lastly, we add an interaction term between parental resources and young adults' education to further analyse how the relationship between young adults' own education and parental resources is associated with the probability of receiving a disability pension. Most previous studies on these issues use odds ratios, and there are no studies on disability pension, to our knowledge, that have used average marginal effects. We argue that the use of average marginal effects is necessary because they are not as sensitive to unobserved heteroscedasticity across groups as are the more widely used odds ratios, and using AMEs enables us to compare the coefficients across nested models; they are also more intuitive to interpret (Mood, 2010). A one-unit change in the expected change in the probability of the outcome corresponds to a one-unit change in the predictor, averaged across all observations in the analytical sample. In the second part of our analysis, we followed those who had been granted disability pension between the ages of 19–27 and examined their labour market status two years after they received their first disability pension. As this sample was relatively small (N = 1490), we use descriptive cross-tabulations to examine whether young adults’ labour market status differ by parental income or parental education. All statistical analyses were performed using Stata version 15. 5. Results 5.1. Descriptive results The descriptive statistics in Table 1 show that a total of 1490 (2.1%) young adults had received a disability pension at least once during the follow-up period. The mean age for the total population was 23 years (sd 2.6), and for those who transferred to disability pension, it was 22.8 years (2.6 sd) (results not shown). The majority of the study population did not receive disability pension; thus, their descriptive statistics did not differ from those of the total population presented in Table 1. There were some differences, particularly in parental characteristics, between the total and disability pension samples. The parents of those young adults who received disability pension had slightly lower educational attainment, 11.5 years on average, and lower income (25,380.2 euros) than the parents in the total population (12 years and 30,497.9 euros, respectively). A larger proportion of those with a disability pension had a history of parental disability pension (21.4%) and parental death (8.0%) than the total population (11.4% and 5.3%, respectively). We performed an 2-test and a t-test to examine the differences between those who received disability pension and those who did not receive disability pension in terms of gender, parental disability pension and parental death. To test differences in parental income and education, we used a two-way t-test. The populations differed statistically significantly in every covariate (p < 0.001). These descriptive results suggest that those who receive disability pension have more disadvantages in their childhood than those who do not receive disability pension, which supports previous findings. 5.2. The association between education, parental resources and disability pension The discrete-time event history models on the probability of receiving disability pension are presented as average marginal effects (AMEs) in Table 2. A negative marginal effects value indicates a decrease in the probability of receiving a disability pension, and a positive value indicates an increase in this probability. The control model in Table 1 (Model 1) shows how the individual and parental characteristics (outside parental resources) predict disability pension. Overall, women had a higher risk of receiving disability pension than men. Parental disability pension also increased the probability of the offspring receiving disability pension, and this effect was consistent across all the models. Parental death did not have a statistically significant impact on disability pension, if education was controlled. Young adults’ own education was the strongest predictor of disability pension; those with a tertiary education had a 5.4% smaller probability of receiving disability pension compared to those with basic education (Model 1). Both parental income and education were negatively associated with the offspring's receipt of disability pension (Models 2–3), suggesting that higher parental resources predict lower probability of receiving disability pension. When introducing offsprings' own education into the models (Models 4 and 5), the effect of parental income decreased to half, whereas the impact of parental education became positive. These results indicate that there are more complex relationships between parental resources, education and disability pension. The full model (Model 6) demonstrates that when including both parental resources in the same model, the negative impact of parental income slightly increased, whereas the impact of parental education remained almost the same. A total of 12% of the variance in the probability to receive disability pension was explained by these six individual and parental variables in the full model. 6
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5.3. Parental resources and labour market status after the disability pension Next, we investigated the association between parental resources and young adults' own education in predicting disability pension more in detail. We conducted discrete-time event history analyses with interaction terms between parental resources and young adults' education (full results in Appendix Table 1). The interaction results between young adults' education and parental income (Fig. 1, left panel) show that low parental income was associated with a higher probability of receiving disability pension. Further, higher parental incomes decreased the probability of receiving disability pension, but only among young adults with a primary education. The results of the interaction between offsprings’ education and parental education (Fig. 1, right panel) show that among young adults with only a primary education, high parental education increased the probability of receiving disability pension. Parental education had no influence on the probability of disability pension among young adults with tertiary education, which supports the previous findings in the health literature (see, e.g., Gravseth et al., 2007; Paananen et al., 2013a, 2013b). The results on the relationships between parental resources, offsprings' own education and disability pension during young adulthood indicate that our hypothesis 1, that high parental resources decrease the risk of disability pension, is partially supported. It seems that high parental income decreases the probability of disability pension, whereas parental education does not. However, our hypothesis 2 is supported: the association between parental resources and young adults' disability pension varies based on young adults' own education. It is, however, possible that parents with more resources are more able to help their children with work disabilities, but the ways of helping are different. To test this, we limited the sample to those who received disability pension during the follow-up period and studied their labour market status two years after their first transition to a disability pension. To examine the role of parental resources, we looked at the young adults’ labour market status by parental income and education (Fig. 2). The cross-tabulation results presented in Fig. 2 show that most young adults were still registered as pensioners two years after receiving their first disability pension, which can be a signal of a more severe disability. However, the young adults' labour market status did vary according to parental resources, which supports our hypothesis 3. Young adults with high parental income or education were more often employed or studying and were less often pensioners or unemployed than young adults with low parental resources. Differences in the number of unemployed young adults and young adults belonging to the “other” group (e.g., army/civil service, outside of the labour market or dead) were less clear, although young adults with low parental education belonged more often to the “other” group than their peers with higher parental education. These results demonstrate that young adults with high parental income or education are better off than those with low parental resources, even among those who had received disability pension previously. These findings indicate that even though parental income and parental education seem to have contradictory influences on predicting young adults’ disability pension, they still have similar impacts on the labour market status of the offspring after they receive a disability pension. 6. Discussion 6.1. Summary of the main results Work disability in youth can have long-lasting effects. Thus, it is surprising that there are only a few previous studies about the link between parental resources and young adult's receipt of disability pension (Gravseth et al., 2007 for parental education and Upmark et al., 2001 for parental social class). In this study, we examined how different parental resources, i.e., income and education, were associated with disability pension between ages 19 and 27 using high quality Finnish register data. Our results showed that parental resources influenced the probability of having a disability pension, although with contrasting impacts when offsprings' own education were adjusted. High parental income was found to decrease the probability, whereas parental education enhanced it slightly. Further, the results demonstrate that the impact of parental resources varied based on the educational levels of the offspring. For example, parental income mattered if the offspring had achieved only a primary education. We also found that young adults with high parental resources were better off after having a disability pension, as they were more often working or studying than unemployed or still receiving a disability pension, compared to those with low parental resources. 6.2. The effect of parental income and education on disability pension Both parental income and parental education were found to impact the probability of receiving disability pension, although the effect sizes were small. Parental income was linked with a lower probability of receiving disability pension, which contributes to the lack of literature on the relationship between parental financial resources and disability pension. There is some evidence to show that higher educated and higher income groups use more often preventive (healthcare) services (Berra et al., 2009; Van Doorslaer, 2006). This would suggest that high-income parents invest more in private sector health services than public ones – thus buying services that enhance rehabilitation would decrease the need for and the probability of receiving (publicly funded) disability pension. The link between parental education and young adults' disability pension is more complex. Parental education was first found to have a preventative impact on disability pension, which can indicate that highly educated parents recognize and act on children's work ability problems differently than parents with lower educational attainment. For example, different parental educational levels can reflect differences in the recognition of work ability problems or in the awareness of treatment options and health literacy, in the same way that some previous studies have come to the conclusion that children with high parental education may have better access to specialized care (Halldorsson et al., 2002; Paananen et al., 2013a, 2013b; Sørensen et al., 2015). The findings of this paper, combined with previous empirical evidence, strongly illustrate that more research should be conducted on the relationships between 7
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parental resources, health awareness, help-seeking behaviour and access to healthcare. The influence of parental education on the probability of receiving disability pension was found to turn from negative to positive after adjustment for young adults’ own education. This was reported earlier in a Dutch study (Gravseth et al., 2007), wherein the authors argued that the effect is explained by status stress created by downward social mobility, with young adults finding it hard to live up to the expectations of their highly educated parents. However, we provide an alternative explanation: We suggest that this effect can be explained by considering the disability pension as a positive outcome – as a sign of obtaining help when needed and a process in which parental education is advantageous. Disability pension are not only an indication of poor health but also a form of rehabilitation that helps one to return to work or education, as is the case for most disability pension receivers under 45 years old. Since young adults with disabilities and low education have a high risk of unemployment and marginalization, participating in rehabilitation can be a desirable outcome. Thus, future research should examine whether disability pension during young adulthood can function as a buffer for the intergenerational inheritance of disadvantages. Unsurprisingly, the young adult's own education was the strongest predictor of disability pension. Further, the interaction results demonstrated that the effect of parental resources varied according to the achieved/enrolled educational level of the offspring, indicating that parental resources have an indirect effect on young adults' receipt of disability pension. This means that a partial effect of parental resources on disability pension is already captured in the young adult's own education. Our results revealed that parental resources had an impact on disability pension only among young adults with primary education. It is possible that young adults who could pursue their studies after compulsory education were suffering from less severe disability. Thus, young adults who had not continued their studies beyond the primary level could be more in need of their parents' resources. 6.3. Labour market status after disability pension Lastly, our results show that young adults with high parental income or education were more often studying or working and were less often pensioners or unemployed after receiving their first disability pension, compared to those young adults with low parental resources. These results indicate that even though the effect of parental income and parental education were seemingly contradictory on the probability of a first disability pension, both have a similar function in promoting young adults' work ability after disability pension. That is, low parental resources lead to more disadvantaged socio-economic positions, whereas high parental resources enhance the young adult's situation after the disability pension. However, about half of those who received disability pension were still on pension two years after their first disability pension, which can signal severe health problems or that the rehabilitation has not been effective. Therefore, more research should be conducted on the mechanisms and processes of labour market attainment and family background after receiving a disability pension. The impacts of parental resources combined with the results on other disadvantageous characteristics indicate that disability pension in young adulthood are an outcome largely linked with cumulative disadvantages in childhood. Parental disability pension had an independent negative effect on young adults' disability pension, which has also been discovered in previous findings (Bratberg et al., 2015; Vinnerljung et al., 2015). It has been argued that parents, through their disability pension, can function as role models to their children (Bratberget al. 2015; Gravsethet al. 2007). Parental death increased the probability of receiving disability pension, but the estimate was not significant after adjusting for young adults' education. It is possible that the negative influence of parental death was captured in young adults’ low education, as parental death is known to affect educational achievement negatively (Amato and Anthony, 2014; Kailaheimo and Erola, 2016). 6.4. Strengths and limitations An important strength of this study is the use of high-quality Finnish register data, which ensures objective information with only a small amount of missing information and no response bias. Another strength of the data is the linkage between parental and offspring information. With the register data, we can use pristine measures for parental resources and childhood experiences, such as annual income, which has often been a limitation in previous studies. A common limitation to virtually all register data is the lack of information on the person's perception of his/her own work (dis)ability and on health-seeking behaviour. This prevents us from distinguishing whether the disability pension was perhaps a desired outcome and successfully met needs or whether it was a measure of an undesired outcome and of disadvantage. Another important factor, genetics, also plays a role in predicting health outcomes, including disability pension (Harkonmäki et al., 2008), but we were not able to specify genetic effects in this study. 7. Conclusions This study contributes to the literature on intergenerational inequalities in health and on the inheritance of (dis)advantages by clarifying the complex association between parental resources and young adults' disability pension. The results demonstrate that high parental income decreased, and high parental education increased, the probability of young adults' disability pension when offsprings' own education was controlled for. Further, the impact of parental resources varied according to the level of education of the offspring. Interestingly, parental resources mattered only among low educated young adults. Further examination of young adults’ labour market status revealed that young adults with high parental income or education were better off than their peers with low parental resources. These findings indicate that while parental resources may function differently, they end up with the same result in regard to helping their young adults with work disabilities. Due to disability pension being a rare event, the effect sizes were relatively small, but the substantial effect may be larger. The 8
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small effects are not surprising because Finland has an extensive social insurance system, and family background in general has a relatively small impact. Policy makers should focus on children from disadvantaged families by offering help and guidance as early as possible. Those with a particularly high probability of receiving disability pension were young adults who did not continue their studies after primary education. There is a need to further study whether the effect of parental resources is replicable in different societies and cultural contexts. Also more studies should be conducted to test the possible mechanisms between parental resources and offspring's disability pension – whether the probability of receiving a disability pension is due to differences in access to healthcare and help-seeking patterns in general, or in recognizing a child's work ability problems. Funding This work is supported by the Strategic Research Council of the Academy of Finland (decision numbers 293103and 314250), by the Academy of Finland Flagship Programme (decision number: 320162) and by the European Union's Seventh Framework Programme for research, technological development and demonstration under grant agreement no. ERC-2013-CoG-617965. Appendix A. Supplementary data Supplementary data to this article can be found online at https://doi.org/10.1016/j.ssresearch.2019.06.006. References Amato, P.R., Anthony, C.J., 2014. Estimating the effects of parental divorce and death with fixed effects models. J. Marriage Fam. 76 (2), 370–383. Ben-Shlomo, Y., Kuh, D., 2002. A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives. Int. J. Epidemol. 31, 285–293. Bernardi, F., Ballarino, G., 2014. Participation, equality of opportunity and returns to tertiary education in contemporary europe. Eur. 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PLoS One 3 (10), e3402. https://doi.org/10.1371/journal.pone. 0003402. Huurre, T., Aro, H., Rahkonen, O., 2003. Well-being and health behaviour by parental socioeconomic status. Soc. Psychiatr. Psychiatr. Epidemiol. 38 (5), 249–255. https://doi.org/10.1007/s00127-003-0630-7. Joensuu, M., Mattila-Holappa, P., Ahola, K., Ervasti, J., Kivimäki, M., Kivekäs, T., Koskinen, A., Vahtera, J., Virtanen, M., 2016. Clustering of adversity in young adults on disability pension due to mental disorders: a latent class Analysis. Soc. Psychiatr. Psychiatr. Epidemiol. 51 (2), 281–287. https://doi.org/10.1007/s00127-0151123-1. Kailaheimo, S., Erola, J., 2016. The effect of early parental death on children's university education. WPSEI 12. http://wpsei.utu.fi/the-effect-of-early-parental-deathon-childrens-university-education/. Kestilä, L., Koskinen, S., Martelin, T., Rahkonen, O., Pensola, T., Aro, H., Aromaa, A., 2006a. Determinants of health in early adulthood: what is the role of parental education, childhood adversities and own education? Eur. J. Public Health 16 (3), 305–314. https://doi.org/10.1093/eurpub/cki164. Kestilä, L., Koskinen, S., Martelin, T., Rahkonen, O., Pensola, T., Pirkola, S., Patja, K., Aromaa, A., 2006b. Influence of parental education, childhood adversities, and current living conditions on daily smoking in early adulthood. Eur. J. Public Health 16 (6), 617–626. Kuh, D., Ben-Shlomo, Y., Lynch, J., Hallqvist, J., Power, C., 2003. Life course epidemiology. J. Epidemiol. Community Health 57 (10), 778–783. https://doi.org/10. 1136/jech.57.10.778. Laaksonen, M., Rahkonen, O., Martikainen, P., Lahelma, E., 2005. Socioeconomic position and self-rated health: the contribution of childhood socioeconomic circumstances, adult socioeconomic status, and material resources. Am. J. Public Health 95 (8), 1403–1409. https://doi.org/10.2105/AJPH.2004.047969. Marmot, M., 2004. Status syndrome. 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Unravelling the relationship between parental resources and disability pension in young adulthood
T
Salonen Laura∗, Kailaheimo-Lönnqvist Sanna, Pöyliö Heta Sociology, Department of Social Research, University of Turku,Assistentinkatu 7, Publicum, 20014, Turku, Finland
ARTICLE INFO
ABSTRACT
Keywords: Health inequalities Parental resources Disability pension Young adults Discrete-time Event history
A vast literature exists on the relationship between family background and health outcomes. However, there is a shortage of evidence on the relationship between parental resources and offsprings' disability pension, a severe form of general poor health and functionability. This article analyses how parental income and education are associated with offsprings' disability pension in young adulthood (19–27 years) among 1980–1985 birth cohorts using Finnish register data. The results of discrete-time event history analysis demonstrate that parental income and education have contrasting impacts. High parental income is found to decrease, and parental education to increase, the probability of offspring having disability pension, although mainly among offspring with compulsory education. Further, young adults with high parental resources are better off two years after their first disability pension. We conclude that the influence of parental resources operates via offsprings' educational attainment but also has divergent direct impacts on offsprings’ disability pension.
1. Introduction Work disability, especially at a young age, can have long-term consequences on future health, educational attainment and labourmarket positioning (Harkko et al., 2016). The different types of social and environmental exposures during childhood and adolescence influence both health and labour market outcomes later in adulthood (Ben-Shlomo and Kuh, 2002; Erola et al. 2016; Kuh et al., 2003). To prevent work disability particularly among vulnerable young people, it is crucial to understand the ways in which work disability and disability pension in young adulthood may be influenced by social conditions in early life. Previous literature has provided inconsistent findings on this issue, using vague or scattered definitions of the childhood environment. This article contributes to the discussion by providing empirical evidence on how the income and education of one's parents during youth is associated with severe forms of work disability, i.e., disability pension, in young adulthood. The aim of this study is to examine the influences of different parental resources on work disability in young adulthood. Finnish register data provides detailed information on the resources and critical life events of parents and their children. First, we look at how parental income and education predict disability pension between the ages of 19–27. Studying both parental income and education provides us insights into their distinct and combined influence on offsprings' disability pension. Second, we study how the association between parental resources and the probability of disability pension varies according to young adults’ educational attainment. Third, we test whether the labour market status of young adults differs according to the level of parental resources two years after having their first disability pension.
∗
Corresponding author. E-mail addresses: [email protected] (S. Laura), [email protected] (K.-L. Sanna), [email protected] (P. Heta).
https://doi.org/10.1016/j.ssresearch.2019.06.006 Received 16 August 2018; Received in revised form 6 May 2019; Accepted 29 June 2019 Available online 03 July 2019 0049-089X/ © 2019 Elsevier Inc. All rights reserved.
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2. Parental resources and health outcomes Socioeconomic inequalities in health are already established in childhood. The social causation model, also referred to as the pathway model, argues that socioeconomic resources during childhood impact adult socioeconomic resources and health (BenShlomo and Kuh, 2002; Duncan and Brooks-Gunn, 2000; Kuh et al., 2003). The model suggests that children can benefit from their parents' resources, investments and endowments or suffer from the lack thereof. Further, the accumulation of these (dis)advantages influence offsprings’ future outcomes, such as health, throughout their lives (Erola and Kilpi-Jakonen, 2017; Merton, 1988). Previous studies have found diverse relationships between parental resources and health outcomes. A particularly consistent finding is that low parental socioeconomic resources predict poor health (Fahy et al., 2017; Rahkonen et al., 1997; Shuey and Willson, 2017). Additionally, the influence can vary according to the resources of the parents. For example, high parental education can assure better health awareness and health behaviour (Grossman, 2005; Huurre et al., 2003; Kestilä et al., 2006a, 2006b), whereas high parental income can lead to a better use of healthcare and health consumption and can inhibit the stress related to being poor (Case et al., 2002; Marmot, 2004; Reinhold and Jürges, 2012). Further, when studying young adults, measuring parental resources during youth, i.e., those who are 12–18 years of age, best captures parents’ influence, especially in terms of educational attainment. Most children in this age range still live at home and are dependent on and influenced by their parents. Work disability is a measure of extreme poor health, but evidence on the impacts of parental socioeconomic resources on offsprings' work disability pension are scarce. One study discovered that having a father belonging to the class of manual workers increased the probability of receiving a disability pension (Upmark et al., 2001). Another study found that high parental education was associated with a negative probability of receiving a disability pension before adjusting for the offspring's education; however, after the adjustment, high parental education increased the probability (Gravseth et al., 2007). To our knowledge, no studies have been conducted on the impacts of parental income on offsprings' disability pension. A disadvantaged background seems to be a common predictor for both poor health and disability pension. Halonen et al. (2017) found that children with both negative childhood experiences and low parental socioeconomic status have a high probability of receiving disability pension. Moreover, parental disability pension (Boschman et al., 2019; Bratberg et al., 2015; Gravseth et al., 2007), parental mental health problems (Merikukka et al., 2018), parental health-related risk behaviours (Upmark et al., 2001; Upmark and Thundal, 2002) and parents' receipt of income support (Harkko et al., 2016) increase the child's probability of receiving a disability pension during young adulthood. Other negative childhood experiences, such as a history of child welfare involvement or care placement (Brännström et al., 2018; Harkko et al., 2016; Joensuu et al., 2016), have also been found to increase the probability of receiving disability pension during young adulthood. Therefore, we assume that high parental income and education decrease the risk of receiving disability pension (H1). 2.1. Education, parental resources and disability pension Previous studies have demonstrated that the probability of receiving a disability pension at a young age has been found to be higher among those who have low educational attainment or difficulties at school (Halonen et al., 2017; Sumanen et al., 2016; Upmark et al., 2001; Upmark and Thundal, 2002). Vital educational decisions are made during youth in most Western societies, which parents can influence directly through their aspirations and by advising children about educational choices (Breen, 2007). Therefore, the offspring's educational attainment not only reflects the inheritance and accumulation of the (dis)advantaged resources of the family but also entails varying health knowledge, skills and behaviour. Naturally, the educational system significantly affects the educational attainment prospects of youth. In Finland, educational tracking starts at age 15, when students decide whether they want to pursue vocational or general upper secondary education. However, some individuals drop out of the system after either completing basic education, or after participating in it until the age of 17. However, there are multiple support systems in place, and only approximately 10% of young adults do not have at least a secondary level education by the age of 20 (Statistics Finland, 2014). Multiple studies have shown that the offspring's own education mediates the effect of parental resources on their health (Kestilä et al., 2006a, 2006b; Laaksonen et al., 2005; Mäkinen et al., 2006). A similar mechanism has been found in relation to the socioeconomic outcomes of the offspring. Parental resources can have a direct influence on the offspring's outcomes but also an indirect influence that operates through educational attainment (Bernardi and Ballarino, 2014; Pöyliö et al., 2018). In other words, most of the intergenerational transmission of inequality passes through a child's own education. Further, in the Finnish context, the education system is created to alleviate the influence of parental resources on children's educational achievement with free of charge attainment through state-support at all levels. Here, we assume this mechanism to apply also to work disability outcome. There is some evidence to that the effect of parental education is mediated by the young adult's education ((Gravseth et al., 2007). In conclusion, we expect that the link between parental resources and young adults' disability pension vary by young adults’ education levels (H2). 2.2. Parental resources helping through the system In Finland, there are two pension schemes (national and earnings-related pensions) that cover all permanent residents aged 16 to 64. An individual can be entitled to a disability pension if s/he is unable to work or study due to long-term health problems. Disability pension is a monetary compensation for the loss of income – salary or benefit – due to health problems, and can be granted either part or full time and either as fixed-term or permanently. Most under 45-year-olds receive disability pension as fixed-term (e.g., rehabilitation subsidy). Obtaining a disability pension is a long process. After the required 300 days of sickness absence, an individual 2
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must meet with a physician, who will determine if and how much the illness, disease or injury affects the person's ability to work. Finally, The Social Insurance Institution of Finland (SIIF) considers the medical statement and a number of socio-demographic factors when deciding on the admittance and the type of disability pension (SIIF, 2017). While most parents actively seek help for their children's health problems, there seems to be some controversy regarding whether help-seeking, use of healthcare or access to healthcare depends on parents' socioeconomic resources (Zwaanswijk et al., 2003a). In countries with universal healthcare systems, such as Finland, income differences in healthcare use are small because financial constraints do not set a barrier to healthcare access (Sourander et al., 2004; Zwaanswijk et al., 2003a; Zwaanswijk et al., 2003b). However, there is a private healthcare sector in Finland, which is more available to those with high financial resources. Additionally, some research evidence indicates that parental education is linked with offsprings' healthcare use, so that highly educated parents have faster access to specialized care than parents with low education (Halldorsson et al., 2002; Paananen et al., 2013a, 2013b). These findings suggest that parents with higher levels of resources may be able to prevent disability pension by acquiring support and care through other services. As parents have an important role in recognizing problems with offsprings' health and ability to work, they can also support them in using the welfare system. As acquiring disability pension requires an extensive process, receiving them can also reflect having the skills and knowledge necessary to navigate the welfare state system. Acknowledging one's eligibility for assistance and eventually filling out an application for a disability pension requires a multitude of resources. Therefore, the impact of parents' resources can be assumed to extend from healthcare use to social assistance, particularly for young adults. Among young adults in Finland, most disability pensions are fixed-term, and the influence of parental resources and support can be assumed to continue after receiving disability pension. Therefore, we hypothesize that those with high parental resources are better off two years after their first disability pension (H3). 3. Data and methods 3.1. The sample population We use Finnish register data (Finnish Growth Environment Panel), which is a sample of 10% of the Finnish population in 1980 that was extended to cover children, spouses and spouses’ parents of the sample population. In our analytical sample, we analyse the probability of receiving disability pension during young adulthood (age 19–27) among the 1980–1985 birth cohorts. The observation period starts when the young adult turns 19, and they are then followed until the year they receive a disability pension, die or turn 27 years old. Lastly, we follow those young adults who have received a disability pension for two years after their first disability pension to study their labour market status. The labour market status among young adults who received their first disability pension at the age of 26 or 27, was accordingly measured at the age of 28 or 29. We excluded from the sample those who had received disability pension continuously from the age of 16 or 17 (n = 330), since most of these individuals are typically diagnosed with malformations, deformations and chromosomal abnormalities. If both of a young adult's parents died before the young adult turned 19 years old, they were also omitted (n = 82), as their inclusion would prevent us from studying the effect of parental resources. Those who moved abroad during the follow-up and those with missing information for gender, education, parental disability pension, parental death or parental resources (N = 220) were also excluded from the analysis. The missing information was randomly distributed among the population. This resulted in 71,745 young adults being included in the total analytical sample. 3.2. Measurement of outcome variable Our outcome variable is a binary variable indicating whether the first receipt of a disability pension took place between ages 19 and 27. The information on disability pension is measured at the end of each year on an annual basis. In this study, we have not separated between different types of disability pensions. 3.3. Measures of parental resources Parental resources are measured between ages 12 and 18. Parental income is calculated as an average of parents' total gross income (adjusted for the cost-of-living index in 2014). In the main part of the analysis (Table 2 & Fig. 1), parental income is included in the models as a log transformation. In the second part of the analysis, where we focus on young adults’ labour market status after their first disability pension (Fig. 2), centered average parental income is divided into three groups that consist of the lowest 20%, the middle 20–80% and the top 20% of the income distribution and are referred as low, median and high-income groups when represented in figures. Parental education is measured as total years of educational attainment using the dominance theory, i.e., the parent with the most years of completed education is chosen. In the figures, parental education is divided into three categories: those with a maximum of 9 years of education (primary education), those with a maximum of 12 years education (secondary education) and those with more than 12 years of education (tertiary education). 3
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Table 1 Descriptive statistics of the total population and of those who received disability pension during the follow-up in person-years.
Demographic and parental characteristics Men Women Parental DP Parental death Parental resources Parental education a Parental income b Parental income (log) Total N in person-years Total N
Total population (%)
Those with a DP (%)
Chi2
51.0 49.0 11.4 5.3 Mean (sd)
53.1 46.9 21.4 8.0 Mean (sd)
p < 0.001
12.0 (2.9) 30,497.9 (27,479.2) 10.2 (0.5) 638,331 71,113
11.5 (2.9) 25,380.2 (14,498.6) 10.0 (0.5) 13,410 (2.1%) 1490 (2.1%)
p < 0.001 p < 0.001 T-test p < 0.001 p < 0.001
Sd = standard deviation. a Measured in years. b Measured as an average of parents' total gross income. Table 2 Average marginal effects and standard errors on the probability of disability pension.
Gender (ref. Men) Parental DP Parental death
Model 1
Model 2
0.0025 (0.0003) 0.0075∗∗∗ (0.0005) 0.0006 (0.0005)
−0.0009 (0.0003) 0.0109∗∗∗ (0.0006) 0.0033∗∗∗ (0.0006)
∗∗∗
Own education (ref. Primary) Secondary −0.0460∗∗∗ (0.0009) Tertiary −0.0538∗∗∗ (0.0009) Parental income1 Parental education2 N pseudo R2 BIC
638,331 0.116 73,017.9678
Model 3 ∗∗∗
−0.0005∗∗∗ (0.0000) 638,331 0.011 81,709.5136
−0.0010 (0.0003) 0.0085∗∗∗ (0.0005) 0.0024∗∗∗ (0.0006)
∗∗∗
−0.0074∗∗∗ (0.0003) 638,331 0.116 73,017.9678
Model 4
Model 5
Model 6
0.0026 (0.0003) 0.0084∗∗∗ (0.0005) 0.0010 (0.0005)
0.0024 (0.0003) 0.0067∗∗∗ (0.0005) 0.0003 (0.0005)
0.0025∗∗∗ (0.0003) 0.0073∗∗∗ (0.0005) 0.0006 (0.0005)
−0.0494∗∗∗ (0.0010) −0.0577∗∗∗ (0.0010)
−0.0439∗∗∗ (0.0009) −0.0515∗∗∗ (0.0009) −0.0022∗∗∗ (0.0003)
−0.0469∗∗∗ (0.0010) −0.0550∗∗∗ (0.0010) −0.0037∗∗∗ (0.0003) 0.0009∗∗∗ (0.0001) 638,331 0.120 72,712.7175
∗∗∗
0.0006∗∗∗ (0.0001) 638,331 0.118 72,876.8102
∗∗∗
638,331 0.117 72,965.7627
*p < 0.05, **p < 0.01, ***p < 0.001.
3.4. Measures of parental disability pension and death To control for the lack of parental resources and, to a certain degree, a disadvantageous background, we have included information on parental death and disability pension that occur during childhood. The link between parental death and young adults' disability pension has not been previously studied but, according to earlier literature, children with negative childhood experiences have a high probability of receiving disability pension (Halonen et al., 2017). Parental disability pension and death are both included as dummy variables in all the models. Parental disability pension was measured when the child was 7–18 years old, on the last day of the year. The variable takes a value of 1 if one or both parents received disability pension during this age period. Parental death was measured when the child was 0–18 years old, and the dummy variable of parental death indicates whether one of the parents died during the young adult's childhood. 3.5. Individual characteristics in early adulthood The gender (binary) and educational attainment of the respondent are adjusted in all the models. Education is measured as a categorical variable consisting of three categories: completed primary level education, completed secondary level education and enrolled or completed tertiary level education. Educational attainment is included as a time-varying variable in order to avoid measuring educational level after receipt of the disability pension and to get a precise measure of education. The labour market status of the respondent after receiving their first disability pension is derived from the variable “main type of activity”, which describes the nature of the individual's economic activity. We created five categories: employed, unemployed, student, pensioner, and others (those who died, were in civil service or in the army or were outside the labour market). These 4
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Fig. 1. Average marginal effects on the interaction between a child's education and parental log income (on the left) and between child's education and parental education (on the right).
Fig. 2. Young adult's labour market status two years after receiving the first disability pension according to level of parental income and parental education. χ2 Square p < 0.001.1 Low = lowest 20%, Median = 40–80%, High = highest 20% in the income distribution.
categories were measured two years after the first disability pension was granted to ensure a long enough recovery time from the disability. Applying for school or work can take a long time, and it would not be possible to see impacts just one year after receipt of the disability pension (although there were no large differences in the results based on whether the ‘waiting period’ was one or two years). Additionally, due to data limitations (data available from 1980 to 2014), a longer observation period for these cohorts was not feasible. 5
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4. Methods Our analyses consist of three parts. In the first part, we examined the demographic differences between the total population and those who had disability pension with 2-tests and a t-test. In the second part, we examine the probability of ever being granted a disability pension between the ages of 19 and 27 by using a discrete-time event history analysis with average marginal effects (AME). Gender and all parental information, i.e., parental income, education, disability pension and death, are included as time invariant variables, whereas the young adult's education is included as a time-varying variable. To examine how parental resources influence the probability of receiving disability pension, we include parental income and parental education separately in the analysis. Then, to study whether offsprings' own education alters the transmission of parental resources, the time-varying variable of education is included in the models. This enables us to see if and how much of the impact of parental education is explained by introducing the young adult's own education into the model. Lastly, we add an interaction term between parental resources and young adults' education to further analyse how the relationship between young adults' own education and parental resources is associated with the probability of receiving a disability pension. Most previous studies on these issues use odds ratios, and there are no studies on disability pension, to our knowledge, that have used average marginal effects. We argue that the use of average marginal effects is necessary because they are not as sensitive to unobserved heteroscedasticity across groups as are the more widely used odds ratios, and using AMEs enables us to compare the coefficients across nested models; they are also more intuitive to interpret (Mood, 2010). A one-unit change in the expected change in the probability of the outcome corresponds to a one-unit change in the predictor, averaged across all observations in the analytical sample. In the second part of our analysis, we followed those who had been granted disability pension between the ages of 19–27 and examined their labour market status two years after they received their first disability pension. As this sample was relatively small (N = 1490), we use descriptive cross-tabulations to examine whether young adults’ labour market status differ by parental income or parental education. All statistical analyses were performed using Stata version 15. 5. Results 5.1. Descriptive results The descriptive statistics in Table 1 show that a total of 1490 (2.1%) young adults had received a disability pension at least once during the follow-up period. The mean age for the total population was 23 years (sd 2.6), and for those who transferred to disability pension, it was 22.8 years (2.6 sd) (results not shown). The majority of the study population did not receive disability pension; thus, their descriptive statistics did not differ from those of the total population presented in Table 1. There were some differences, particularly in parental characteristics, between the total and disability pension samples. The parents of those young adults who received disability pension had slightly lower educational attainment, 11.5 years on average, and lower income (25,380.2 euros) than the parents in the total population (12 years and 30,497.9 euros, respectively). A larger proportion of those with a disability pension had a history of parental disability pension (21.4%) and parental death (8.0%) than the total population (11.4% and 5.3%, respectively). We performed an 2-test and a t-test to examine the differences between those who received disability pension and those who did not receive disability pension in terms of gender, parental disability pension and parental death. To test differences in parental income and education, we used a two-way t-test. The populations differed statistically significantly in every covariate (p < 0.001). These descriptive results suggest that those who receive disability pension have more disadvantages in their childhood than those who do not receive disability pension, which supports previous findings. 5.2. The association between education, parental resources and disability pension The discrete-time event history models on the probability of receiving disability pension are presented as average marginal effects (AMEs) in Table 2. A negative marginal effects value indicates a decrease in the probability of receiving a disability pension, and a positive value indicates an increase in this probability. The control model in Table 1 (Model 1) shows how the individual and parental characteristics (outside parental resources) predict disability pension. Overall, women had a higher risk of receiving disability pension than men. Parental disability pension also increased the probability of the offspring receiving disability pension, and this effect was consistent across all the models. Parental death did not have a statistically significant impact on disability pension, if education was controlled. Young adults’ own education was the strongest predictor of disability pension; those with a tertiary education had a 5.4% smaller probability of receiving disability pension compared to those with basic education (Model 1). Both parental income and education were negatively associated with the offspring's receipt of disability pension (Models 2–3), suggesting that higher parental resources predict lower probability of receiving disability pension. When introducing offsprings' own education into the models (Models 4 and 5), the effect of parental income decreased to half, whereas the impact of parental education became positive. These results indicate that there are more complex relationships between parental resources, education and disability pension. The full model (Model 6) demonstrates that when including both parental resources in the same model, the negative impact of parental income slightly increased, whereas the impact of parental education remained almost the same. A total of 12% of the variance in the probability to receive disability pension was explained by these six individual and parental variables in the full model. 6
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5.3. Parental resources and labour market status after the disability pension Next, we investigated the association between parental resources and young adults' own education in predicting disability pension more in detail. We conducted discrete-time event history analyses with interaction terms between parental resources and young adults' education (full results in Appendix Table 1). The interaction results between young adults' education and parental income (Fig. 1, left panel) show that low parental income was associated with a higher probability of receiving disability pension. Further, higher parental incomes decreased the probability of receiving disability pension, but only among young adults with a primary education. The results of the interaction between offsprings’ education and parental education (Fig. 1, right panel) show that among young adults with only a primary education, high parental education increased the probability of receiving disability pension. Parental education had no influence on the probability of disability pension among young adults with tertiary education, which supports the previous findings in the health literature (see, e.g., Gravseth et al., 2007; Paananen et al., 2013a, 2013b). The results on the relationships between parental resources, offsprings' own education and disability pension during young adulthood indicate that our hypothesis 1, that high parental resources decrease the risk of disability pension, is partially supported. It seems that high parental income decreases the probability of disability pension, whereas parental education does not. However, our hypothesis 2 is supported: the association between parental resources and young adults' disability pension varies based on young adults' own education. It is, however, possible that parents with more resources are more able to help their children with work disabilities, but the ways of helping are different. To test this, we limited the sample to those who received disability pension during the follow-up period and studied their labour market status two years after their first transition to a disability pension. To examine the role of parental resources, we looked at the young adults’ labour market status by parental income and education (Fig. 2). The cross-tabulation results presented in Fig. 2 show that most young adults were still registered as pensioners two years after receiving their first disability pension, which can be a signal of a more severe disability. However, the young adults' labour market status did vary according to parental resources, which supports our hypothesis 3. Young adults with high parental income or education were more often employed or studying and were less often pensioners or unemployed than young adults with low parental resources. Differences in the number of unemployed young adults and young adults belonging to the “other” group (e.g., army/civil service, outside of the labour market or dead) were less clear, although young adults with low parental education belonged more often to the “other” group than their peers with higher parental education. These results demonstrate that young adults with high parental income or education are better off than those with low parental resources, even among those who had received disability pension previously. These findings indicate that even though parental income and parental education seem to have contradictory influences on predicting young adults’ disability pension, they still have similar impacts on the labour market status of the offspring after they receive a disability pension. 6. Discussion 6.1. Summary of the main results Work disability in youth can have long-lasting effects. Thus, it is surprising that there are only a few previous studies about the link between parental resources and young adult's receipt of disability pension (Gravseth et al., 2007 for parental education and Upmark et al., 2001 for parental social class). In this study, we examined how different parental resources, i.e., income and education, were associated with disability pension between ages 19 and 27 using high quality Finnish register data. Our results showed that parental resources influenced the probability of having a disability pension, although with contrasting impacts when offsprings' own education were adjusted. High parental income was found to decrease the probability, whereas parental education enhanced it slightly. Further, the results demonstrate that the impact of parental resources varied based on the educational levels of the offspring. For example, parental income mattered if the offspring had achieved only a primary education. We also found that young adults with high parental resources were better off after having a disability pension, as they were more often working or studying than unemployed or still receiving a disability pension, compared to those with low parental resources. 6.2. The effect of parental income and education on disability pension Both parental income and parental education were found to impact the probability of receiving disability pension, although the effect sizes were small. Parental income was linked with a lower probability of receiving disability pension, which contributes to the lack of literature on the relationship between parental financial resources and disability pension. There is some evidence to show that higher educated and higher income groups use more often preventive (healthcare) services (Berra et al., 2009; Van Doorslaer, 2006). This would suggest that high-income parents invest more in private sector health services than public ones – thus buying services that enhance rehabilitation would decrease the need for and the probability of receiving (publicly funded) disability pension. The link between parental education and young adults' disability pension is more complex. Parental education was first found to have a preventative impact on disability pension, which can indicate that highly educated parents recognize and act on children's work ability problems differently than parents with lower educational attainment. For example, different parental educational levels can reflect differences in the recognition of work ability problems or in the awareness of treatment options and health literacy, in the same way that some previous studies have come to the conclusion that children with high parental education may have better access to specialized care (Halldorsson et al., 2002; Paananen et al., 2013a, 2013b; Sørensen et al., 2015). The findings of this paper, combined with previous empirical evidence, strongly illustrate that more research should be conducted on the relationships between 7
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parental resources, health awareness, help-seeking behaviour and access to healthcare. The influence of parental education on the probability of receiving disability pension was found to turn from negative to positive after adjustment for young adults’ own education. This was reported earlier in a Dutch study (Gravseth et al., 2007), wherein the authors argued that the effect is explained by status stress created by downward social mobility, with young adults finding it hard to live up to the expectations of their highly educated parents. However, we provide an alternative explanation: We suggest that this effect can be explained by considering the disability pension as a positive outcome – as a sign of obtaining help when needed and a process in which parental education is advantageous. Disability pension are not only an indication of poor health but also a form of rehabilitation that helps one to return to work or education, as is the case for most disability pension receivers under 45 years old. Since young adults with disabilities and low education have a high risk of unemployment and marginalization, participating in rehabilitation can be a desirable outcome. Thus, future research should examine whether disability pension during young adulthood can function as a buffer for the intergenerational inheritance of disadvantages. Unsurprisingly, the young adult's own education was the strongest predictor of disability pension. Further, the interaction results demonstrated that the effect of parental resources varied according to the achieved/enrolled educational level of the offspring, indicating that parental resources have an indirect effect on young adults' receipt of disability pension. This means that a partial effect of parental resources on disability pension is already captured in the young adult's own education. Our results revealed that parental resources had an impact on disability pension only among young adults with primary education. It is possible that young adults who could pursue their studies after compulsory education were suffering from less severe disability. Thus, young adults who had not continued their studies beyond the primary level could be more in need of their parents' resources. 6.3. Labour market status after disability pension Lastly, our results show that young adults with high parental income or education were more often studying or working and were less often pensioners or unemployed after receiving their first disability pension, compared to those young adults with low parental resources. These results indicate that even though the effect of parental income and parental education were seemingly contradictory on the probability of a first disability pension, both have a similar function in promoting young adults' work ability after disability pension. That is, low parental resources lead to more disadvantaged socio-economic positions, whereas high parental resources enhance the young adult's situation after the disability pension. However, about half of those who received disability pension were still on pension two years after their first disability pension, which can signal severe health problems or that the rehabilitation has not been effective. Therefore, more research should be conducted on the mechanisms and processes of labour market attainment and family background after receiving a disability pension. The impacts of parental resources combined with the results on other disadvantageous characteristics indicate that disability pension in young adulthood are an outcome largely linked with cumulative disadvantages in childhood. Parental disability pension had an independent negative effect on young adults' disability pension, which has also been discovered in previous findings (Bratberg et al., 2015; Vinnerljung et al., 2015). It has been argued that parents, through their disability pension, can function as role models to their children (Bratberget al. 2015; Gravsethet al. 2007). Parental death increased the probability of receiving disability pension, but the estimate was not significant after adjusting for young adults' education. It is possible that the negative influence of parental death was captured in young adults’ low education, as parental death is known to affect educational achievement negatively (Amato and Anthony, 2014; Kailaheimo and Erola, 2016). 6.4. Strengths and limitations An important strength of this study is the use of high-quality Finnish register data, which ensures objective information with only a small amount of missing information and no response bias. Another strength of the data is the linkage between parental and offspring information. With the register data, we can use pristine measures for parental resources and childhood experiences, such as annual income, which has often been a limitation in previous studies. A common limitation to virtually all register data is the lack of information on the person's perception of his/her own work (dis)ability and on health-seeking behaviour. This prevents us from distinguishing whether the disability pension was perhaps a desired outcome and successfully met needs or whether it was a measure of an undesired outcome and of disadvantage. Another important factor, genetics, also plays a role in predicting health outcomes, including disability pension (Harkonmäki et al., 2008), but we were not able to specify genetic effects in this study. 7. Conclusions This study contributes to the literature on intergenerational inequalities in health and on the inheritance of (dis)advantages by clarifying the complex association between parental resources and young adults' disability pension. The results demonstrate that high parental income decreased, and high parental education increased, the probability of young adults' disability pension when offsprings' own education was controlled for. Further, the impact of parental resources varied according to the level of education of the offspring. Interestingly, parental resources mattered only among low educated young adults. Further examination of young adults’ labour market status revealed that young adults with high parental income or education were better off than their peers with low parental resources. These findings indicate that while parental resources may function differently, they end up with the same result in regard to helping their young adults with work disabilities. Due to disability pension being a rare event, the effect sizes were relatively small, but the substantial effect may be larger. The 8
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small effects are not surprising because Finland has an extensive social insurance system, and family background in general has a relatively small impact. Policy makers should focus on children from disadvantaged families by offering help and guidance as early as possible. Those with a particularly high probability of receiving disability pension were young adults who did not continue their studies after primary education. There is a need to further study whether the effect of parental resources is replicable in different societies and cultural contexts. Also more studies should be conducted to test the possible mechanisms between parental resources and offspring's disability pension – whether the probability of receiving a disability pension is due to differences in access to healthcare and help-seeking patterns in general, or in recognizing a child's work ability problems. Funding This work is supported by the Strategic Research Council of the Academy of Finland (decision numbers 293103and 314250), by the Academy of Finland Flagship Programme (decision number: 320162) and by the European Union's Seventh Framework Programme for research, technological development and demonstration under grant agreement no. ERC-2013-CoG-617965. Appendix A. Supplementary data Supplementary data to this article can be found online at https://doi.org/10.1016/j.ssresearch.2019.06.006. References Amato, P.R., Anthony, C.J., 2014. Estimating the effects of parental divorce and death with fixed effects models. J. Marriage Fam. 76 (2), 370–383. Ben-Shlomo, Y., Kuh, D., 2002. A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives. Int. J. Epidemol. 31, 285–293. Bernardi, F., Ballarino, G., 2014. Participation, equality of opportunity and returns to tertiary education in contemporary europe. Eur. 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