Educational attainment in survivors of childhood cancer in Denmark, Finland, and Sweden.

BACKGROUND: Survivors of childhood cancer may face difficulties at school. We investigated whether childhood cancer affects attainment of upper secondary education, in a register-based cohort study from Denmark, Finland, and Sweden, where we limit bias from selection and participation. METHODS: From the national cancer registers, we identified all long-term survivors of childhood cancer diagnosed aged 0-14 years in 1971-2005 (n = 7629), compared them to matched population comparisons (n = 35,411) and siblings (n = 6114), using odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Overall, 6127 survivors (80%) had attained upper secondary education by age 25, compared to 84% among comparison groups. Elevated OR for not attaining this level were mainly confined to survivors of central nervous system (CNS) tumours (ORSurv_PopComp2.05, 95%CI: 1.83-2.29). Other risk groups were survivors who had spent more time in hospital around cancer diagnosis and those who had hospital contacts in early adulthood, particularly psychiatric. Survivors of all cancer types were less likely to have attained upper secondary education without delay. CONCLUSIONS: Although survivors of childhood cancer experienced delays in their education, many had caught up by age 25. Except for survivors of CNS tumours, survivors attained upper secondary education to almost the same extent as their peers.

Childhood trauma and fear of childbirth: findings from a birth cohort study.

The aim of this study is to investigate if experiencing childhood trauma (emotional abuse, emotional neglect, physical abuse, physical neglect, or sexual abuse) or a greater total burden of childhood trauma increase the risk of fear of childbirth (FOC). This study included 2556 women living in Southwest Finland. Women were recruited during routine ultrasound visits at gestational week (gwk) 12. Experiencing childhood trauma was assessed in retrospect with the Trauma and Distress Scale (TADS) questionnaire completed at gwk 14. Information on the diagnosis of FOC (ICD-10 diagnosis O99.80) was obtained from the Finnish Medical Birth Register. Associations between childhood trauma (domains and total TADS score) and FOC were analyzed with logistic regression in unadjusted and adjusted models. Emotional abuse (aOR 1.25, 95% CI 1.10-1.42), emotional neglect (aOR 1.26, 95% CI 1.08-1.46), and a greater total burden of trauma (TADS total score) (aOR 1.06, 95% CI 1.02-1.10) increased the risk for FOC. We found no evidence for physical abuse (aOR 1.15, 95% CI 1.00-1.32), physical neglect (aOR 1.06, 95% CI 0.92-1.22), and sexual abuse (aOR 1.24, 95% CI 0.99-1.56) associating with FOC. Childhood emotional abuse, emotional neglect, and a greater total burden of childhood trauma increase the risk for FOC. However, the childhood traumatic events were inquired in retrospect, which could distort the events.

Double Disadvantage in a Nordic Welfare State: A Demographic Analysis of the Single-Parent Employment Gap in Finland, 1987-2018.

This study demonstrates how an evolving negative educational gradient of single parenthood can interact with changing labour market conditions to shape labour market inequalities between partnered and single parents. We analysed trends in employment rates among Finnish partnered and single mothers and fathers from 1987 to 2018. In the late 1980s' Finland, single mothers' employment was internationally high and on par with that of partnered mothers, and single fathers' employment rate was just below that of partnered fathers. The gaps between single and partnered parents emerged and increased during the 1990s recession, and after the 2008 economic crisis, it widened further. In 2018, the employment rates of single parents were 11-12 percentage points lower than those of partnered parents. We ask how much of this single-parent employment gap could be explained by compositional factors, and the widening educational gradient of single parenthood in particular. We use Chevan and Sutherland's decomposition technique on register data, which allows us to decompose the single-parent employment gap into the composition and rate effects by each category of the background variables. The findings point to an increasing double disadvantage of single parents: the gradually evolving disadvantage in educational backgrounds together with large differences in employment rates between single and partnered parents with low education explain large parts of the widening employment gap. Sociodemographic changes in interaction with changes in the labour market can produce inequalities by family structure in a Nordic society known for its extensive support for combining childcare and employment for all parents.

Inequalities in Income and Education Are Associated With Survival Differences After Out-of-Hospital Cardiac Arrest: Nationwide Observational Study.

BACKGROUND: Despite the acknowledged importance of socioeconomic factors as regards cardiovascular disease onset and survival, the relationship between individual-level socioeconomic factors and survival after out-of-hospital cardiac arrest is not established. Our aim was to investigate whether socioeconomic variables are associated with 30-day survival after out-of-hospital cardiac arrest. METHODS: We linked data from the Swedish Registry for Cardiopulmonary Resuscitation with individual-level data on socioeconomic factors (ie, educational level and disposable income) from Statistics Sweden. Confounding and mediating variables included demographic factors, comorbidity, and Utstein resuscitation variables. Outcome was 30-day survival. Multiple modified Poisson regression was used for the main analyses. RESULTS: A total of 31 373 out-of-hospital cardiac arrests occurring in 2010 to 2017 were included. Crude 30-day survival rates by income quintiles were as follows: Q1 (low), 414/6277 (6.6%); Q2, 339/6276 (5.4%); Q3, 423/6275 (6.7%); Q4, 652/6273 (10.4%); and Q5 (high), 928/6272 (14.8%). In adjusted analysis, the chance of survival by income level followed a gradient-like increase, with a risk ratio of 1.86 (95% CI, 1.65-2.09) in the highest-income quintile versus the lowest. This association remained after adjusting for comorbidity, resuscitation factors, and initial rhythm. A higher educational level was associated with improved 30-day survival, with the risk ratio associated with postsecondary education ≥4 years being 1.51 (95% CI, 1.30-1.74). Survival disparities by income and educational level were observed in both men and women. CONCLUSIONS: In this nationwide observational study using individual-level socioeconomic data, higher income and higher educational level were associated with better 30-day survival after out-of-hospital cardiac arrest in both sexes.

Cash-for-Care Use and Union Dissolution in Finland.

OBJECTIVE: This study examines how the receipt of the cash-for-care (CFC) benefit affects short- and long-term risks of union dissolution. BACKGROUND: Several theories predict that couples' gendered division of labor decreases their risk of separation, either due to increased partnership satisfaction or because it establishes economic dependency. Family policies such as the Finnish CFC benefit, which is paid if a young child does not attend public daycare, may encourage such a gendered division of labor, at least temporarily. METHOD: Using Finnish register data, this study analyzes the first childbearing unions of 38,093 couples between 1987 and 2009. Discrete-time event history analyses and fixed effects models for nonrepeated events are applied. RESULTS: The results suggest a lower separation risk while the benefit is received as compared to couples who do not use it, but no effect in the long-term. Fixed effects models that control for selection into CFC indicate postponement of separation until after take-up. Higher-income mothers show a stronger postponement effect, possibly due to greater income following leave. CONCLUSION: CFC use, which signals a temporary gendered division of labor and losses in mothers' earnings, predicts a lower separation risk during receipt of the benefit, but not beyond. IMPLICATIONS: Policies that affect the division of paid and unpaid labor at best only temporarily reduce dissolution risks.

Associations between maternal socioeconomic, psychosocial and seasonal factors, infant characteristics and human milk cortisol concentrations.

OBJECTIVES: Glucocorticoids are one component of human milk (HM) potentially affecting offspring development. Previous studies have identified various maternal, obstetric and socioeconomic characteristics that are associated with HM cortisol concentration but the literature is still scarce concerning these determinants in human populations. We aimed to identify which factors are linked with HM cortisol concentration at 2 months postpartum. METHODS: We analyzed data from 340 lactating Finnish mothers using ordinary least squares regression with log-transformed HM cortisol concentration as the dependent variable. Potential predictors included obstetric and maternal factors (maternal age, parity status, delivery mode, gestational age, pre-pregnancy obesity, and smoking in pregnancy), socioeconomic status (education and socioeconomic class), subjective economic well-being, maternal psychosocial factors (postpartum depression and anxiety symptoms), infant sex and age, and HM sample characteristics (time of the day and season of the year at sample collection). RESULTS: The strongest and most robust predictors were season of the year of sample collection and parity status. HM cortisol concentration was significantly higher for primiparas than multiparas. HM samples collected in summer showed significantly higher cortisol concentrations than those collected in winter, spring or autumn. CONCLUSIONS: The findings suggest that parity and season of the year at sample collection may be important factors to control for when examining HM cortisol. The strongest and most robust associations were related to maternal and sample characteristics and not to socioeconomic and psychosocial distress. This may be related to the fact that the study was conducted in a low-risk population.

Educational differences in prenatal anxiety and depressive symptoms and the role of childhood circumstances.

Despite interest in unequal maternal and child health, previous research has not focused on educational differences in anxiety and depressive symptoms during pregnancy, although they threaten maternal and child wellbeing. Using the prospective FinnBrain Cohort Study data on 2763 pregnant women over the three pregnancy trimesters and Finnish register data, we estimated multilevel regressions to describe educational differences in prenatal anxiety and depressive symptoms and to analyze whether they can be explained by socioeconomic background, parental mental disorders and adverse experiences during childhood. Prenatal anxiety was measured by the Symptom Checklist (SCL-90-anxiety subscale) and depressive symptoms by the Edinburgh Postnatal Depression Scale (EPDS). The results showed less anxiety and depressive symptoms among more educated pregnant women. In accounting for the educational differences, we found support for both the social selection and the social causation perspectives. Adverse childhood experiences partly explained the educational differences, highlighting the role of an undisturbed childhood environment in prenatal mental health disparities. Results from the regression models as well as sensitivity analyses also suggested that education is likely to buffer against prenatal distress.

Parental divorce in childhood does not independently predict maternal depressive symptoms during pregnancy.

BACKGROUND: This study sought to investigate if parental divorce in childhood increases the risk for depressive symptoms in pregnancy. METHODS: Women were recruited during their ultrasound screening in gestational week (gwk) 12. The final study sample consisted of 2,899 pregnant women. Questionnaires (including the Edinburgh Postnatal Depression Scale) were completed at three measurement points (gwk 14, 24 and 34). Prenatal depressive symptoms were defined as Edinburgh Postnatal Depression Scale score ≥ 13. Parental divorce and other stressful life events in childhood were assessed at gwk 14. Parental divorce was defined as separation of parents who were married or cohabiting. Questionnaire data was supplemented with data from Statistics Finland and the Finnish Medical Birth Register. RESULTS: Parental divorce in childhood increased the risk for depressive symptoms during pregnancy (OR 1.47; 95% CI 1.02-2.13), but the connection was no longer significant after adjusting for socioeconomic status, family conflicts and witnessing domestic violence in the childhood family (OR 0.80; 95% CI 0.54-1.18). CONCLUSIONS: Parental divorce alone does not predict depressive symptoms during pregnancy.

Relationship between socioeconomic status and incidence of out-of-hospital cardiac arrest is dependent on age.

BACKGROUND: The association between socioeconomic status (SES) and incidence of out-of-hospital cardiac arrest (OHCA) is not fully understood. The aim of this study was to see if area-level socioeconomic differences, measured in terms of area-level income and education, are associated with the incidence of OHCA, and if this relationship is dependent on age. METHODS: We included OHCAs that occurred in Stockholm County between the 1st of January 2006 and the 31st of December 2017, the victims being confirmed residents (n=10 574). We linked the home address to a matching neighbourhood (base unit) via available socioeconomic and demographic information. Socioeconomic variables and incidence rates were assessed by using cross-sectional values at the end of each year. We used zero-inflated negative binomial regression to calculate incidence rate ratios (IRRs). RESULTS: Among 1349 areas with complete SES information, 10 503 OHCAs occurred between 2006 and 2017. The IRR in the highest versus the lowest SES area was 0.61 (0.50-0.75) among persons in the 0-44 age group. Among patients in the 45-64 age group, the corresponding IRR was 0.55 (0.47-0.65). The highest SES areas versus the lowest showed an IRR of 0.59 (0.50-0.70) in the 65-74 age group. In the two highest age groups, no significant association was seen (75-84 age group: 0.93 (0.80-1.08); 85+ age group: 1.05 (0.84-1.23)). Similar crude patterns were seen among both men and women. CONCLUSIONS: Areas characterised by high SES showed a significantly lower incidence of OHCA. This relationship was seen up to the age of 75, after which the relationship disappeared, suggesting a levelling effect.

Understanding the effects of Covid-19 through a life course lens.

The Covid-19 pandemic is shaking fundamental assumptions about the human life course in societies around the world. In this essay, we draw on our collective expertise to illustrate how a life course perspective can make critical contributions to understanding the pandemic's effects on individuals, families, and populations. We explore the pandemic's implications for the organization and experience of life transitions and trajectories within and across central domains: health, personal control and planning, social relationships and family, education, work and careers, and migration and mobility. We consider both the life course implications of being infected by the Covid-19 virus or attached to someone who has; and being affected by the pandemic's social, economic, cultural, and psychological consequences. It is our goal to offer some programmatic observations on which life course research and policies can build as the pandemic's short- and long-term consequences unfold.

Residential context and COVID-19 mortality among adults aged 70 years and older in Stockholm: a population-based, observational study using individual-level data.

BACKGROUND: Housing characteristics and neighbourhood context are considered risk factors for COVID-19 mortality among older adults. The aim of this study was to investigate how individual-level housing and neighbourhood characteristics are associated with COVID-19 mortality in older adults. METHODS: For this population-based, observational study, we used data from the cause-of-death register held by the Swedish National Board of Health and Welfare to identify recorded COVID-19 mortality and mortality from other causes among individuals (aged ≥70 years) in Stockholm county, Sweden, between March 12 and May 8, 2020. This information was linked to population-register data from December, 2019, including socioeconomic, demographic, and residential characteristics. We ran Cox proportional hazards regressions for the risk of dying from COVID-19 and from all other causes. The independent variables were area (m2) per individual in the household, the age structure of the household, type of housing, confirmed cases of COVID-19 in the borough, and neighbourhood population density. All models were adjusted for individual age, sex, country of birth, income, and education. FINDINGS: Of 279 961 individuals identified to be aged 70 years or older on March 12, 2020, and residing in Stockholm in December, 2019, 274 712 met the eligibility criteria and were included in the study population. Between March 12 and May 8, 2020, 3386 deaths occurred, of which 1301 were reported as COVID-19 deaths. In fully adjusted models, household and neighbourhood characteristics were independently associated with COVID-19 mortality among older adults. Compared with living in a household with individuals aged 66 years or older, living with someone of working age (<66 years) was associated with increased COVID-19 mortality (hazard ratio 1·6; 95% CI 1·3-2·0). Living in a care home was associated with an increased risk of COVID-19 mortality (4·1; 3·5-4·9) compared with living in independent housing. Living in neighbourhoods with the highest population density (≥5000 individuals per km2) was associated with higher COVID-19 mortality (1·7; 1·1-2·4) compared with living in the least densely populated neighbourhoods (0 to <150 individuals per km2). INTERPRETATION: Close exposure to working-age household members and neighbours is associated with increased COVID-19 mortality among older adults. Similarly, living in a care home is associated with increased mortality, potentially through exposure to visitors and care workers, but also due to poor underlying health among care-home residents. These factors should be considered when developing strategies to protect this group. FUNDING: Swedish Research Council for Health, Working Life and Welfare (FORTE), Swedish Foundation for Humanities and Social Sciences.

Over-coverage in population registers leads to bias in demographic estimates.

Estimating the number of individuals living in a country is an essential task for demographers. This study assesses the potential bias in estimating the size of different migrant populations due to over-coverage in population registers. Over-coverage-individuals registered but not living in a country-is an increasingly pressing phenomenon; however, there is no common understanding of how to deal with over-coverage in demographic research. This study examines different approaches to and improvements in over-coverage estimation using Swedish total population register data. We assess over-coverage levels across migrant groups, test how estimates of age-specific death and fertility rates are affected when adjusting for over-coverage, and examine whether over-coverage can explain part of the healthy migrant paradox. Our results confirm the existence of over-coverage and we find substantial changes in mortality and fertility rates, when adjusted, for people of migrating age. Accounting for over-coverage is particularly important for correctly estimating migrant fertility.

Survival after out-of-hospital cardiac arrest is associated with area-level socioeconomic status.

OBJECTIVE: Out-of-hospital cardiac arrest (OHCA) is a major cause of death in the Western world. In this study we aimed to investigate the relationship between area-level socioeconomic status (SES) and 30-day survival after OHCA. We hypothesised that high SES at an area level is associated with an improved chance of 30-day survival. METHODS: Patients with OHCA in Stockholm County between 1 January 2006 and 31 December 2015 were analysed retrospectively. To quantify area-level SES, we linked the patient's home address to 250 × 250/1000 × 1000 meter grids with aggregated information about income and education. We constructed multivariable logistic regression models in which area-level SES measures were adjusted for age, sex, emergency medical services response time, witnessed status, initial rhythm, aetiology, location and year of cardiac arrest. RESULTS: We included 7431 OHCAs. There was significantly greater 30-day survival (p=0.003) in areas with a high proportion of university-educated people. No statistically significant association was seen between median disposable income and 30-day survival. The adjusted OR for 30-day survival among patients in the highest educational quintile was 1.70 (95% CI 1.15 to 2.51) compared with patients in the lowest educational quintile. We found no significant interaction for sex. Positive trend with increasing area-level education was seen in both men and women but the trend was only statistically significant among men (p=0.012) CONCLUSIONS: Survival to 30 days after OHCA is positively associated with the average educational level of the residential area. Area-level income does not independently predict 30-day survival after OHCA.

Parental Education and Family Dissolution: A Cross-National and Cohort Comparison.

This is the first study to systematically analyze whether the association between parental education and family dissolution varies cross-nationally and over time. The authors use meta-analytic tools to study cross-national variation between 17 countries with data from the Generations and Gender Study and Harmonized Histories. The association shows considerable cross-national variation, but is positive in most countries. The association between parental education and family dissolution has become less positive or even negative in six countries. The findings show that the association between parental education and family dissolution is generally positive or nil, even if the association between own education and family dissolution is in many countries increasingly negative. The authors find suggestive evidence that the association is related to the crude divorce rate, but not to the generosity of the welfare state in these countries. The implications of these findings for understanding the stratification in family dissolution are discussed.

Education is the strongest socio-economic predictor of smoking in pregnancy.

AIMS: To investigate socio-economic disparities in smoking in pregnancy (SIP) by the mother's education, occupational class and current economic conditions. DESIGN: Cross-sectional analysis with linked survey and register data. SETTING: South-western Finland. PARTICIPANTS: A total of 2667 pregnant women [70% of the original sample (n = 3808)] from FinnBrain, a prospective pregnancy cohort study. MEASUREMENTS: The outcome was smoking during the first pregnancy trimester, measured from the Finnish Medical Birth Register. Education and occupational class were linked from population registers. Income support recipiency and subjective economic wellbeing were questionnaire-based measures of current economic conditions. These were adjusted for age, partnership status, residential area type, parental separation, parity, childhood socio-economic background, childhood adversities (the Trauma and Distressing Events During Childhood scale) and antenatal stress (Edinburgh Postnatal Depression Scale). Logistic regressions and attributable fractions (AF) were estimated. FINDINGS: Mother's education was the strongest socio-economic predictor of SIP. Compared with university education, adjusted odds ratios (aORs) of SIP were: 2.2 [95% confidence interval (CI) = 1.2-3.9; P = 0.011] for tertiary vocational education, 4.4 (95% CI = 2.1-9.0; P < 0.001) for combined general and vocational secondary education, 2.9 (95% CI = 1.4-6.1; P = 0.006) for general secondary education, 9.5 (95% CI 5.0-18.2; P < 0.001) for vocational secondary education and 14.4 (95% CI = 6.3-33.0; P < 0.001) for compulsory schooling. The total AF of education was 0.5. Adjusted for the other variables, occupational class and subjective economic wellbeing did not predict SIP. Income support recipiency was associated positively with SIP (aOR = 1.8; 95% CI = 1.1-3.1; P = 0.022). Antenatal stress predicted SIP (aOR = 2.0; 95% CI = 1.4-2.8; P < 0.001), but did not attenuate its socio-economic disparities. CONCLUSIONS: In Finland, socio-economic disparities in smoking in pregnancy are attributable primarily to differences in the mother's educational level (low versus high) and orientation (vocational versus general).

Parental Separation and School Performance Among Children of Immigrant Mothers in Sweden.

Immigration and family change are two demographic processes that have changed the face of European societies and are associated with inequalities in child outcomes. Yet there is little research outside the USA on whether the effects of family dynamics on children's life chances vary by immigrant background. We asked whether the effect of parental separation on educational achievement varies between immigrant backgrounds (ancestries) in Sweden. We used Swedish population register data on two birth cohorts (born in 1995 and 1996) of Swedish-born children and analyzed parental separation penalties on grade sums and non-passing grades (measured at ninth grade) across ten ancestry groups, defined by the mother's country of birth. We found that the parental separation effects vary across ancestries, being weakest among children with Chilean-born mothers and strongest among children with mothers born in Bosnia and Herzegovina. In general, the effects were weaker in groups in which parental separation was a more common experience.

Family Dynamics and Child Outcomes: An Overview of Research and Open Questions.

Previous research has documented that children who do not live with both biological parents fare somewhat worse on a variety of outcomes than those who do. In this article, which is the introduction to the Special Issue on "Family dynamics and children's well-being and life chances in Europe," we refine this picture by identifying variation in this conclusion depending on the family transitions and subpopulations studied. We start by discussing the general evidence accumulated for parental separation and ask whether the same picture emerges from research on other family transitions and structures. Subsequently, we review studies that have aimed to deal with endogeneity and discuss whether issues of causality challenge the general picture of family transitions lowering child well-being. Finally, we discuss whether previous evidence finds effects of family transitions on child outcomes to differ between children from different socioeconomic and ethnic backgrounds, and across countries and time-periods studied. Each of the subsequent articles in this Special Issue contributes to these issues. Two articles provide evidence on how several less often studied family forms relate to child outcomes in the European context. Two other articles in this Special Issue contribute by resolving several key questions in research on variation in the consequences of parental separation by socioeconomic and immigrant background, two areas of research that have produced conflicting results so far.

Marital status, education, and income in relation to the risk of esophageal and gastric cancer by histological type and site.

BACKGROUND: Marital status, income, and education might influence the risk of esophageal and gastric cancer, but the literature is limited. A large study addressing subtypes of these tumors was used to clarify these associations. METHODS: A nationwide, Swedish population-based cohort study from 1991 to 2010 included individuals who were 50 years old or older. Data on exposures, covariates, and outcomes were obtained from well-maintained registers. Four esophagogastric tumor subtypes were analyzed in combination and separately: esophageal adenocarcinoma, esophageal squamous cell carcinoma, cardia adenocarcinoma, and noncardia gastric adenocarcinoma. Poisson regression was used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Analyses were stratified by sex and adjusted for confounders. RESULTS: Among 4,734,227 participants (60,634,007 person-years), 24,095 developed esophageal or gastric cancer. In comparison with individuals in a long marriage, increased IRRs were found among participants who were in a shorter marriage or were never married, remarried, divorced, or widowed. These associations were indicated for each tumor subtype but were generally stronger for esophageal squamous cell carcinoma. Higher education and income were associated with decreased IRRs in a seemingly dose-response manner and similarly for each subtype. In comparison with the completion of only primary school, higher tertiary education rendered an IRR of 0.64 (95% CI, 0.60-0.69) for men and an IRR of 0.68 (95% CI, 0.61-0.75) for women. Comparing participants in the highest and lowest income brackets (highest 20% vs lowest 20%) revealed an IRR of 0.74 (95% CI, 0.70-0.79) for men and an IRR of 0.83 (95% CI, 0.76-0.91) for women. CONCLUSIONS: Divorce, widowhood, living alone, low educational attainment, and low income increase the risk of each subtype of esophageal and gastric cancer. These associations require attention when high-risk individuals are being identified. Cancer 2016;122:207-212. © 2015 American Cancer Society.

Cross-national differences in the gender gap in subjective health in Europe: does country-level gender equality matter?

Multiple studies have found that women report being in worse health despite living longer. Gender gaps vary cross-nationally, but relatively little is known about the causes of comparative differences. Existing literature is inconclusive as to whether gender gaps in health are smaller in more gender equal societies. We analyze gender gaps in self-rated health (SRH) and limiting longstanding illness (LLI) with five waves of European Social Survey data for 191,104 respondents from 28 countries. We use means, odds ratios, logistic regressions, and multilevel random slopes logistic regressions. Gender gaps in subjective health vary visibly across Europe. In many countries (especially in Eastern and Southern Europe), women report distinctly worse health, while in others (such as Estonia, Finland, and Great Britain) there are small or no differences. Logistic regressions ran separately for each country revealed that individual-level socioeconomic and demographic variables explain a majority of these gaps in some countries, but contribute little to their understanding in most countries. In yet other countries, men had worse health when these variables were controlled for. Cross-national variation in the gender gaps exists after accounting for individual-level factors. Against expectations, the remaining gaps are not systematically related to societal-level gender inequality in the multilevel analyses. Our findings stress persistent cross-national variability in gender gaps in health and call for further analysis.