The Enduring Association between Education and Mortality: The Role of Widening and Narrowing Disparities

Abstract

This paper examines how educational disparities in mortality emerge, grow, decline, and disappear across causes of death in the United States and how these change contribute to the enduring association of education and mortality over time. Focusing on adults age 40-64, we first examine the extent to which disparities in all-cause mortality by education persisted from 1989-2007. We then test the "fundamental cause" prediction that mortality disparities persist, in part, by shifting to new health outcomes over time, most importantly for those causes of death that have increasing mortality rates. To test this hypothesis, we focus in depth on the period from 1999-2007, when all causes of death were coded to the same classification system. The results indicate (a) both substantial widening and narrowing of mortality disparities across causes of death, (b) almost all causes of death that had increasing mortality rates also had widening disparities by education, and (c) the total disparity by education in all-cause mortality would be about 25% smaller today were it not for newly widened or emergent disparities since 1999. These results point to the theoretical and policy importance of identifying the social forces that cause health disparities to widen over time.

Figure 1

Trends in U.S. Mortality Levels by Education for Men and Women Aged 40–64, 1989–2007 [Table: see text]

Figure 2

Trends in U.S. Mortality Levels by Race/Ethnicity and Education for Men and Women Aged 40–64, 1989–2007 [Table: see text]

Figure 3

Scatterplots of Change in U.S. Mortality Disparities by Change in Total Mortality Rates, 1999–2007. [Table: see text]

Figure 4

Predicted and Simulated Mortality Trends, Based on Results in Table 2 Note: The analysis pool excludes causes of death that are residual categories, and consequently the total number of deaths in these predicted models is less than the total number of deaths in the observed data. Source: U.S. Vital Statistics and U.S. Census Note: Age standardized to year 2000 U.S. population