Alcohol-Attributable Deaths Help Drive Growing Socioeconomic Inequalities In US Life Expectancy, 2000-18

Abstract

Socioeconomic gaps in life expectancy have widened substantially in the United States since 2000. Yet the contribution of specific causes to these growing disparities remains unknown. We used death records from the National Vital Statistics System and population data from Current Population Surveys to quantify the contribution of alcohol-attributable causes of death to changes in US life expectancy between 2000 and 2018 by sex and socioeconomic status (as measured by educational attainment). During the study period, the gap in life expectancy between people with low (high school diploma or less) compared with high (college degree) levels of education increased by three years among men and five years among women. Between 2000 and 2010 declines in cardiovascular disease mortality among people with high education made major contributions to growing inequalities. In contrast, between 2010 and 2018 deaths from a cause with an alcohol-attributable fraction of 20 percent or more were a dominant driver of socioeconomic divergence. Increased efforts to implement cost-effective alcohol control policies will be essential for reducing health disparities.

EXHIBIT 1. Life expectancy at age 18 for men in the US, by educational attainment, 2000–18

SOURCE Authors’ analysis of mortality data from the National Vital Statistics System and population data from Current Population Surveys, 2000–18. NOTES “Low education” means high school diploma or less, “middle education” means some college but no college degree, and “high education” means college degree or more. Educational attainment is used here as an indicator of socioeconomic status.

EXHIBIT 2. Life expectancy at age 18 for women in the US, by educational attainment, 2000–18

SOURCE Authors’ analysis of mortality data from the National Vital Statistics System and population data from Current Population Surveys, 2000–18. NOTES Education levels are defined in the notes to exhibit 1. Educational attainment is used here as an indicator of socioeconomic status.

EXHIBIT 4. Absolute contribution to increases and decreases in inequality in life expectancy at age 18 for people with middle and low education compared with high education in the US, by cause of death, time period, and sex, 2000–18

SOURCE Authors’ analysis of mortality data from the National Vital Statistics System and population data from Current Population Surveys, 2000–18. NOTES Positive numbers indicate an increase in absolute socioeconomic inequalities (difference) in life expectancy in years; negative numbers indicate a decline in the inequality in life expectancy. Education levels are defined in the notes to exhibit 1. Educational attainment is used here as an indicator of socioeconomic status. Cause-of-death categories are defined by alcohol-attributable fraction (AAF). Diseases in each of the three categories are defined in the text.