Testing for changes in the SES-mortality gradient when the distribution of education changes too

Abstract

We develop a flexible test for changes in the SES-mortality gradient over time that accounts for how education, commonly used as the primary marker of SES, is distributed in the population. We implement the test for the period between 1984 and 2006 using microdata from the Census, CPS, and NHIS linked to death records. Using our flexible test, we find that the evidence for a change in the education-mortality gradient is not as strong and universal as previous research has suggested. Our results indicate that the gradient increased for females during this time period, but we cannot rule out that the gradient among males has not changed. Informally, the results suggest that the changes for females are mainly driven by the bottom of the education distribution.

Inequality in mortality between Black and White Americans by age, place, and cause and in comparison to Europe, 1990 to 2018

“…We also avoid problems due to changes in the education distribution over time. For example, high school dropouts in the United States have become an increasingly small and more negatively selected group as high school completion and college attendance have become more normative ( 32 – 35 ). A limitation of our approach is that we cannot examine inequalities within small areas.…”

“…We examine trends in mortality inequality in six wealthy European countries using methods identical to the US analysis. Mortality inequality in these countries is of interest in its own right but also serves as a useful baseline for considering developments in the United States, contributing to a growing body of comparative literature on mortality differentials ( 6 – 39 ). Our main analysis focuses on six countries (England, France, Germany, the Netherlands, Norway, and Spain) for which consistent mortality data by geographic areas exist for the entire time period.…”

Declining Life Expectancy in the United States: Missing the Trees for the Forest

“…Generally speaking, analyses that have relied strictly on death certificates, education credentials, and census denominators have reported large and growing gaps in life expectancy for non-Hispanic men and women (90,106,125,133). Other studies that have either used linked data (58,94,95,147) or accounted for the changing composition of education groups over time (7,43,58) report increasing educational differentials but, importantly, do not report increasing mortality (or decreasing life expectancy) for any group, apart from non-Hispanic white women with less than a high school education. The majority of these studies have excluded the most recent period of worsening national life expectancy; however, a recent report using linked data found evidence that, during the period of stagnating and decreasing life expectancy from 2010 to 2017, educational differences increased among non-Hispanic blacks and whites.…”

Living and Dying in America: An Essay on Deaths of Despair and the Future of Capitalism

“…The first is that increases over time in schooling change the composition of education groups (Dowd and Hamoudi 2014;Bound et al 2015;Goldring, Lange, and Richards-Shubik 2016). Consider a situation where educational attainment at a point in time is monotonically increasing in individual quality (measured by some criterion).…”