Widening Educational Disparities in Premature Death Rates in Twenty Six States in the United States, 1993–2007

Abstract

BackgroundEliminating socioeconomic disparities in health is an overarching goal of the U.S. Healthy People decennial initiatives. We present recent trends in mortality by education among working-aged populations.Methods and FindingsAge-standardized death rates and their average annual percent change for all-cause and five major causes (cancer, heart disease, stroke, diabetes, and accidents) were calculated from 1993 through 2007 for individuals aged 25–64 years by educational attainment as a marker of socioeconomic status, using national vital registration data for 26 states with consistent educational information on the death certificates. Rate ratios and rate differences were used to assess disparities (≤12 versus ≥16 years of education) for 1993 through 2007. From 1993 through 2007, relative educational disparities in all-cause mortality continued to increase among working-aged men and women in the U.S., due to larger decreases of mortality rates among the most educated coupled with smaller decreases or even worsening trends in the less educated. For example, the rate ratios of all-cause mortality increased from 2.5 (95% confidence interval (CI), 2.4–2.6) in 1993 to 3.6 (95% CI, 3.5–3.7) in 2007 in men and from 1.9 (95% CI, 1.8–2.0) to 3.0 (95% CI, 2.9–3.1) in women. Generally, the rate differences (per 100,000 persons) of all-cause mortality increased from 415.5 (95% CI, 399.1–431.9) in 1993 to 472.7 (95% CI, 460.2–485.2) in 2007 in men and from 165.4 (95% CI, 154.5–176.2) to 256.2 (95% CI, 248.3–264.2) in women. Disparity patterns varied largely across the five specific causes considered in this study, with the largest increases of relative disparities for accidents, especially in women.ConclusionsRelative educational differentials in mortality continued to widen among men and women despite emphasis on reducing disparities in the U.S. Healthy People decennial initiatives.

Forty years of economic growth and plummeting mortality: the mortality experience of the poorly educated in South Korea

“…Similar findings have been observed in other US studies 8 10. In an international comparison study in Europe, increased mortality rates among those with low education were found in Lithuania and Estonia between the 1990s and 2000s 11.…”

Colorectal Cancer Mortality Characteristics and Predictions in China, 1991-2011

“…Moreover, the higher rates in the urban areas also could be partly attributed to improved diagnoses. A previous study shows that education predicted greater screening frequency, as the colorectal cancer screening rate is higher in college graduates than in those with less than a high school education (Ma et al, 2012). People living in rural areas have a lower education level and were less likely to have ever received any type of screening Characteristics andPredictions in China, 1991-2011 for colorectal cancer.…”

The Health Effects of Income Inequality: Averages and Disparities

“…Individual-level studies consistently showed that life expectancy increased markedly for high-SES individuals but increased very little or decreased slightly for low-SES individuals (34,43,47,59). Studies comparing rich and poor counties and census tracts in the United States also showed increasing mortality ratios in the late twentieth century (24,53,54).…”