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Trends in the educational gradient of mortality among US adults aged 45 to 84 years: Bringing regional context into the explanation

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  • Montez, J.K.
  • Berkman, L.F.

Abstract

Objectives: We investigated trends in the educational gradient of US adult mortality, which has increased at the national level since the mid-1980s, within US regions. Methods: We used data from the 1986-2006 National Health Interview Survey Linked Mortality File on non-Hispanic White and Black adults aged 45 to 84 years (n = 498 517). We examined trends in the gradient within 4 US regions by race-gender subgroup by using age-standardized death rates. Results: Trends in the gradient exhibited a few subtle regional differences. Among women, the gradient was often narrowest in the Northeast. The region's distinction grew over time mainly because low-educated women in the Northeast did not experience a significant increase in mortality like their counterparts in other regions (particularly for White women). Among White men, the gradient narrowed to a small degree in the West. Conclusions: The subtle regional differences indicate that geographic context can accentuate or suppress trends in the gradient. Studies of smaller areas may provide insights into the specific contextual characteristics (e.g., state tax policies) that have shaped the trends, and thus help explain and reverse the widening mortality disparities among US adults.

Suggested Citation

  • Montez, J.K. & Berkman, L.F., 2014. "Trends in the educational gradient of mortality among US adults aged 45 to 84 years: Bringing regional context into the explanation," American Journal of Public Health, American Public Health Association, vol. 104(1), pages 82-90.
    • Handle: RePEc:aph:ajpbhl:10.2105/ajph.2013.301526_2
    DOI: 10.2105/AJPH.2013.301526
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    Cited by:

    1. Janet Currie & Hannes Schwandt & Josselin Thuilliez, 2020. "Pauvreté, Egalité, Mortalité: mortality (in)equality in France and the United States," Journal of Population Economics, Springer;European Society for Population Economics, vol. 33(1), pages 197-231, January.
    2. Enrique Regidor & Laura Reques & Carolina Giráldez-García & Estrella Miqueleiz & Juana M Santos & David Martínez & Luis de la Fuente, 2015. "The Association of Geographic Coordinates with Mortality in People with Lower and Higher Education and with Mortality Inequalities in Spain," PLOS ONE, Public Library of Science, vol. 10(7), pages 1-16, July.
    3. Janet Currie & Hannes Schwandt & Josselin Thuilliez, 2020. "Pauvreté, Egalité, Mortalité: mortality (in)equality in France and the United States," Journal of Population Economics, Springer;European Society for Population Economics, vol. 33(1), pages 197-231, January.
    4. James Banks & Janet Currie & Sonya Krutikova & Kjell G. Salvanes & Hannes Schwandt, 2021. "The Evolution of Mortality Inequality in 11 OECD Countries: Introduction," Fiscal Studies, John Wiley & Sons, vol. 42(1), pages 9-23, March.
    5. Blankenship, Kim M. & del Rio Gonzalez, Ana Maria & Keene, Danya E. & Groves, Allison K. & Rosenberg, Alana P., 2018. "Mass incarceration, race inequality, and health: Expanding concepts and assessing impacts on well-being," Social Science & Medicine, Elsevier, vol. 215(C), pages 45-52.
    6. Vincenzo Atella & Dana Goldman & Daniel McFadden, 2021. "Disparate ageing: The role of education and socioeconomic gradients in future health and disability in an international context," Health Economics, John Wiley & Sons, Ltd., vol. 30(S1), pages 3-10, November.
    7. Benjamin K. Couillard & Christopher L. Foote & Kavish Gandhi & Ellen Meara & Jonathan Skinner, 2021. "Rising Geographic Disparities in US Mortality," Journal of Economic Perspectives, American Economic Association, vol. 35(4), pages 123-146, Fall.
    8. Goldring, Thomas & Lange, Fabian & Richards-Shubik, Seth, 2016. "Testing for changes in the SES-mortality gradient when the distribution of education changes too," Journal of Health Economics, Elsevier, vol. 46(C), pages 120-130.
    9. Kadir Atalay & Rebecca Edwards & Fiona Georgiakakis, 2023. "Mortality inequality, spatial differences and health care access," Health Economics, John Wiley & Sons, Ltd., vol. 32(11), pages 2632-2654, November.
    10. Nathan T. Dollar & Iliya Gutin & Elizabeth M. Lawrence & David B. Braudt & Samuel Fishman & Richard G. Rogers & Robert A. Hummer, 2020. "The persistent southern disadvantage in US early life mortality, 1965‒2014," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 42(11), pages 343-382.
    11. Janet Currie & Hannes Schwandt, 2016. "Mortality Inequality: The Good News from a County-Level Approach," Journal of Economic Perspectives, American Economic Association, vol. 30(2), pages 29-52, Spring.
    12. Delaruelle, Katrijn & Buffel, Veerle & Bracke, Piet, 2015. "Educational expansion and the education gradient in health: A hierarchical age-period-cohort analysis," Social Science & Medicine, Elsevier, vol. 145(C), pages 79-88.
    13. Jennifer Karas Montez & Anna Zajacova & Mark D. Hayward & Steven H. Woolf & Derek Chapman & Jason Beckfield, 2019. "Educational Disparities in Adult Mortality Across U.S. States: How Do They Differ, and Have They Changed Since the Mid-1980s?," Demography, Springer;Population Association of America (PAA), vol. 56(2), pages 621-644, April.
    14. Nelda Mier & Marcia G. Ory & Samuel D. Towne & Matthew Lee Smith, 2017. "Relative Association of Multi-Level Supportive Environments on Poor Health among Older Adults," IJERPH, MDPI, vol. 14(4), pages 1-16, April.

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