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Association Between Educational Attainment and Causes of Death Among White and Black US Adults, 2010-2017

Educational Objective
To understand that life expectancy may vary by educational attainment.
1 Credit CME
Key Points

Question  Has there been an association between educational attainment and causes of death among US adults?

Findings  In this serial cross-sectional study that included 4 690 729 deaths among US adults, estimated life expectancy at age 25 years declined overall between 2010 and 2017; however, it declined among persons without a 4-year college degree and increased among college-educated persons. Much of the increasing educational differences in years of life lost may be related to deaths attributed to drug use.

Meaning  Increasing differences in life expectancy based on educational attainment have occurred between 2010 and 2017.

Abstract

Importance  There are substantial and increasing educational differences in US adult life expectancy. To reduce social inequalities in mortality, it is important to understand how specific causes of death have contributed to increasing educational differences in adult life expectancy in recent years.

Objective  To estimate the relationship of specific causes of death with increasing educational differences in adult life expectancy from 2010 to 2017.

Design, Setting, and Participants  Serial cross-sectional study of 4 690 729 deaths recorded in the US National Vital Statistics System in 2010 and 2017.

Exposures  Sex, race/ethnicity, and educational attainment.

Main Outcomes and Measures  Life expectancy at age 25 years and years of life lost between ages 25 and 84 years by cause of death.

Results  The analysis included a total of 2 211 633 deaths in 2010 and 2 479 096 deaths in 2017. Between 2010 and 2017, life expectancy at age 25 significantly declined among white and black non-Hispanic US residents from an expected age at death of 79.34 to 79.15 years (difference, −0.18 [95% CI, −0.23 to −0.14]). Greater decreases were observed among persons with a high school degree or less (white men: −1.05 years [95% CI, −1.15 to −0.94], white women: −1.14 years [95% CI, −1.24 to −1.04], and black men: −0.30 years [95% CI, −0.56 to −0.04]). White adults with some college education but no 4-year college degree experienced similar declines in life expectancy (men: −0.89 years [95% CI, −1.07 to −0.73], women: −0.59 years [95% CI, −0.77 to −0.42]). In contrast, life expectancy at age 25 significantly increased among the college-educated (white men: 0.58 years [95% CI, 0.42 to 0.73], white women: 0.78 years [95% CI, 0.57 to 1.00], and black women: 1.70 years [95% CI, 0.91 to 2.53]). The difference between high- and low-education groups increased from 2010 to 2017, largely because life-years lost to drug use increased among those with a high school degree or less (white men: 0.93 years [95% CI, 0.90 to 0.96], white women: 0.50 years [95% CI, 0.47 to 0.52], black men: 0.75 years [95% CI, 0.71 to 0.79], and black women: 0.28 years [95% CI, 0.25 to 0.31]).

Conclusions and Relevance  In this serial cross-sectional study, estimated life expectancy at age 25 years declined overall between 2010 and 2017; however, it declined among persons without a 4-year college degree and increased among college-educated persons. Much of the increasing educational differences in years of life lost may be related to deaths attributed to drug use.

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Article Information

Corresponding Author: Isaac Sasson, PhD, Department of Sociology and Anthropology and the Herczeg Institute on Aging, Tel Aviv University, Tel Aviv 6997801, Israel (isasson@tauex.tau.ac.il).

Accepted for Publication: July 18, 2019.

Author Contributions: Dr Sasson had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Both authors.

Acquisition, analysis, or interpretation of data: Both authors.

Drafting of the manuscript: Sasson.

Critical revision of the manuscript for important intellectual content: Hayward.

Statistical analysis: Sasson.

Obtained funding: Sasson.

Conflict of Interest Disclosures: None reported.

Funding/Support: This research was supported by a grant from the German-Israeli Foundation for Scientific Research and Development (GIF) awarded to Dr Sasson and an infrastructure grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; P2C HD042849) awarded to the Population Research Center at The University of Texas at Austin.

Role of the Funder/Sponsor: The GIF and the NICHD had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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