Economic distress and growing educational disparities in life expectancy: Weathering, high effort coping, and despair

项目概述：研究人员使用各种数据源和方法， 记录了两个令人不安的趋势：美国各亚群的预期寿命（LE）普遍增长停止， 以及自1990年以来LE教育不平等的加剧-这两者都使我们进一步实现 人口健康公平这一国家公共卫生高度优先目标。LE不平等日益严重的时间 这表明，中等收入家庭的经济前景停滞或恶化， 全球化和自动化带来的就业机会减少是一个重要原因。然而，这一假设尚未得到严格验证。 经验测试。全球化和自动化的影响因地域而异。我们建议 利用这种地理差异来研究持续性和结构性经济困境的累积效应 关于LE中死亡率和日益增长的教育不平等。另一个重要的问题涉及机制 通过这种方式，与外生经济趋势有关的生活水平差距扩大了。随着时间的推移， 死亡原因在受教育程度较低的人群中增加，还是在受教育程度较高的人群中减少，还是两者兼而有之？如何 这是否因种族、性别、年龄组或地区而异？除了会计机制，我们还将考虑 不同的死亡原因如何在生命过程中遵循不同的生物心理社会轨迹，概念上 在风化假说的指导下风化理论认为，累积和应力介导的磨损， 对细胞完整性的破坏导致加速的生物衰老， 中年，以及老年慢性病的早期发作，健康引起的残疾和过度死亡， 相关的个人、家庭和社会费用以及增加的医疗保健费用。生活中日益增长的不平等是 假设，以反映风化的影响，加深和长期的结构不平等和 在人的一生中，持续不断地努力应对这种不平等所带来的累积生理效应。 我们的经验方法旨在检验风化假设所预测的命题，并检验 已被转发来解释教育增加的共同竞争假设的力量 1990年至2015年之间的不平等。这些相互竞争的假设包括关注吸烟的作用， 肥胖，医疗保健，以及“绝望的死亡”，如阿片类药物死亡和自杀。具体位置 与其他原因相比，在受教育程度较低的人中可能增加的死亡原因 死亡率也可能增加，并考虑到他们在生物学上合理的理论 框架对于评估社会、经济、公共卫生和卫生服务政策至关重要， 可能会促进或阻碍国家和次国家一级的健康公平。

PROJECT SUMMARY: Researchers have used a variety of data sources and methodologies to independently document two disturbing trends: a halt to universal gains in life expectancy (LE) across US subpopulations, and a subsequent rise in educational inequality in LE since 1990—both of which take us further from achieving the high-priority national public health objective of population health equity. The timing of growing LE inequities suggests that the stagnating or deteriorating economic prospects of moderate income households in light of jobs lost to globalization and automation play an important role. Yet, this hypothesis has yet to be rigorously empirically tested. The impact of globalization and automation has varied geographically. We propose to leverage this geographic variation to study the cumulative effect of persistent and structural economic distress on mortality and growing educational inequities in LE. Another important question concerns the mechanisms through which LE disparities linked to exogenous economic trends have grown. Over time, which specific causes of death increased among the less educated or decreased among the more educated, or both? How might this vary by race, gender, age-group or locale? Beyond the accounting mechanics, we will also consider how different causes of death follow different biopsychosocial trajectories over the life course, conceptually guided by the weathering hypothesis. Weathering theorizes that cumulative and stress-mediated wear and tear on cellular integrity leads to accelerated biological aging, the dysregulation of important body systems by midlife, and the early onset of chronic diseases of aging, health-induced disability, and excess death, with their associated personal, familial, and societal tolls and increased health care costs. Growing inequity in LE is hypothesized to reflect the weathering effects of deepening and prolonged structural inequity and the cumulative physiological effects of the persistent high-effort coping such inequity entails over the life course. Our empirical approach is designed to test propositions predicted by the weathering hypothesis and also to test the strength of common competing hypotheses that have been forwarded to explain increased educational inequity in LE between 1990 and 2015. These competing hypotheses include focusing on the roles of smoking, obesity, medical care, and also on “deaths of despair,” such as opioid deaths and suicide. Placing specific causes of death that may have risen among the educationally disadvantaged in perspective with other causes of death that may have also increased, and considering them within a biologically plausible theoretical framework, is critical to the evaluation of the social, economic, public health, and health services policies that are likely to promote or impede health equity nationally and subnationally going forward.