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

项目摘要：研究人员已经使用了各种数据源和方法来独立 记录两个令人不安的趋势：美国亚人群普遍预期寿命(LE)的增长停止， 以及随后自1990年以来教育不平等的加剧--这两项都使我们进一步远离实现 人口健康公平的高度优先的国家公共卫生目标。LE不平等加剧的时机 建议中等收入家庭停滞不前或恶化的经济前景 全球化和自动化带来的工作岗位流失起到了重要作用。然而，这一假设还没有得到严格的验证。 经验性检验。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影响 关于死亡和日益严重的教育不平等。另一个重要问题涉及机制 通过这一点，与外生经济趋势相关的小差距扩大了。随着时间的推移，具体是什么 死因在受教育程度较低的人群中增加了，还是在受教育程度较高的人群中减少了，还是两者兼而有之？多么 这是否会因种族、性别、年龄组或地区而有所不同？除了会计机制，我们还将考虑 从概念上讲，不同的死因在生命过程中遵循不同的生物心理社会轨迹 在风化假说的指导下。风化理论认为，累积和应力调节的磨损和 撕裂细胞完整性导致生物衰老加速，重要的身体系统通过 中年，以及老龄化、健康导致的残疾和过度死亡等慢性病的早期发病，以及他们的 相关的个人、家庭和社会通行费以及增加的医疗保健成本。LE中日益严重的不平等 假设反映结构性不平等加深和延长的风化效应，以及 在整个生命过程中，持续的高努力应对这种不平等所产生的累积的生理效应。 我们的经验方法是为了检验风化假说所预测的命题，也是为了检验 常见的相互竞争的假说的力量已经被转发来解释增加的教育 1990至2015年间的不平等现象。这些相互矛盾的假说包括关注吸烟的作用， 肥胖症、医疗保健，以及“绝望之死”，如阿片类药物死亡和自杀。放置特定位置 与其他原因相比，在受教育程度较低的人群中可能有所上升的死因 死亡的可能性也在增加，并在生物学上看似合理的理论中考虑它们 框架，对于评价社会、经济、公共卫生和保健服务政策至关重要 很可能促进或阻碍国家和国家以下各级的卫生公平。

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.