Educational Attainment, Geography, and U.S. Adult Mortality Risk

项目总结 教育程度是美国成年人死亡风险的最大社会决定因素之一。研究到 解释教育与死亡的关系更多地关注个体层面的“近端”机制 (例如，吸烟)，而不是确定支撑这种联系的背景条件。这一专业知识 GAP对科学和公共政策有影响；它限制了对解释和干预的发现。 这一差距可能反映了美国研究中的主流观点，即教育是一种个人资源。因此， 美国对教育与死亡关联的研究强调了代理机制：患有 人们认为，更多的教育可以融合健康的生活方式，获取医学知识，避免经济困难 艰难困苦等等。虽然代理解释很重要，但它们忽略了这样一个事实，即个体 影响教育对死亡率的重要程度的社会和政治背景。 尽管许多研究表明欧洲存在这种情况，但美国的研究一直很少。 这项研究的目标是研究教育与死亡率之间的关联在美国各州是如何以及为什么会不同。 州长和州立法机构的决定影响到就业、住房、交通、社会 社会融合、健康的生活方式和许多其他社会决定死亡的因素。这些状态上下文具有 在几十年的放松管制和权力下放过程中，它们变得越来越不同。这些趋势可能解释了为什么， 到20世纪末，美国各州50岁的预期寿命范围超过了这一范围 在可比的高收入国家中，美国各县的预期寿命差异的一半是 归因于它们所在的州。这项研究解决了三个问题：(1)如何 教育-死亡率的关联在各州和时间上是不同的？(2)教育-死亡率的变化是如何- 跨州和随时间推移的死亡率关联反映了州政策、资源和机会结构？ 以及(3)国家政策、资源和机会结构的个体路径是什么 塑造教育与死亡之间的联系？中心假设是，这种联系明显不同。 在各州，这在经济政策进步、就业强劲的州是最弱的 机会，以及高度的社会凝聚力。这项研究将使用年龄在45岁-之间的成年人的数据 1985-2011年全国健康访谈调查与死亡率档案挂钩。使用离散时间生存模型，它将 检查所有原因和特定原因的死亡率。所有分析将按性别、年龄段和时间分层 句号。分析说明了州际迁移和县级死亡率的差异，以更好地隔离 国家背景的重要性。这项研究的预期结果包括：(A)对教育死亡率的估计 按州分列的关联性，以及(B)对各州可能采用的降低死亡率的政策和战略的见解 在他们的种群中。长期目标是降低成人死亡率，特别是在弱势群体中。

PROJECT SUMMARY Educational attainment is one of the strongest social determinants of U.S. adult mortality risk. Studies to explain the education-mortality association have focused more on the individual-level “proximal” mechanisms (e.g., smoking) than identifying the contextual conditions that undergird the association. This major knowledge gap has consequences for science and public policy; it limits the discovery of explanations and interventions. The gap may reflect the dominant view in U.S. research that education is a personal resource. Accordingly, U.S. studies of the education-mortality association have emphasized agentic mechanisms: individuals with more education are thought to coalesce healthy lifestyles, seek out medical knowledge, avoid financial hardship, and so on. While agentic explanations are important, they ignore the fact that individuals are embedded in social and political contexts that influence the extent to which education matters for mortality. Despite numerous studies showing this to be the case in Europe, there has been scant research in the U.S. The goal of this study is to examine how and why the education-mortality association varies across U.S. states. Decisions made by governors and state legislatures affect employment, housing, transportation, social integration, healthy lifestyles, and numerous other social determinants of mortality. These state contexts have grown increasingly disparate through decades of deregulation and devolution. These trends may explain why, by the end of the 20th century, the range in life expectancy at age 50 across U.S. states exceeded the range across comparable high-income countries, and ½ of the variation in life expectancy across U.S. counties was attributable to the state within which they are located. This study addresses three questions: (1) How does the education-mortality association vary across states and over time?, (2) How does the variation in the education- mortality association across states and over time reflect state policies, resources, and opportunity structures?, and (3) What are the individual pathways through which state policies, resources, and opportunity structures shape the education-mortality association? The central hypothesis is that the association differs markedly across states, and that it is weakest in states with progressive economic policies, robust employment opportunities, and high social cohesion. The study will use data on adults aged 45-89 years in the restricted 1985-2011 National Health Interview Survey Linked Mortality File. Using discrete-time survival models, it will examine all-cause and cause-specific mortality. All analyses will be stratified by gender, age group, and time period. Analyses account for interstate migration and county-level mortality variation to better isolate the importance of state contexts. Expected outcomes of this study include: (a) estimates of the education-mortality association by state, and (b) insights into policies and strategies that states might employ to reduce mortality among their populations. The long-term goal is to reduce adult mortality, especially among vulnerable groups.