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

教育程度、地理和美国成人死亡率风险

• 批准号: 9284575
• 负责人: Jennifer Karas Montez
• 金额: $ 28.15万
• 依托单位: SYRACUSE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9284575
• 关键词: Address; Adult; Affect; Age; American; Cessation of life; Characteristics; Cigarette; Country; County; Data; Decentralization; Disease; Documentation; Economic Conditions; Economic Policy; Economics; Education; Educational Background; Elderly; Employment; Employment Opportunities; Europe; Gender; Geography; Goals; Health; Health Policy; Health behavior; Housing; Income; Individual; Inequality; Intervention; Knowledge; Left; Life Expectancy; Link; Longevity; Medicaid; Medical; Methods; Modeling; Mortality Determinants; National Health Interview Survey; Outcome Study; Output; Pathway interactions; Pattern; Policies; Politics; Population; Public Health; Public Policy; Research; Resources; Risk; Sales; Science; Science Policy; Shapes; Smoking; Structure; Taxation; Taxes; Time; Tobacco; Transportation; Variant; Vulnerable Populations; Wages; Woman; age group; aged; authority; cohesion; discrete time; disorder control; education research; effective intervention; health disparity; healthy lifestyle; improved; insight; local economy; men; migration; mortality; premature; prevent; programs; social; social capital; social integration; socioeconomics; tobacco control; trend

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.

项目概要 教育程度是美国成人死亡风险最重要的社会决定因素之一。研究到 解释教育-死亡率关联更关注个体层面的“近端”机制 （例如吸烟）而不是确定支撑这种关联的背景条件。这个主要知识 差距对科学和公共政策产生影响；它限制了解释和干预的发现。 这种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， 美国对教育与死亡率关联的研究强调了代理机制： 人们认为更多的教育可以结合健康的生活方式、寻求医学知识、避免财务问题 困难等等。虽然主体解释很重要，但它们忽略了个体是 根植于影响教育对死亡率影响程度的社会和政治背景。 尽管大量研究表明欧洲确实存在这种情况，但美国的研究却很少。 本研究的目的是探讨美国各州教育与死亡率之间的关联如何以及为何存在差异。 州长和州立法机构做出的决定影响就业、住房、交通、社会 融合、健康的生活方式以及许多其他死亡率的社会决定因素。这些状态上下文有 经过几十年的放松管制和权力下放，它们变得越来越不同。这些趋势可以解释为什么， 到20世纪末，美国各州50岁预期寿命的范围超过了这个范围 在可比较的高收入国家中，美国各县预期寿命差异的 1/2 归因于他们所在的州。本研究解决了三个问题：（1） 教育与死亡率的关联因州和时间而异？ (2) 教育与死亡率的变化如何- 各州之间以及一段时间内的死亡率关联反映了国家政策、资源和机会结构？ (3) 国家政策、资源和机会结构通过哪些具体途径 塑造教育与死亡率的关联？中心假设是这种关联显着不同 在各州之间，经济政策进步、就业强劲的州表现最弱 机会和高度的社会凝聚力。该研究将使用 45-89 岁成年人的数据 1985-2011 年全国健康访谈调查相关死亡率档案。使用离散时间生存模型，它将 检查全因死亡率和特定原因死亡率。所有分析都将按性别、年龄组和时间进行分层 时期。分析考虑了州际迁移和县级死亡率差异，以更好地隔离 国家背景的重要性。本研究的预期结果包括： (a) 教育死亡率的估计 各国的关联，以及(b) 对各国可能采取的降低死亡率的政策和战略的见解 在他们的人口中。长期目标是降低成人死亡率，特别是弱势群体的死亡率。