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

项目摘要 教育程度是美国成年人死亡风险的最强社会决定因素之一。研究来 解释教育与死亡率的关联更关注于个人层面的“近端”机制 (e.g.,吸烟），而不是识别支撑这种关联的背景条件。这一重大知识 差距对科学和公共政策有影响;它限制了解释和干预的发现。 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，委员会认为， 美国教育-死亡率关系的研究强调了代理机制： 更多的教育被认为是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。虽然代理解释是重要的，他们忽略了一个事实，即个人是 这一现象植根于社会和政治背景，影响教育对死亡率的影响程度。 尽管许多研究表明欧洲的情况就是如此，但美国的研究却很少。 这项研究的目的是研究教育与死亡率之间的关联如何以及为什么在美国各州有所不同。 州长和州立法机构的决定影响到就业、住房、交通、社会福利、 社会融合、健康的生活方式以及其他许多死亡率的社会决定因素。这些国家背景下， 在几十年的放松管制和权力下放中变得越来越分散。这些趋势可以解释为什么， 到世纪末，美国各州50岁时的预期寿命超过了 在可比的高收入国家中，美国各县预期寿命的差异有一半是 他们所处的国家，本研究主要探讨三个问题：（1） 教育与死亡率之间的关联在各州和不同时期都有不同，(2)教育中的差异- 各州之间以及随着时间的推移，死亡率的关联反映了州的政策、资源和机会结构， 以及（3）国家政策、资源和机会结构通过什么途径 塑造教育与死亡率的关联？核心假设是，这种关联明显不同 在各州，它是最弱的国家与进步的经济政策，强劲的就业 机会和高度的社会凝聚力。这项研究将使用年龄在45-89岁之间的成年人的数据， 1985-2011年全国健康访谈调查关联死亡率文件。使用离散时间生存模型，它将 检查全因和特定原因死亡率。所有分析将按性别、年龄组和时间分层 期分析说明了州际移民和县级死亡率的变化，以更好地隔离 国家背景的重要性。这项研究的预期成果包括：（a）估计教育死亡率 各州的关联，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。

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.