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: 10188362
• 负责人: Jennifer Karas Montez
• 金额: $ 18.68万
• 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 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10188362
• 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; Financial Hardship; Gender; Geography; Goals; 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; Sales; Science; Science Policy; Shapes; Smoking; Structure; Taxation; Taxes; Time; Tobacco; Transportation; Variant; Vulnerable Populations; Wages; Woman; age group; aged; authority; discrete time; disorder control; education research; effective intervention; health disparity; health inequalities; healthy lifestyle; improved; insight; local economy; men; migration; mortality; mortality risk; premature; prevent; programs; social; social capital; social cohesion; social determinants; 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.

项目摘要 教育程度是美国成人死亡率风险的强大社会决定者之一。研究 解释教育年道道协会更多地关注个人级别的“近端”机制 （例如，吸烟）比确定属于关联的上下文条件。这主要知识 差距对科学和公共政策有后果；它限制了解释和干预措施的发现。 该差距可能反映了美国研究中的主要观点，即教育是个人资源。根据， 美国对教育女性协会的研究强调了代理机制： 人们认为更多的教育被认为可以使健康的生活方式结合在一起，寻求医学知识，避免财务 艰辛，等等。尽管代理解释很重要，但他们忽略了个人是 嵌入在影响教育对死亡率重要程度的社会和政治环境中。 尽管许多研究表明在欧洲情况，但在美国仍有很少的研究 这项研究的目的是研究如何以及为什么在美国各州各州的教育死亡率协会如何变化。 州长和州立法机关的决定影响就业，住房，运输，社会 整合，健康的生活方式以及对死亡率的许多其他社会决定。这些状态环境有 通过数十年的放松管制和权力下放，越来越不同。这些趋势可以解释为什么， 到20世纪末，美国州50岁的预期寿命超过了范围 在可比的高收入国家中，美国县的预期寿命差异是 归因于它们所在的状态。本研究解决了三个问题：（1） 教育年道道协会在各州和随着时间的流逝之间有所不同吗？（2）教育的差异如何 各州的死亡率关联，随着时间的流逝，反映了国家政策，资源和机会结构？ （3）国家政策，资源和机会结构的个人途径是什么 塑造教育女性协会？中心假设是该关联明显不同 整个州，并且在具有渐进式经济政策，强大的就业的州中最弱 机遇和高度社会凝聚力。该研究将使用受限制的45-89岁成年人的数据 1985- 2011年，全国健康访谈调查联系了死亡率文件。使用离散的时间生存模型，它将 检查全原因和特定原因死亡率。所有分析将按性别，年龄组和时间进行分层 时期。分析说明了州际迁移和县级死亡率差异，以更好地隔离 国家环境的重要性。这项研究的预期结果包括：（a）估计教育年代性 按州进行关联，以及（b）对政策和策略的见解 在他们的人口中。长期目标是降低成人死亡率，尤其是在弱势群体中。