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

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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.