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Educational Disparities in Adult Mortality Across U.S. States: How Do They Differ, and Have They Changed Since the Mid-1980s?

  • Jennifer Karas MontezEmail author
  • Anna Zajacova
  • Mark D. Hayward
  • Steven H. Woolf
  • Derek Chapman
  • Jason Beckfield


Adult mortality varies greatly by educational attainment. Explanations have focused on actions and choices made by individuals, neglecting contextual factors such as economic and policy environments. This study takes an important step toward explaining educational disparities in U.S. adult mortality and their growth since the mid-1980s by examining them across U.S. states. We analyzed data on adults aged 45–89 in the 1985–2011 National Health Interview Survey Linked Mortality File (721,448 adults; 225,592 deaths). We compared educational disparities in mortality in the early twenty-first century (1999–2011) with those of the late twentieth century (1985–1998) for 36 large-sample states, accounting for demographic covariates and birth state. We found that disparities vary considerably by state: in the early twenty-first century, the greater risk of death associated with lacking a high school credential, compared with having completed at least one year of college, ranged from 40 % in Arizona to 104 % in Maryland. The size of the disparities varies across states primarily because mortality associated with low education varies. Between the two periods, higher-educated adult mortality declined to similar levels across most states, but lower-educated adult mortality decreased, increased, or changed little, depending on the state. Consequently, educational disparities in mortality grew over time in many, but not all, states, with growth most common in the South and Midwest. The findings provide new insights into the troubling trends and disparities in U.S. adult mortality.


Mortality Disparities Education Social determinants U.S. states 



This research was supported in part by Grant R01AG055481-01, Educational Attainment, Geography, and U.S. Adult Mortality Risk, awarded by the National Institute on Aging (PI: Montez); the Andrew Carnegie Foundation (PI: Montez); and Grant 5 R24 HD042849 awarded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development to the Population Research Center at the University of Texas at Austin (PI: Hayward). We thank three anonymous reviewers for exceptionally helpful comments on an earlier version of this paper. The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the Research Data Center, the National Center for Health Statistics, or the Centers for Disease Control and Prevention.

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Copyright information

© Population Association of America 2019

Authors and Affiliations

  • Jennifer Karas Montez
    • 1
    Email author
  • Anna Zajacova
    • 2
  • Mark D. Hayward
    • 3
  • Steven H. Woolf
    • 4
  • Derek Chapman
    • 4
  • Jason Beckfield
    • 5
  1. 1.Department of Sociology and Aging Studies InstituteSyracuse UniversitySyracuseUSA
  2. 2.Department of SociologyWestern UniversityLondonCanada
  3. 3.Department of Sociology and Population Research CenterUniversity of Texas at AustinAustinUSA
  4. 4.Department of Family Medicine and Population Health and the Center on Society and HealthVirginia Commonwealth UniversityRichmondUSA
  5. 5.Department of SociologyHarvard UniversityCambridgeUSA

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