A new study finds a gap in overall death rates between Americans with less than high school education and college graduates increased rapidly from 1993 to 2001. The study says the widening gap was due to significant decreases in mortality from all causes, heart disease, cancer, stroke, and other conditions, in the most educated while death rates among the least educated remained relatively unchanged. The study is the first to examine recent trends in socioeconomic inequalities in mortality from all causes as well as several leading causes of death in the United States using national individual-level socioeconomic measures.
American Cancer Society epidemiologists led by Ahmedin Jemal, Ph.D., working with scientists from the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS) used data from the National Vital Statistics System (NVSS) and death certificate information to analyze more than 3.5 million deaths recorded from 1993 to 2001. They found the overall death rate from all causes decreased significantly during the time period among the most educated (e16 years) men and women, with the largest decrease in black men. In contrast, the all cause death rate actually increased in those with less than a high school education.
The annual percent increase was largest among white women with less than 12 years of education (3.2 percent per year), but was also statistically significant (0.7 percent per year) in white women who had completed high school. The authors say the growing gap was caused largely by an unprecedented decrease in the all-cause death rate among the most educated men (totaling 36 percent in black men and 25 percent in white men over the nine-year interval) largely due to decreases in death rates from HIV infection, cancer, and heart disease.
"This study finds the socioeconomic inequalities in mortality rates are not only failing to drop, they are actually increasing in the U.S.," said Otis W. Brawley, M.D., American Cancer Society chief executive officer. "People with less education have fewer financial resources, less access to health insurance or stable employment, and less health literacy. As a result, while the death rate among the most educated Americans is dropping dramatically, we're seeing a real lack of progress or even worsening trends in the least educated persons. The gap between the best and worst off in the country is actually getting wider."
- Jemal A, Ward E, Anderson RN, Murray T, Thun MJ (2008) Widening of Socioeconomic Inequalities in U.S. Death Rates, 1993--2001. PLoS ONE 3(5): e2181. doi:10.1371/journal.pone.0002181 [link]
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