Association Between Educational Attainment and Causes of Death Among White and Black US Adults, 2010-2017
Level 4 - case-series / case-control
Serial cross-sectional study of national vital registry mortality data
OpenAlex W2970330854 · doi:10.1001/jama.2019.11330
What was done
Serial cross-sectional study analyzing 4,690,729 deaths recorded in the US National Vital Statistics System in 2010 (n = 2,211,633) and 2017 (n = 2,479,096). The study evaluated White and Black non-Hispanic US adults stratified by sex, race/ethnicity, and educational attainment, calculating life expectancy at age 25 years and cause-specific years of life lost between ages 25 and 84 years.
What was found
Between 2010 and 2017, life expectancy at age 25 declined overall from 79.34 to 79.15 years (difference, -0.18 [95% CI, -0.23 to -0.14]). Decreases were concentrated in individuals with a high school degree or less (White men: -1.05 years [95% CI, -1.15 to -0.94]; White women: -1.14 years [95% CI, -1.24 to -1.04]; Black men: -0.30 years [95% CI, -0.56 to -0.04]) and White adults with some college but no 4-year degree (men: -0.89 years [95% CI, -1.07 to -0.73]; women: -0.59 years [95% CI, -0.77 to -0.42]). Conversely, life expectancy rose among college-educated adults (White men: +0.58 years [95% CI, 0.42 to 0.73]; White women: +0.78 years [95% CI, 0.57 to 1.00]; Black women: +1.70 years [95% CI, 0.91 to 2.53]). Increased life-years lost to drug use among those with a high school degree or less (White men: 0.93 years; White women: 0.50 years; Black men: 0.75 years; Black women: 0.28 years) accounted for much of the widening educational disparity.
Why it matters
This study shows that the stagnation and decline in overall US adult life expectancy during the 2010s was concentrated among adults without a 4-year college degree, driven largely by escalating drug-related mortality.
Limits
The study is observational and cross-sectional, precluding causal conclusions. Data rely on death certificate recordings, which carry potential misclassification of educational attainment and specific causes of death. The analysis was restricted to Black and White non-Hispanic adults, omitting Hispanic, Asian, and Indigenous populations.
Cited by
- context Attaining a college degree is associated with being twice as likely to get married, half as likely to commit suicide, three times as likely to become a millionaire, and three times less likely to be obese.