Trends in mortality risk by education level and cause of death among US White women from 1986 to 2006

Am J Public Health. 2013 Mar;103(3):473-9. doi: 10.2105/AJPH.2012.301128. Epub 2013 Jan 17.


Objectives: To elucidate why the inverse association between education level and mortality risk (the gradient) has increased markedly among White women since the mid-1980s, we identified causes of death for which the gradient increased.

Methods: We used data from the 1986 to 2006 National Health Interview Survey Linked Mortality File on non-Hispanic White women aged 45 to 84 years (n = 230 692). We examined trends in the gradient by cause of death across 4 time periods and 4 education levels using age-standardized death rates.

Results: During 1986 to 2002, the growing gradient for all-cause mortality reflected increasing mortality among low-educated women and declining mortality among college-educated women; during 2003 to 2006 it mainly reflected declining mortality among college-educated women. The gradient increased for heart disease, lung cancer, chronic lower respiratory disease, cerebrovascular disease, diabetes, and Alzheimer's disease. Lung cancer and chronic lower respiratory disease explained 47% of the overall increase.

Conclusions: Mortality disparities among White women widened across 1986 to 2006 partially because of causes of death for which smoking is a major risk factor. A comprehensive policy framework should address the social conditions that influence smoking among disadvantaged women.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cause of Death / trends*
  • Cross-Sectional Studies
  • Educational Status*
  • Female
  • Health Status Disparities
  • Humans
  • Middle Aged
  • Mortality / trends*
  • Risk Factors
  • United States / epidemiology
  • White People / statistics & numerical data*
  • Women*