Trends and group differences in the association between educational attainment and U.S. adult mortality: implications for understanding education's causal influence

Soc Sci Med. 2015 Feb;127:8-18. doi: 10.1016/j.socscimed.2014.11.024. Epub 2014 Nov 20.


Has the shape of the association between educational attainment and U.S. adult mortality changed in recent decades? If so, is it changing consistently across demographic groups? What can changes in the shape of the association tell us about the possible mechanisms in play for improving health and lowering mortality risk over the adult life course? This paper develops the argument that societal technological change may have had profound effects on the importance of educational attainment - particularly advanced education - in the U.S. adult population for garnering health advantages and that these changes should be reflected in changes in the functional form of the association between educational attainment and mortality. We review the historical evidence on the changing functional form of the association, drawing on studies based in the United States, to assess whether these changes are consistent with our argument about the role of technological change. We also provide an updated analysis of these functional form patterns and trends, contrasting data from the early 21st Century with data from the late 20th Century. This updated evidence suggests that the shape of the association between educational attainment and U.S. adult mortality appears to be reflecting lower and lower adult mortality for very highly educated Americans compared to their low-educated counterparts in the 21st Century. We draw on this review and updated evidence to reflect on the question whether education's association with adult mortality has become increasingly causal in recent decades, why, and the potential research, policy, and global implications of these changes.

Keywords: Adult mortality; Causal effect; Educational disparities; Functional form; Historical trends; Race and gender differences.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Causality*
  • Cross-Sectional Studies
  • Educational Status
  • Health Status
  • Health Surveys
  • Humans
  • Middle Aged
  • Mortality / ethnology
  • Mortality / trends*
  • Racial Groups / statistics & numerical data
  • Sex Factors
  • Social Determinants of Health*
  • Socioeconomic Factors
  • United States / epidemiology