Widening Educational Disparities in Premature Death Rates in Twenty Six States in the United States, 1993–2007

<div><h3>Background</h3><p>Eliminating socioeconomic disparities in health is an overarching goal of the U.S. Healthy People decennial initiatives. We present recent trends in mortality by education among working-aged populations.</p> <h3>Methods and Findings</h3><p>Age-standardized death rates and their average annual percent change for all-cause and five major causes (cancer, heart disease, stroke, diabetes, and accidents) were calculated from 1993 through 2007 for individuals aged 25–64 years by educational attainment as a marker of socioeconomic status, using national vital registration data for 26 states with consistent educational information on the death certificates. Rate ratios and rate differences were used to assess disparities (≤12 versus ≥16 years of education) for 1993 through 2007. From 1993 through 2007, relative educational disparities in all-cause mortality continued to increase among working-aged men and women in the U.S., due to larger decreases of mortality rates among the most educated coupled with smaller decreases or even worsening trends in the less educated. For example, the rate ratios of all-cause mortality increased from 2.5 (95% confidence interval (CI), 2.4–2.6) in 1993 to 3.6 (95% CI, 3.5–3.7) in 2007 in men and from 1.9 (95% CI, 1.8–2.0) to 3.0 (95% CI, 2.9–3.1) in women. Generally, the rate differences (per 100,000 persons) of all-cause mortality increased from 415.5 (95% CI, 399.1–431.9) in 1993 to 472.7 (95% CI, 460.2–485.2) in 2007 in men and from 165.4 (95% CI, 154.5–176.2) to 256.2 (95% CI, 248.3–264.2) in women. Disparity patterns varied largely across the five specific causes considered in this study, with the largest increases of relative disparities for accidents, especially in women.</p> <h3>Conclusions</h3><p>Relative educational differentials in mortality continued to widen among men and women despite emphasis on reducing disparities in the U.S. Healthy People decennial initiatives.</p> </div

Educational Distribution of Population and Cause of Death Fractions by Gender in 1993 and 2007.

<p>Educational Distribution of Population and Cause of Death Fractions by Gender in 1993 and 2007.</p

Relative and Absolute Disparities in Mortality by Educational Attainment in 1993, 2001, and 2007.

<p>Abbreviation: CI, Confidence Interval; RR, Relative Risk; RD, Rate Difference.</p>*<p>≤12 years of education Vs. ≥16 years of education.</p

Temporal Changes of Educational Disparities in Mortality from All Causes and Five Major Causes in 26 U.S. States, 1993–2007.

<p>Temporal Changes of Educational Disparities in Mortality from All Causes and Five Major Causes in 26 U.S. States, 1993–2007.</p

Temporal Trends in Relative Educational Disparities Measured by Relative Risk (RR) and Relative Index of Inequality (RII).

<p>Temporal Trends in Relative Educational Disparities Measured by Relative Risk (RR) and Relative Index of Inequality (RII).</p

Temporal Trends in Absolute Educational Disparities Measured by Rate Difference (RD) and Slope Index of Inequality (SII).

<p>Temporal Trends in Absolute Educational Disparities Measured by Rate Difference (RD) and Slope Index of Inequality (SII).</p

Trends in Age-Standardized Death Rates from All Causes and Five Major Causes by Educational Attainment in 26 U.S. States, 1993–2007.

<p>Trends in Age-Standardized Death Rates from All Causes and Five Major Causes by Educational Attainment in 26 U.S. States, 1993–2007.</p