Harvard Medical School
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Harvard Medical School Office of Public Affairs
Life expectancy rises for the educated; the less-educated reap no benefit
While life-expectancy has increased significantly for educated people over the last twenty years, it has plateaued for less educated people. In other words, those whose education level does not exceed high school have not been sharing the benefits of prolonged lifespan. This is the case for both African Americans and Caucasians. Deaths related to tobacco use account for at least one-fifth of the growth in mortality differences by education that create this life-expectancy gap.
Numerous policies in the United States are aimed at reducing health disparities. Still, the educational gap in life expectancy is rising despite all the funds directed at groups with lower socioeconomic status.
“We like to think that as we as a country get healthier, everyone benefits,” says David Cutler, dean for social sciences at the Faculty of Arts and Sciences at Harvard University, and study co-author. “Here we’ve found that you can have a rising tide that only lifts half the boats—and the ones lifted are the ones doing better to begin with.”
The research, which was conducted by Cutler and Ellen Meara, assistant professor of health care policy at Harvard Medical School, appears in the March/April edition of the journal Health Affairs.
Over the years, much attention has been paid to mortality rates based on socio-economic status, but less attention has been paid to recent trends in life expectancy, mortality, and education level. To understand recent mortality trends, Meara and Cutler combined death certificate data with census population estimates and data from the National Longitudinal Mortality Study. Restricting analyses to whites and non-Hispanic blacks, the team created two separate data sets, one covering 1981-1988, and the other 1990-2000.
In both data sets, life expectancy rose for individuals who had more than 12 years of education. For those with 12 years or less, it plateaued.
For example, comparing the 1980s to the 1990s, better educated individuals experienced nearly a year and a half of increased life expectancy, while the less educated experienced only half a year. For 1990-2000, life expectancy rose an additional 1.6 years for better educated, while remaining fixed for the less educated.
In addition, when the data was broken down by gender, the researchers found that women fared worse than men. Less educated women, regardless of race, experienced a slight decline in life expectancy at age 25.
Overall in the groups studied, as of 2000, better educated at age 25 could expect to live to age 82; for less educated, 75.
“Although improvements in health often occur more rapidly within some groups than others, it is surprising that life expectancy remained so flat for the less educated during periods when others enjoyed dramatic gains in longevity,” says Meara.
The researchers found that much of the mortality gap can be attributed to smoking related illnesses. Just two diseases usually caused by smoking, lung cancer and chronic obstructive pulmonary disorder (which comprises chronic bronchitis and emphysema), account for 20 percent of growing mortality differences in the 1990s. Many other illnesses like heart disease and other types of cancer, also count smoking as contributing factors. The importance of smoking is not surprising, since other data has shown that the less educated have not given up smoking to the same extent that those with more education have. (Other causes of death examined were diseases of the heart, non-lung cancers, stroke, and unintentional injuries.)
“There’s a bit of complacency in the fact that year after year lifespan goes up,” says Cutler. “Our data shows us that we need to start thinking about doing much more for the groups at the bottom if we don’t want to see these gaps grow.”
This research was funded by the National Institute on Aging and the National Institute on Drug Abuse.
Written by David Cameron
March/April, Vol. 27, No. 2, 2008
“The Gap Gets Bigger: Changes in Mortality and Life Expectancy, by Education, 1981-2000”
Ellen Meara(1), Seth Richards(2), and David Cutler(3)
David Cameron (Harvard Medical School)
Harvard Medical School has more than 7,500 full-time faculty working in 11 academic departments located at the School's Boston campus or in one of 47 hospital-based clinical departments at 17 Harvard-affiliated teaching hospitals and research institutes. Those affiliates include Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Cambridge Health Alliance, Children's Hospital Boston, Dana-Farber Cancer Institute, Forsyth Institute, Harvard Pilgrim Health Care, Joslin Diabetes Center, Judge Baker Children's Center, Immune Disease Institute, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital, and VA Boston Healthcare System.