Why Has the Educational Gradient in Mortality Increased among White U.S. Women? Examining the Contribution of Family, Psychosocial Resources, Behaviors, and Economics

Jennifer Karas Montez, Harvard University
Anna Zajacova, University of Wyoming

The inverse association between education and mortality risk (“the gradient”) in the U.S. is firmly established. Since the mid-1980s the gradient increased markedly for white women; however, little is known about underlying mechanisms. We use the National Health Interview Survey Linked Mortality File to examine the increasing gradient from 1986-2006 among non-Hispanic white women 45-84 years of age (N=230,692). We examine trends by cause of death and we assess the contribution of key mechanisms, including early-life conditions, marriage and spousal education, economic well-being, psychosocial well-being, and health behaviors. Results reveal that the gradient increased for deaths from lung cancer, chronic lower respiratory disease, cerebrovascular disease, diabetes, and Alzheimer’s disease; underlying trends in economic well-being (mainly employment status) and health behaviors (mainly smoking) were important contributors. Increasing the high school graduation rate and (re)designing work-family policies that allow all women to secure desirable employment may reduce the widening mortality gap.