A study in the December issue of the American Sociological Review has brought new understanding as to why death rates for less educated middle aged adults are much higher than for their more educated peers despite increased awareness and treatments aimed at reducing health disparities.
For decades, data has shown that middle aged adults with low education levels—that is high school or less—are twice as likely to die as those with higher education levels. Professor Richard Miech, of the Department of Health and Behavioral Sciences at the University of Colorado Denver's College of Liberal Arts and Sciences, and his colleagues wanted to better understand why this persists. They found that as new causes of death emerge, people with lower education levels are slower to respond with behavioral changes, creating a moving target that often remains a step ahead of prevention. Almost all causes of death that are on the increase are fueled by high rates of mortality among people with lower education, a trend that counters any progress made in the reduction of today's health disparities.
"Money, power, prestige, knowledge, and beneficial social connections allow people of higher education status to take better advantage of health developments," said Miech.
Despite efforts to reduce education-based mortality disparities, the gap remains because new health disparities counteract the efforts to reduce the death rates for those with less education. While the causes of death have changed, rates have not.
"One hundred years ago, the top causes of death were tuberculosis, diarrhea, and pneumonia," said Miech. "They've been replaced by heart disease, cancer, and stroke. But, one thing that hasn't changed is that people with lower levels of education continue to be the ones dying at greater rates."
For example, from 1999 to 2007 heart attacks came to play less of a role in mortality disparities by education, but this progress was countered by an increasing role for drug overdose deaths. The study finds that overall, mortality disparities by education today would be about 25 percent smaller than their current levels if new disparities had not emerged or widened since 1999.
This work points to the importance of preventing new disparities from emerging and growing as well as the importance of reducing the prominent ones of today. Without such prevention efforts, any progress in reducing disparities will be short lived as new disparities assert themselves in the causes of death that will come to predominate in the future.
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