Trends in Mortality Risk by Education Level and Cause of Death Among US White Women From 1986 to 2006

Jennifer Karas Montez, Anna Zajacova

doi:10.2105/ajph.2012.301128

<jats:p> Objectives. To elucidate why the inverse association between education level and mortality risk (the gradient) has increased markedly among White women since the mid-1980s, we identified causes of death for which the gradient increased. </jats:p><jats:p> Methods. We used data from the 1986 to 2006 National Health Interview Survey Linked Mortality File on non-Hispanic White women aged 45 to 84 years (n = 230 692). We examined trends in the gradient by cause of death across 4 time periods and 4 education levels using age-standardized death rates. </jats:p><jats:p> Results. During 1986 to 2002, the growing gradient for all-cause mortality reflected increasing mortality among low-educated women and declining mortality among college-educated women; during 2003 to 2006 it mainly reflected declining mortality among college-educated women. The gradient increased for heart disease, lung cancer, chronic lower respiratory disease, cerebrovascular disease, diabetes, and Alzheimer’s disease. Lung cancer and chronic lower respiratory disease explained 47% of the overall increase. </jats:p><jats:p> Conclusions. Mortality disparities among White women widened across 1986 to 2006 partially because of causes of death for which smoking is a major risk factor. A comprehensive policy framework should address the social conditions that influence smoking among disadvantaged women. </jats:p>

Trends in Mortality Risk by Education Level and Cause of Death Among US White Women From 1986 to 2006

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