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Recent research 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 (American Sociological Review, December 2011).
For decades data have shown that middle-aged adults with low education levels (high school or less) are twice as likely to die as those with higher education levels. Richard Miech, PhD, of the Department of Health and Behavioral Sciences at the University of Colorado, 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 Dr. 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," he said. "They have been replaced by heart disease, cancer and stroke.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. However, this progress was countered by the increasing role of drug overdose deaths. Overall, the study found, 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.
The research 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 be predominant in the future.
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