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Life expectancy and education: evidence from the cardiovascular revolution

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Abstract

This paper exploits the unexpected decline in the death rate from cardiovascular diseases since the 1970s as a large positive health shock that affected predominantly old-age mortality; i.e. the fourth stage of the epidemiological transition. Using a difference-in-differences estimation strategy, we find that US states with higher mortality rates from cardiovascular disease prior to the 1970s experienced greater increases in adult life expectancy and higher education enrollment. Our estimates suggest that a one-standard deviation higher treatment intensity is associated with an increase in adult life expectancy of 0.37 years and 0.07–0.15 more years of higher education.

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Fig. 1

Data source: National Heart, Lung, and Blood Institute

Fig. 2
Fig. 3

Source: columns 3 and 6 in Table 4

Fig. 4

Source: column 3 in Table 4

Fig. 5

Source: column 6 in Table 4

Fig. 6

Source: column 6 in Table 5

Fig. 7

Source: column 3 in Table 5

Fig. 8

Source: column 6 in Table 5

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Notes

  1.   For example, for white U.S. American men, the incidence of heart attack or fatal coronary heart disease is about 4% in the 55–64 age bracket and almost 8 and 12% in the 65–74 and 75–84 age brackets, respectively; see Mozaffarian et al. (2015).

  2.   In biology, aging is understood as the “intrinsic, cumulative, progressive, and deleterious loss of function that eventually culminates in death” (Arking 2006). For an introduction to the evolutionary foundations of human aging, see Kirkwood (1999). For a detailed formal description of the aging process by reliability theory, see Gavrilov and Gavrilova (1991).

  3.   For all variables derived from IPUMS, we apply the personal weight (PERWT) to ensure representativeness.

  4.   Data on College Enrollment II in 1960 are missing for the following states: Delaware, Idaho, Montana, North Dakota, South Dakota, Vermont, and Wyoming. In the baseline, we interpolate missing values, however, similar results are obtained if these are kept as missing observations.

  5.   The color-groups correspond to quantiles of the distribution of CVD mortality in 1960, such that each color contains 12 states. Appendix Figure 2 in the online appendix shows a map of the same variable, but where states have been grouped into nine equally sized intervals of CVD.

  6.   We obtain similar results if Initial Income is derived for the age group 30–65.

  7. Throughout the analysis, the regressions include state and year fixed effects and are weighted by the size of white population in 1960.

  8. The estimated coefficients of these control variable interactions are not reported in the tables to save space. The estimates for Initial Mortality show, for example, that life expectancy at age 30 was increasing more from 1940 to 1950 for states with higher Initial Mortality, whereas from 1950 onwards, there are no trend differences. These estimates are available upon request.

  9.   Appendix Figures 5 and 6 graph partial correlation plots without the baseline controls, which then corresponds to the specifications in column(1) and (4) of Table 4.

  10. Redefining the continuous measure of treatment into an indicatorwhich equals one/zero if states have a CVD-mortality rate higher/lower than the sample median suggests that high-CVD states experienced 0.53 years increase in life expectancy at age 30 relative to low-CVD states in 2000 relative to 1960 (see Appendix Table 9 in the online appendix).

  11. Data from the National Heart, Lung, and Blood Institute indicate that the cardiovascular disease mortality rate decreased by about 50% from 1960–2000.

  12.   If we do not condition on state fixed effects, we find that average adult life expectancy of the treatment states are converging towards the control states after 1960.

  13.   Appendix Figure 4 in the online appendix depicts the state-demeaned development of average College Enrollment II from 1940 to 2000, where states have been grouped according to whether their treatment value is below or above the sample median (as we also did for adult life expectancy). In line with the estimates in Table 5, pretreatment trends are similar between the two groups, while only after the 1960s does the treatment group catch up and overtake the control group in terms of the average enrollment rate. In addition, Appendix Figures 7 and 8 graph partial correlation plots without the baseline controls, which then corresponds to the specifications in column (1) and (4) of Table 5.

  14.   We show in the Online Appendix that the results for adult life expectancy and higher education enrollment are robust to the inclusion of state-specific linear time trends.

  15. We only report robustness checks for the variables where we have established a significant effect of the cardiovascular revolution in the baseline specification.

  16. We do so in practice by interacting these cross-sectional state characteristics with a full set of year fixed effects.

  17. This also partially addresses the issue of population sorting caused by the shock we are considering. In particular, in an unreported specification, we show that CVD is actually able to explain time variation in migration rates, however, this effect completely disappears once we control for Initial Migration interacted with a full set of year fixed effects.

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Authors and Affiliations

  1. Department of Economics, University of Copenhagen, Øster Farimagsgade 5, Building 26, 1353, Copenhagen, Denmark

    Casper Worm Hansen

  2. Department of Economics, University of Goettingen, Platz der Goettinger Sieben 3, 37073, Göttingen, Germany

    Holger Strulik

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  1. Casper Worm Hansen
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  2. Holger Strulik
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Correspondence to Holger Strulik.

Additional information

We would like to thank Carl-Johan Dalgaard, Peter Sandholt Jensen, Sophia Kan, Lars Lønstrup, Uwe Sunde, participants at the 2015 EEA congress in Mannheim, and three anonymous referees for helpful comments.

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Hansen, C.W., Strulik, H. Life expectancy and education: evidence from the cardiovascular revolution. J Econ Growth 22, 421–450 (2017). https://doi.org/10.1007/s10887-017-9147-x

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