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The Benefits of Educational Attainment for U.S. Adult Mortality: Are they Contingent on the Broader Environment?

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Abstract

The growing recognition that educational attainment is one of the strongest preventive factors for adult health and longevity has fueled an interest in educational attainment as a population health strategy. However, less attention has been given to identifying social, economic, and behavioral resources that may moderate the health and longevity benefits of education. We draw on theories of resource substitution and multiplication to examine the extent to which the education–mortality association is contingent on other resources (marriage, employment, income, healthy lifestyles). We use data on adults aged 30–84 in the 1997–2006 National Health Interview Survey Linked Mortality File and estimate discrete-time event history models stratified by gender (N = 146,558; deaths = 10,399). We find that the mortality benefits of education are generally largest for adults—especially women—who have other resources such as employment and marriage, supporting the theory of resource multiplication. Nonetheless, our results also imply that other resources can potentially attenuate the mortality disadvantages (advantages) associated with low (high) levels of education. The findings suggest that efforts to improve population health and longevity by raising education levels should be augmented with strategies that assure widespread access to social, economic, and behavioral resources.

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Notes

  1. Given our aims, we focus on studies that examined interactions between education and social, economic, and behavioral resources, rather than interactions between two non-education resources, such as employment and children (e.g., Montez et al. 2015), employment and family households (e.g., Denney 2014), and employment, marriage, and children (e.g., Verbrugge 1983).

  2. While education’s benefits for longevity appear to be greater among men than women, its benefits for health appear to be greater among women (Ross and Mirwosky 2006; Ross et al. 2012).

  3. Some studies of working-age adults have used the NHIS household roster to identify the presence of minor children (e.g., Denney 2014; Montez et al. 2015). We do not include this information due to the age range of our sample, with very few respondents over the age of 60 living with minor children. Moreover, like many studies, both Denney (2014) and Montez et al (2015) find that marriage has a much stronger moderating effect on mortality than do children in the household.

  4. We chose a discrete-time method because the public-use NHIS-LMF only provides quarter and year of death. More importantly, we chose logistic regression over Cox proportional hazards models—two common methods of survival analysis—because we wanted to estimate probabilities of death from the covariates. In Cox models, the baseline hazard rate is unspecified and absorbs the intercept term; thus, the models do not provide a direct estimate of the model intercept which is needed to estimate probabilities of death (Box-Steffensmeier and Jones 2004). The use of logistic regression to estimate log-odds and probabilities of death from a person-time data structure is a common method in survival analysis (see Allison 1995). We conducted preliminary analyses (available on request) to ensure our model estimates are comparable to the National Center for Health Statistics.

  5. Probabilities are estimated for non-Hispanic white women aged 60 with no work limitations.

  6. To glean some insights into whether our results were robust across age groups, in ancillary analyses we estimated the models in Tables 2 and 3 for two broad groups (ages 30–64 and 65–84) using a continuous measure of education. This measure is not ideal because several studies have found the education–mortality association among U.S. adults is non-linear (Backlund et al. 1999; Everett et al. 2013; Hayward et al. 2015; Montez et al. 2012). However, we had to use the linear measure because the categorical measure created sparse education-by-resource cells in the age-stratified analyses. The analyses generally corroborate our main findings. The mortality benefits of education were largest for adults with other resources such as marriage and employment, supporting the theory of resource multiplication, with stronger support for the younger than older age group as anticipated.

    Table 3 Coefficients predicting the log-odds of death among non-Hispanic white and black men aged 30–84 years
    Full size table

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  1. Department of Sociology and Aging Studies Institute, Syracuse University, 314 Lyman Hall, Syracuse, NY, 13244, USA

    Jennifer Karas Montez

  2. Department of Sociology, Case Western Reserve University, 226 Mather Memorial Building, Cleveland, OH, 44106, USA

    Kaitlyn Barnes

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Montez, J.K., Barnes, K. The Benefits of Educational Attainment for U.S. Adult Mortality: Are they Contingent on the Broader Environment?. Popul Res Policy Rev 35, 73–100 (2016). https://doi.org/10.1007/s11113-015-9377-6

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