The Contribution of Drug Overdose to Educational Gradients in Life Expectancy in the United States, 1992–2011

Abstract

Since the mid-1990s, the United States has witnessed a dramatic rise in drug overdose mortality. Educational gradients in life expectancy widened over the same period, and drug overdose likely plays a role in this widening, particularly for non-Hispanic whites. The contemporary drug epidemic is distinctive in terms of its scope, the nature of the substances involved, and its geographic patterning, which influence how it impacts different education groups. I use vital statistics and National Health Interview Survey data to examine the contribution of drug overdose to educational gradients in life expectancy from 1992–2011. I find that over this period, years of life lost due to drug overdose increased for all education groups and for both males and females. The contribution of drug overdose to educational gradients in life expectancy has increased over time and is greater for non-Hispanic whites than for the population as a whole. Drug overdose accounts for a sizable proportion of the increases in educational gradients in life expectancy, particularly at the prime adult ages (ages 30–60), where it accounts for 25 % to 100 % of the widening in educational gradients between 1992 and 2011. Drug overdose mortality has increased more rapidly for females than for males, leading to a gender convergence. These findings shed light on the processes driving recent changes in educational gradients in life expectancy and suggest that effective measures to address the drug overdose epidemic should take into account its differential burden across education groups.

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Fig. 1
Fig. 2

Notes

  1. 1.

    This is related to the release of an abuse-deterrent reformulation of OxyContin in 2010 and significant increases in the availability of cheap, high-grade heroin throughout the United States.

  2. 2.

    In this article, I focus on the more-educated as one particular group of social elites.

  3. 3.

    These are deaths for which the underlying cause of death was ICD-9 codes E850–E858, E950.0–E950.5, E962.0, or E980.0–E980.5 prior to 1999 and ICD-10 codes X40–X44, X60–X64, X85, and Y10–Y14 from 1999 onward.

  4. 4.

    Fewer than 700 accidental poisoning deaths were recorded in the 1986–2004 NHIS files.

  5. 5.

    The latter measure is informative because it captures the ages at which drug overdose mortality rates are highest and have increased the most over time (see Fig. 3 in the appendix, with the online version of the article showing the figure in color), and it is less sensitive to issues of age misreporting and changes in institutionalization at older ages.

  6. 6.

    This is partly related to differences in opioid prescribing by race/ethnicity. Blacks, Hispanics, and Asians are less likely than whites to receive opioid prescriptions, even controlling for pain severity (Burgess et al. 2014; Pletcher et al. 2008). Even if they are prescribed opioids, nonwhites are more likely to live in areas where they cannot obtain them. One study in New York City found that only 25 % of pharmacies in predominantly nonwhite neighborhoods carried sufficient supplies of opioids to treat severe pain compared with 72 % of pharmacies in predominantly white neighborhoods (Morrison et al. 2000).

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Acknowledgments

The author thanks Arun Hendi for helpful comments on earlier drafts of this article. The author is grateful to the National Center for Health Statistics for the use of the restricted-use microdata files for mortality. This research was supported in part by the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) of the National Institutes of Health under Award Number K99 HD083519.

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Correspondence to Jessica Y. Ho.

Appendix

Appendix

Table 4 Life expectancy at age 25 and years of life lived between ages 30 and 60 in the absence of drug overdose, three variants
Table 5 Drug overdose death as a percentage of total deaths by age, education, and sex, select years in 1992–2011
Fig. 3
figure3

Age-specific death rates (per 100,000) from drug overdose by education, 1992–1996 and 2007–2011. Estimates are based on data from the CDC/NCHS Multiple Cause-of-Death files (CDC and NCHS 2000/2003, 2015) and the National Health Interview Survey (NHIS). LHS = less than high school, HS = high school, SC = some college, COL = college or more

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Ho, J.Y. The Contribution of Drug Overdose to Educational Gradients in Life Expectancy in the United States, 1992–2011. Demography 54, 1175–1202 (2017). https://doi.org/10.1007/s13524-017-0565-3

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Keywords

  • Life expectancy
  • Educational gradients
  • Drug overdose