Mortality Trends by Education in the United States and Europe: Is the U.S. Lagging Behind?

Karen van Hedel, Erasmus Medical Centre, Rotterdam
Frank Van Lenthe, Erasmus Medical Centre, Rotterdam
Johan P. Mackenbach, Erasmus Medical Centre, Rotterdam

Trends in mortality between the United States (US) and Europe have been diverging in recent times. Although mortality for the whole US population has been declining, there is evidence of an educational gradient. While mortality among the higher educated has decreased, it increased among the lower educated. The question is whether this educational gradient is larger in the US than in other high-income countries. We hypothesize that diverging trends in mortality between the US and Europe are driven primarily by the higher mortality among lower socioeconomic group in the US as compared to their European counterparts. We use data from the US National Health Interview Survey, and census data linked to mortality registries for 15 European countries to examine international differences in trends in mortality by education over the period 1990 to 2005. We predict that diverging trends in mortality can be explained by the larger educational gradient found in the US than in other high-income countries.