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Widening of socioeconomic inequalities in U.S. death rates, 1993-2001.

Jemal A, Ward E, Anderson RN, Murray T, Thun MJ - PLoS ONE (2008)

Bottom Line: Socioeconomic inequalities in death rates from all causes combined widened from 1960 until 1990 in the U.S., largely because cardiovascular death rates decreased more slowly in lower than in higher socioeconomic groups.The inequalities in all cause death rates between Americans with less than high school education and college graduates increased rapidly from 1993 to 2001 due to both significant decreases in mortality from all causes, heart disease, cancer, stroke, and other conditions in the most educated and lack of change or increases among the least educated.For white women, the all cause death rate increased significantly by 3.2 percent per year in the least educated and by 0.7 percent per year in high school graduates.

View Article: PubMed Central - PubMed

Affiliation: Epidemiology and Surveillance Research, American Cancer Society, Atlanta, Georgia, United States of America. ajemal@cancer.org

ABSTRACT

Background: Socioeconomic inequalities in death rates from all causes combined widened from 1960 until 1990 in the U.S., largely because cardiovascular death rates decreased more slowly in lower than in higher socioeconomic groups. However, no studies have examined trends in inequalities using recent US national data.

Methodology/principal findings: We calculated annual age-standardized death rates from 1993-2001 for 25-64 year old non-Hispanic whites and blacks by level of education for all causes and for the seven most common causes of death using death certificate information from 43 states and Washington, D.C. Regression analysis was used to estimate annual percent change. The inequalities in all cause death rates between Americans with less than high school education and college graduates increased rapidly from 1993 to 2001 due to both significant decreases in mortality from all causes, heart disease, cancer, stroke, and other conditions in the most educated and lack of change or increases among the least educated. For white women, the all cause death rate increased significantly by 3.2 percent per year in the least educated and by 0.7 percent per year in high school graduates. The rate ratio (RR) comparing the least versus most educated increased from 2.9 (95% CI, 2.8-3.1) in 1993 to 4.4 (4.1-4.6) in 2001 among white men, from 2.1 (1.8-2.5) to 3.4 (2.9-3-9) in black men, and from 2.6 (2.4-2.7) to 3.8 (3.6-4.0) in white women.

Conclusion: Socioeconomic inequalities in mortality are increasing rapidly due to continued progress by educated white and black men and white women, and stable or worsening trends among the least educated.

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Related in: MedlinePlus

Temporal trends in age-standardized death rates from all causes combined among 25–64 year old U.S. adults by educational attainment, 1993–2001.
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pone-0002181-g001: Temporal trends in age-standardized death rates from all causes combined among 25–64 year old U.S. adults by educational attainment, 1993–2001.

Mentions: Table 1 and Figure 1 show trends in death rates from all causes combined from 1993 through 2001 among white and black men and women, 25–64 years old, in relation to educational attainment. The all cause death rate decreased significantly during this interval among the most educated (≥16 years) men and women, with the largest decrease in black men. In contrast, the all cause death rate increased in those with less than a high school education. The annual percent increase was largest among white women with less than 12 years of education (3.2% per year), but was also statistically significant (0.7% per year) in white women who had completed high school (Table 1). Between 1993 and 2001, the ratio of the all cause death rate in persons with <12 years versus ≥16 years of education increased from 2.9 (95% CI, 2.8–3.1) to 4.4 (4.1–4.6) in white men, from 2.1 (1.8–2.5) to 3.4 (2.9–3–9) in black men, from 2.6 (2.4–2.7) to 3.8 (3.6–4.0) in white women and from 1.8 (1.5–2.1) to 2.0 (1.8–2.3) over this nine-year interval. Among black women this ratio increased, but the trend was not statistically significant.


Widening of socioeconomic inequalities in U.S. death rates, 1993-2001.

Jemal A, Ward E, Anderson RN, Murray T, Thun MJ - PLoS ONE (2008)

Temporal trends in age-standardized death rates from all causes combined among 25–64 year old U.S. adults by educational attainment, 1993–2001.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2367434&req=5

pone-0002181-g001: Temporal trends in age-standardized death rates from all causes combined among 25–64 year old U.S. adults by educational attainment, 1993–2001.
Mentions: Table 1 and Figure 1 show trends in death rates from all causes combined from 1993 through 2001 among white and black men and women, 25–64 years old, in relation to educational attainment. The all cause death rate decreased significantly during this interval among the most educated (≥16 years) men and women, with the largest decrease in black men. In contrast, the all cause death rate increased in those with less than a high school education. The annual percent increase was largest among white women with less than 12 years of education (3.2% per year), but was also statistically significant (0.7% per year) in white women who had completed high school (Table 1). Between 1993 and 2001, the ratio of the all cause death rate in persons with <12 years versus ≥16 years of education increased from 2.9 (95% CI, 2.8–3.1) to 4.4 (4.1–4.6) in white men, from 2.1 (1.8–2.5) to 3.4 (2.9–3–9) in black men, from 2.6 (2.4–2.7) to 3.8 (3.6–4.0) in white women and from 1.8 (1.5–2.1) to 2.0 (1.8–2.3) over this nine-year interval. Among black women this ratio increased, but the trend was not statistically significant.

Bottom Line: Socioeconomic inequalities in death rates from all causes combined widened from 1960 until 1990 in the U.S., largely because cardiovascular death rates decreased more slowly in lower than in higher socioeconomic groups.The inequalities in all cause death rates between Americans with less than high school education and college graduates increased rapidly from 1993 to 2001 due to both significant decreases in mortality from all causes, heart disease, cancer, stroke, and other conditions in the most educated and lack of change or increases among the least educated.For white women, the all cause death rate increased significantly by 3.2 percent per year in the least educated and by 0.7 percent per year in high school graduates.

View Article: PubMed Central - PubMed

Affiliation: Epidemiology and Surveillance Research, American Cancer Society, Atlanta, Georgia, United States of America. ajemal@cancer.org

ABSTRACT

Background: Socioeconomic inequalities in death rates from all causes combined widened from 1960 until 1990 in the U.S., largely because cardiovascular death rates decreased more slowly in lower than in higher socioeconomic groups. However, no studies have examined trends in inequalities using recent US national data.

Methodology/principal findings: We calculated annual age-standardized death rates from 1993-2001 for 25-64 year old non-Hispanic whites and blacks by level of education for all causes and for the seven most common causes of death using death certificate information from 43 states and Washington, D.C. Regression analysis was used to estimate annual percent change. The inequalities in all cause death rates between Americans with less than high school education and college graduates increased rapidly from 1993 to 2001 due to both significant decreases in mortality from all causes, heart disease, cancer, stroke, and other conditions in the most educated and lack of change or increases among the least educated. For white women, the all cause death rate increased significantly by 3.2 percent per year in the least educated and by 0.7 percent per year in high school graduates. The rate ratio (RR) comparing the least versus most educated increased from 2.9 (95% CI, 2.8-3.1) in 1993 to 4.4 (4.1-4.6) in 2001 among white men, from 2.1 (1.8-2.5) to 3.4 (2.9-3-9) in black men, and from 2.6 (2.4-2.7) to 3.8 (3.6-4.0) in white women.

Conclusion: Socioeconomic inequalities in mortality are increasing rapidly due to continued progress by educated white and black men and white women, and stable or worsening trends among the least educated.

Show MeSH
Related in: MedlinePlus