Testing for changes in the SES-mortality gradient when the distribution of education changes too

Area of Science:

• Sociology
• Public Health
• Biostatistics

Background:

• The socioeconomic status (SES)-mortality gradient, a key indicator of health inequality, is influenced by education.
• Changes in the distribution of education may affect the observed SES-mortality gradient over time.
• Previous research has suggested significant changes in the SES-mortality gradient, but methodological limitations exist.

Purpose of the Study:

• To develop and implement a flexible statistical test to assess changes in the SES-mortality gradient.
• To account for shifts in educational attainment when evaluating the SES-mortality relationship.
• To provide a more accurate estimation of trends in health disparities linked to socioeconomic status.

Main Methods:

• Developed a novel statistical methodology to test for changes in the SES-mortality gradient.
• Utilized US microdata from 1984-2006, linking Census and survey data with death records.
• Applied the flexible test to analyze the relationship between education and mortality over time.

Main Results:

• The evidence for a substantial change in the overall SES-mortality gradient was weaker than previously reported.
• An increasing SES-mortality gradient was observed for females between 1984 and 2006.
• No significant change in the SES-mortality gradient was detected for males during the study period.
• Changes in the female gradient appeared concentrated among those with lower educational attainment.

Conclusions:

• The flexible test provides a more nuanced understanding of trends in SES-related health inequalities.
• The SES-mortality gradient has evolved differently for males and females in the US.
• Educational shifts play a critical role in interpreting changes in the SES-mortality gradient, particularly for women.