Long-term Economic Distress and Growing Educational Inequity in Life Expectancy.

Area of Science:

• Public Health
• Economics
• Sociology

Background:

• Educational inequity in US life expectancy was increasing before the COVID-19 pandemic.
• Adverse labor market conditions due to globalization and technological change may have impacted less-educated workers.
• The link between labor market changes and mortality disparities had not been previously tested.

Purpose of the Study:

• To estimate the relationship between macroeconomic restructuring and diverging mortality trends.
• To analyze these trends by race, sex, and education level.
• To test the hypothesis that long-term adverse labor market conditions contributed to educational inequity in life expectancy.

Main Methods:

• Utilized spatiotemporal variation in mortality and economic conditions at the year and commuting zone level (1990-2017).
• Defined macroeconomic restructuring based on an area's baseline industrial mix, considered exogenous to mortality.
• Examined mortality trends across different racial, sex, and education groups.

Main Results:

• Commuting zones with long-term economic stagnation showed substantially worse mortality trends.
• The association between economic stagnation and mortality was strongest in the lowest education quartile for both White and Black adults.
• Living in areas with better economic conditions was associated with 1-2 additional years of life (ages 25-84) compared to areas with poor economic conditions.
• Mediating causes of death included cancer, cardiovascular diseases, and other internal body system diseases; suicide and substance abuse were not significant contributors.

Conclusions:

• Diverging US life expectancy trends are associated with macroeconomic changes over the past 50 years.
• Stress-related internal diseases were the primary mediators of the link between economic stagnation and mortality.
• Findings highlight the impact of economic conditions on population health and life expectancy disparities.