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Changes in the Education-Health Gradient Within U.S. States, 1993-2019.

Jennifer Karas Montez1, Iliya Gutin1, Julia M Finan1

  • 1Syracuse University, Syracuse, USA.

Population Research and Policy Review
|June 25, 2026
PubMed
Summary
This summary is machine-generated.

The education-health gradient has widened across most U.S. states, driven primarily by household income and employment, though smoking has had a mitigating effect. Understanding state-level differences is crucial for addressing this growing disparity.

Keywords:
DisparitiesEducationGradientHealthU.S. States

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Area of Science:

  • Public Health
  • Sociology
  • Health Economics

Background:

  • The association between education and health (education-health gradient) has strengthened in the U.S. in recent decades.
  • The strength of this gradient varies significantly across different U.S. states, necessitating a subnational analysis.
  • Existing explanations for the widening education-health gradient remain incomplete.

Purpose of the Study:

  • To investigate how and why the education-health gradient has changed over time within each U.S. state.
  • To assess the contribution of individual-level and state-level factors to these temporal changes in the gradient.

Main Methods:

  • Utilized 27 years (1993-2019) of cross-sectional data from the Behavioral Risk Factor Surveillance System.
  • Analyzed data for U.S. adults aged 30-64 years.
  • Estimated changes in the association between educational attainment and self-rated health, examining six individual factors and three state-level factors.

Main Results:

  • The education-health gradient significantly increased in 49 out of 50 states.
  • Household income was the largest contributor to the increasing gradient in most states.
  • Employment and obesity contributed to the gradient increase, while smoking suppressed it in over half of states; state-level factors had minimal impact.

Conclusions:

  • The education-health gradient has demonstrably widened across the U.S. at the state level.
  • Individual socioeconomic factors, particularly income, are key drivers of this trend.
  • A subnational focus is essential for understanding and potentially mitigating the growing education-health disparity.