Trends in education gradients of ‘preventable’ mortality: A test of fundamental cause theory

Fundamental cause theory explains persisting associations between socioeconomic status and mortality in terms of personal resources such as knowledge, money, power, prestige, and social connections, as well as disparate social contexts related to these resources. We review evidence concerning fundamental cause theory and test three central claims using the National Health Interview Survey Linked Mortality Files 1986–2004. We then examine cohort-based variation in the associations between a fundamental social cause of disease, educational attainment, and mortality rates from heart disease, other “preventable” causes of death, and less preventable causes of death. We further explore race/ethnic and gender variation in these associations. Overall, findings are consistent with nearly all features of fundamental cause theory. Results show, first, larger education gradients in mortality risk for causes of death that are under greater human control than for less preventable causes of death, and, second, that these gradients grew more rapidly across successive cohorts than gradients for less preventable causes. Results also show that relative sizes and cohort-based changes in the education gradients vary substantially by race/ethnicity and gender.