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Widening of Socioeconomic Inequalities in U.S. Death Rates, 1993–2001

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  • Ahmedin Jemal
  • Elizabeth Ward
  • Robert N Anderson
  • Taylor Murray
  • Michael J Thun

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.

Suggested Citation

  • Ahmedin Jemal & Elizabeth Ward & Robert N Anderson & Taylor Murray & Michael J Thun, 2008. "Widening of Socioeconomic Inequalities in U.S. Death Rates, 1993–2001," PLOS ONE, Public Library of Science, vol. 3(5), pages 1-8, May.
  • Handle: RePEc:plo:pone00:0002181
    DOI: 10.1371/journal.pone.0002181
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    References listed on IDEAS

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    1. Steenland, K. & Hu, S. & Walker, J., 2004. "All-cause and cause-specific mortality by socioeconomic status among employed persons in 27 US states, 1984-1997," American Journal of Public Health, American Public Health Association, vol. 94(6), pages 1037-1042.
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    3. Powell, L.M. & Slater, S. & Chaloupka, F.J. & Harper, D., 2006. "Availability of physical activity-related facilities and neighborhood demographic and socioeconomic characteristics: A national study," American Journal of Public Health, American Public Health Association, vol. 96(9), pages 1676-1680.
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    1. Redondo Lourés, Cristian & Cairns, Andrew J.G., 2021. "Cause of death specific cohort effects in U.S. mortality," Insurance: Mathematics and Economics, Elsevier, vol. 99(C), pages 190-199.

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