Life Spans Shrink for Least-Educated Whites in the U.S.
For
generations of Americans, it was a given that children would live
longer than their parents. But there is now mounting evidence that this
enduring trend has reversed itself for the country’s least-educated
whites, an increasingly troubled group whose life expectancy has fallen
by four years since 1990.
John Gress for The New York Times
S. Jay Olshansky, the lead researcher in a study that showed a life span drop based on education.
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Researchers
have long documented that the most educated Americans were making the
biggest gains in life expectancy, but now they say mortality data show
that life spans for some of the least educated Americans are actually
contracting. Four studies in recent years identified modest declines,
but a new one that looks separately at Americans lacking a high school
diploma found disturbingly sharp drops in life expectancy for whites in
this group. Experts not involved in the new research said its findings
were persuasive.
The
reasons for the decline remain unclear, but researchers offered
possible explanations, including a spike in prescription drug overdoses
among young whites, higher rates of smoking among less educated white
women, rising obesity, and a steady increase in the number of the least
educated Americans who lack health insurance.
The
steepest declines were for white women without a high school diploma,
who lost five years of life between 1990 and 2008, said S. Jay
Olshansky, a public health professor at the University of Illinois at
Chicago and the lead investigator on the study, published last month in
Health Affairs. By 2008, life expectancy for black women without a high
school diploma had surpassed that of white women of the same education
level, the study found.
White
men lacking a high school diploma lost three years of life. Life
expectancy for both blacks and Hispanics of the same education level
rose, the data showed. But blacks over all do not live as long as
whites, while Hispanics live longer than both whites and blacks.
“We’re
used to looking at groups and complaining that their mortality rates
haven’t improved fast enough, but to actually go backward is deeply
troubling,” said John G. Haaga, head of the Population and Social
Processes Branch of the National Institute on Aging, who was not
involved in the new study.
The
five-year decline for white women rivals the catastrophic seven-year
drop for Russian men in the years after the collapse of the Soviet
Union, said Michael Marmot, director of the Institute of Health Equity
in London.
The
decline among the least educated non-Hispanic whites, who make up a
shrinking share of the population, widened an already troubling gap. The
latest estimate shows life expectancy for white women without a high
school diploma was 73.5 years, compared with 83.9 years for white women
with a college degree or more. For white men, the gap was even bigger:
67.5 years for the least educated white men compared with 80.4 for those
with a college degree or better.
The
dropping life expectancies have helped weigh down the United States in
international life expectancy rankings, particularly for women. In 2010,
American women fell to 41st place, down from 14th place in 1985, in the
United Nations rankings. Among developed countries, American women sank
from the middle of the pack in 1970 to last place in 2010, according to
the Human Mortality Database.
The
slump is so vexing that it became the subject of an inquiry by the
National Academy of Sciences, which published a report on it last year.
“There’s
this enormous issue of why,” said David Cutler, an economics professor
at Harvard who was an author of a 2008 paper that found modest declines
in life expectancy for less educated white women from 1981 to 2000.
“It’s very puzzling and we don’t have a great explanation.”
And
it is yet another sign of distress in one of the country’s most
vulnerable groups during a period when major social changes are
transforming life for less educated whites. Childbirth outside marriage
has soared, increasing pressures on women who are more likely to be
single parents. Those who do marry tend to choose mates with similar
education levels, concentrating the disadvantage.
Inklings
of this decline have been accumulating since 2008. Professor Cutler’s
paper, published in Health Affairs, found a decline in life expectancy
of about a year for less educated white women from 1990 to 2000. Three
other studies, by Ahmedin Jemal, a researcher at the American Cancer
Society; Jennifer Karas Montez, a Robert Wood Johnson Foundation Health
and Society Scholar at Harvard; and Richard Miech, a professor at the
University of Colorado Denver, found increases in mortality rates (the
ratio of deaths to a population) for the least educated Americans.
Professor Olshansky’s study, financed by the MacArthur Foundation Research
Network on an Aging Society, found by far the biggest decline in life
expectancy for the least educated non-Hispanic whites, in large part
because he isolated those without a high school diploma, a group usually
combined with high school graduates. Non-Hispanic whites currently make
up 63 percent of the population of the United States.
Researchers
said they were baffled by the magnitude of the drop. Some cautioned
that the results could be overstated because Americans without a high
school diploma — about 12 percent of the population, down from about 22
percent in 1990, according to the Census Bureau — were a shrinking group
that was now more likely to be disadvantaged in ways besides education,
compared with past generations.
Professor
Olshansky agreed that the group was now smaller, but said the magnitude
of the drop in life expectancy was still a measure of deterioration.
“The good news is that there are fewer people in this group,” he said.
“The bad news is that those who are in it are dying more quickly.”
Researchers,
including some involved in the earlier studies that found more modest
declines in life expectancy, said that Professor Olshansky’s methodology
was sound and that the findings reinforced evidence of a troubling
pattern that has emerged for those at the bottom of the education
ladder, particularly white women.
“Something
is going on in the lives of disadvantaged white women that is leading
to some really alarming trends in life expectancy,” said Ms. Montez of
Harvard.
Researchers offered theories for the drop in life expectancy, but cautioned that none could fully explain it.
James
Jackson, director of the Institute of Social Research at the University
of Michigan and an author of the new study, said white women with low
levels of education may exhibit more risky behavior than that of
previous generations.
Overdoses
from prescription drugs have spiked since 1990, disproportionately
affecting whites, particularly women. Professor Miech, of the University
of Colorado, noted the rise in a 2011 paper in the American
Sociological Review, arguing that it was among the biggest changes for
whites in recent decades and that it appeared to have offset gains for
less educated people in the rate of heart attacks.
Ms.
Montez, who studies women’s health, said that smoking was a big part of
declines in life expectancy for less educated women. Smoking rates have
increased among women without a high school diploma, both white and
black, she said. But for men of the same education level, they have
declined.
This
group also has less access to health care than before. The share of
working-age adults with less than a high school diploma who did not have
health insurance rose to 43 percent in 2006, up from 35 percent in
1993, according to Mr. Jemal at the American Cancer Society. Just 10
percent of those with a college degree were uninsured last year, the
Census Bureau reported.
The
shift should be seen against the backdrop of sweeping changes in the
American economy and in women’s lives, said Lisa Berkman, director of
the Harvard Center for Population and Development Studies. The
overwhelming majority of women now work, while fertility has remained
higher than in European countries. For women in low-wage jobs, which are
often less flexible, this could take a toll on health, a topic
that Professor Berkman has a grant from the National Institute on Aging
to study.
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