TUESDAY, March 11 (HealthDay News) -- Life expectancy in the
United States is on the increase, but only among people with more
than 12 years of education, a new study finds.
In fact, those with more than 12 years of education -- more than
a high school diploma -- can expect to live to 82; for those with
12 or fewer years of education, life expectancy is 75.
"If you look in recent decades, you will find that life
expectancy has been increasing, which is good, but when you split
this out by better-educated groups, the life expectancy gained is
really occurring much more so in the better-educated groups," said
lead researcher Ellen R. Meara, an assistant professor of health
care policy at Harvard Medical School.
"The puzzle is why we have been successful in extending life
span for some groups. Why haven't we been successful in getting
that for less advantaged groups?" Meara said.
The answer may lie with tobacco, the study found.
About one-fifth of the difference in mortality between
well-educated and less-educated groups can be accounted for by
smoking-related diseases such as lung cancer and emphysema, Meara
said.
But the disparity in life expectancy is not only a function of
education, Meara said. "Those with less education are likely to
have lower income. They're likely to live in areas that have their
own health threats, either through crime or poor housing
conditions. In addition, they may have worse access to health
insurance coverage and health services," she said.
The study was published in the March/April issue of
Health Affairs.
For the study, Meara's team collected data on people who took
part in the National Longitudinal Mortality Study. The researchers
used death certificates, plus estimates from Census data, to create
two datasets -- one covering 1981 to 1988 and the other from 1990
to 2000.
The researchers found that in both datasets, life expectancy
rose but only for people with more than 12 years of education. For
those with 12 years of education or less, life expectancy remained
flat through the periods.
When the researchers compared data from the 1980s to data from
the 1990s, people with more education had almost a year and half of
increased life expectancy. But, for people with less education,
life expectancy increased by only six months.
In the period of 1990 to 2000, the better educated saw their
life expectancy increase by 1.6 years. For the less educated, life
expectancy didn't increase in all.
When the researchers looked at gender differences, they found
that less-educated women actually had a decline in life expectancy.
In 2000, those women with more than 12 years of education by age 25
could expect to live five years longer than less-educated women,
the study found.
The challenge, Meara said, is to figure out ways to extend life
expectancy of all groups in U.S society. "We need to get a better
understanding of how we can extend these great things we're
learning about how to lead healthier lives into these groups," she
said.
Dr. David L. Katz, director of the Yale University School of
Medicine's Prevention Research Center, thinks fighting poverty and
improving education are key to increasing life expectancy among
less-advantaged Americans.
"Disparities in health are a major challenge in the United
States," he said. "The less affluent and less educated are also,
invariably, less healthy."
Initiatives that target health disparities are always welcome,
but they may not go far enough if they don't relieve underlying
discrepancies in educational or economic status, Katz said.
"Despite efforts throughout the 1980s and 1990s to reduce the
disproportionate mortality and morbidity burden experienced by
ethnic minorities and the socio-economically disadvantaged, those
burdens have persisted," Katz said. "And the gap in life expectancy
between the more educated and the less has actually widened."
The take-home message is to redouble efforts to eliminate health
disparities, Katz said. "Health is not a product of health care per
se, but of one's life course and opportunities. Poverty and limited
education are enemies to both opportunity and health. Public health
efforts must strive against them as earnestly as against the
diseases they drag in their wake."
In another report in the same journal issue, Rachel Kimbro, a
sociology professor at Rice University, and colleagues found that
immigrants with low levels of education fared better in health
outcomes compared with native-born Americans, regardless of race or
ethnicity.
The researchers said these differences should be taken into
account when targeting programs to reach specific groups of
people.
More information
For more on health-care disparities, visit the
U.S. Agency for Healthcare Research and
Quality.