Socioeconomic Disparities in Health and Mortality at Older Ages

It is now well documented that the midlife mortality declines experienced in other wealthy countries over the last 20 years have bypassed US white non-Hispanics (WNHs). For all five-year age groups from 25-29 to 50-54, mortality rates for WNHs were higher in 2015 than in 1999, but lower for black non-Hispanics and Hispanics. This stalling and reversal of progress is largely driven by the increasing deaths of white non-Hispanics without a four-year college degree. Deaths from drug overdose, suicide, and alcohol-related liver
disease (“deaths of despair”) rose over this period, while progress against heart disease stalled. What is not well understood is the causes of these differential trends. Using data on mortality, morbidity, labor market conditions, credit scores, and social connection, our proposed research will analyze why these alarming trends
in early mortality and opioid use have occurred. We will explore multiple causal explanations, channeling through education, employment opportunities, inequality, health behaviors, and health care. What role does education play in rising “deaths of despair”? To what degree does deterioration in the quality and availability of
low-skilled jobs cumulatively impact mortality and morbidity over the life course? Does the success of the highly educated come at the expense of those with less education? To what degree are disparities accentuated by health behaviors and health care, such as opioid prescribing and treatment of cardiovascular
conditions? These various potential causal pathways are not mutually exclusive, but establishing their importance is critical to developing meaningful interventions, whether in education, labor markets, health care, social supports, or other policies. And finally, we will consider whether the adverse mortality and morbidity patterns evident in midlife, are likely to carry forward into older ages, or to revert to the more favorable patterns currently experienced by the elderly.