According to the report, death rates among the most educated Americans decreased significantly from 1993 to 2001, while those of the least educated leveled off or went up for some causes. The study offers still more evidence of deepening socioeconomic disparities affecting quality-of-life and survival in the United States.

"This study shows a real disparity in mortality between the haves and the have-nots in this country," said Ahmedin Jemal, PhD, American Cancer Society Strategic Director, Cancer Occurrence and lead author of the study.

ACS researchers and scientists from the US Centers for Disease Control and Prevention's National Center for Health Statistics used death certificate information from the National Vital Statistics System (NVSS) to assess death rates for more than 3.5 million 25-64-year-old non-Hispanic whites and blacks from 1993 to 2001. The results were published in the May issue of PLoS ONE, the open-access journal of the Public Library of Science.

Disparity in Death Rates

The researchers looked at data for all causes of death as well as for 7 of the leading causes: cancer, heart disease, stroke, accidents, HIV infection, diabetes, chronic lung disease. Overall, rates for deaths related HIV, cancer, heart disease, and stroke decreased, while those from accidents, diabetes, and lung disease rose.

According to NVSS data, the death rate dropped most significantly among the most educated men and women (those with 16 years or more of school), with the largest decrease seen among highly educated black men. Among the highly educated, about 90% of the total decrease seen in white men and 78% seen in black men was due to declines in deaths due to HIV infection, heart disease, and cancer, with HIV alone contributing over 50%. Eighty percent of the decrease among white women and 65% among black women could be linked to decreases in deaths from cancer, heart disease, and stroke.

Individuals without high school diplomas didn't fare as well. In fact, the death rate increased among people with less than 12 years of education, a finding that was most pronounced among the least educated white women. The death rate for those women was 3.2 times higher than for people with 13 or more years of schooling.

Among less educated white men, death rates from accidents, cancer, and suicide went up. Death rates due to accidents, cancer, lung disease, and heart disease were high among the least educated white women. In black men without high school diplomas, increases were seen in t accidents and deaths from nephritis (kidney inflammation). Among black women, rates from accidents and deaths from HIV infection and septicemia (bacterial infection of the blood) increased. However, for both black men and women, those numbers were offset by decreases in deaths from heart disease and cancer.

Narrowing the Gap

The researchers focused on the relationship between education level and death rates, but they note that education is only "one indicator of socioeconomic position." They also detail many of the environmental, social, and economic factors that "increase the vulnerability of low socioeconomic communities to risk factors such as smoking, obesity, physical inactivity, hypertension, and HIV infection." Lack of health insurance also plays a significant role.

"People with less education have fewer financial resources, less access to health insurance or stable employment, and less health literacy," said Otis W. Brawley, MD, American Cancer Society chief medical officer. "As a result, while the death rate among the most educated Americans is dropping dramatically, we're seeing a real lack of progress or even worsening trends in the least educated persons. The gap between the best and worst off in the country is actually getting worse."

In 2007, the American Cancer Society launched the Access to Care campaign, a national initiative dedicated to raising awareness about plight of uninsured and underinsured people in the United States. For more information, see this video.

Citation: "Widening of Socioeconomic Inequalities in U.S. Death Rates, 1993-2001." Published online May 13, 2008. First author: Ahmedin Jemal, PhD, Department of Epidemiology and Surveillance Research. American Cancer Society.