ABSTRACT

To understand the education–mortality association among U.S. adults, recent studies have documented its national functional form. However, the functional form of education–mortality relationship may vary across geographic contexts. The four U.S. Census regions differ considerably in their social and economic policies, employment opportunities, income levels, and other factors that may affect how education lowers the risk of mortality. Thus, we documented regional differences in the functional form of the education–mortality association and examined the role of employment and income in accounting for regional differences. We used data on non-Hispanic white adults (2,981,672, person years) aged 45–84 in the 2000–2009 National Health Interview Survey, with Linked Mortality File through 2011 (37,598 deaths) and estimated discrete-time hazard models. The functional form of education and adult mortality was best characterized by credentialism in the Midwest, Northeast, and for Western men. For Western women, the association was linear, consistent with the human capital model. In the South, we observed a combination of mechanisms, with mortality risk declining with each year of schooling and a step change with high school graduation, followed by steeper decline thereafter. Our work adds to the increasing body of research that stresses the importance of contexts in shaping the education–mortality relationship.

摘要

为了了解美国成年人的教育与死亡率之间的关系，最近的研究记录了其全国功能形式。然而，教育与死亡率关系的功能形式可能因地理环境而异。美国四个人口普查地区的社会和经济政策、就业机会、收入水平以及其他可能影响教育如何降低死亡风险的因素存在很大差异。因此，我们记录了教育与死亡率关联的功能形式的区域差异，并研究了就业和收入在解释区域差异中的作用。我们使用了 2000-2009 年全国健康访谈调查中 45-84 岁非西班牙裔白人成年人（2,981,672 人年）的数据，以及截至 2011 年的关联死亡率档案（37,598 例死亡）和估计的离散时间风险模型。中西部、东北部和西方男性的学历主义是教育和成人死亡率的功能形式的最佳特征。对于西方女性来说，这种关联是线性的，与人力资本模型一致。在南方，我们观察到了多种机制的结合，死亡率风险随着受教育年数的增加而下降，并随着高中毕业而发生阶跃变化，此后下降幅度更大。我们的工作丰富了越来越多的研究，这些研究强调背景在塑造教育与死亡率关系方面的重要性。