Case Anne, Deaton Angus
School of Public and International Affairs, Princeton University, Princeton, NJ 08544, United States.
National Bureau of Economic Research, Cambridge, MA 02138, United States.
Am J Epidemiol. 2025 Aug 5;194(8):2281-2286. doi: 10.1093/aje/kwae420.
Gaps in life expectancy between Americans with and without a college degree have widened markedly over the past 3 decades. One explanation points to increasing educational attainment changing the type of people with and without a degree. If preexisting health condition in the 2 education groups changes as the fraction with a degree changes, health selection might explain the widening mortality gap. We examined this explanation using (1) education and mortality in each birth cohort of men and women from 1940 to 1988, and (2) the natural experiment caused by the Vietnam War, which increased the fractions of men with a degree in affected birth cohorts. For each cohort, we examined the relationship between the mortality gap and the fraction of the study population with a degree. We found no relationship between the fraction of a birth cohort with a degree and the corresponding mortality gap. For men, the large increase in college attendance spurred by the Vietnam War has no perceptible counterpart in the mortality gap. The evidence from the natural experiment induced by the Vietnam War does not support a health-selection explanation for the widening mortality gap. This article is part of a Special Collection on Methods in Social Epidemiology.
在过去三十年里，拥有大学学位和没有大学学位的美国人在预期寿命上的差距显著扩大。一种解释认为，教育程度的提高改变了有学位和无学位人群的类型。如果随着有学位人群比例的变化，这两个教育群体先前存在的健康状况发生改变，那么健康选择可能解释了死亡率差距的扩大。我们通过以下方式检验了这一解释：（1）研究了1940年至1988年每个出生队列中男性和女性的教育程度与死亡率情况；（2）利用越南战争引发的自然实验，该实验增加了受影响出生队列中有学位男性的比例。对于每个队列，我们考察了死亡率差距与有学位的研究人群比例之间的关系。我们发现出生队列中有学位的比例与相应的死亡率差距之间没有关系。对于男性而言，越南战争促使大学入学率大幅上升，但在死亡率差距方面却没有明显的对应变化。越南战争引发的自然实验所提供的证据并不支持用健康选择来解释死亡率差距的扩大。本文是社会流行病学方法专题文集的一部分。
