The Contribution of Drug Overdose to Educational Gradients in Life Expectancy in the United States, 1992–2011

Abstract

Over the past two decades, the United States has witnessed a dramatic rise in drug overdose mortality. Educational gradients in life expectancy widened over the same period, and it is likely that drug overdose plays a role in this widening, particularly for non-Hispanic whites. The contemporary drug epidemic is distinctive in terms of its scope, the nature of the substances involved, and its geographic patterning, which influence how it impacts different education groups. I use data from vital statistics and from the National Health Interview Survey to examine the contribution of drug overdose to educational gradients in life expectancy from 1992–2011. I find that over this period, years of life lost due to drug overdose increased for all education groups and for both males and females. The contribution of drug overdose to educational gradients in life expectancy has increased over time and is greater for non-Hispanic whites than for the population as a whole. Drug overdose accounts for a sizeable proportion of the increases in educational gradients in life expectancy, particularly at the prime adult ages (ages 30–60) where it accounts for 25–100% of the widening in educational gradients between 1992–2011. Over time, drug overdose mortality has increased more rapidly for females than for males, leading to a gender convergence. These findings shed light on the processes driving recent changes in educational gradients in life expectancy and suggest that effective measures to address the drug overdose epidemic should take into account its differential burden across education groups.

Trends in Education-Specific Life Expectancy, Data Quality, and Shifting Education Distributions: A Note on Recent Research

“…Sometimes this has led to erroneous conclusions, as in Sasson (2016) and Olshansky et al (2012). In other cases, some conclusions hold true: in Case and Deaton (2015), the conclusion that poisoning mortality is concentrated among the less-educated remains correct, but numerator-denominator bias leads to inconsistent estimates of the magnitude of education-cause-specific mortality (see Ho 2017). 2 Here is what we do know: to the best of our knowledge, life expectancy appears to have improved or stagnated since 1990 for all race-sex groups except for non-Hispanic white women.…”

Trends in Non‐Hispanic White Mortality in the United States by Metropolitan‐Nonmetropolitan Status and Region, 1990–2016

“…Cardiovascular disease, which is the leading cause of death and influenced by both health behaviors and health care system variables, constitutes another category. We also consider the role of a composite category, “deaths of despair” (the aggregation of alcohol‐attributable, drug overdose, and suicide mortality), which has been hypothesized to play a key role in adverse mortality trends among whites in recent years (Case and Deaton , ; Ho ). In addition, we separate out mental and nervous system disorders, a category that includes Alzheimer's disease and is of emerging importance (Xu et al.…”

“…Case and Deaton (, ) drew attention to the role that “deaths of despair”—consisting of accidental poisoning (linked to the epidemic of prescription opioids and heroin), suicide, and chronic liver disease—play in mortality increases among non‐Hispanic whites. Elevated mortality from these causes of death is especially concentrated among individuals with low levels of education (see also Ho ; Kochanek et al. ).…”

Increasing Disparities in Mortality by Socioeconomic Status

“…Finally, they attribute a large portion of the increase in deaths to drug overdoses, alcohol abuse, and suicide. Their emphasis on a widening of the mortality difference by educational attainment and its link to drug overdoses is echoed in a recent study by Ho (21). Analyses of the geographical distribution of drug-poisoning deaths found a broad-based phenomenon with large increases in both rural and urban areas (40,41).…”