bility is consistent with the conclusion of Avendano and colleagues (2010, p. 322), that “our results partly support the hypothesis that U.S. excess mortality is to some extent attributable to larger excess mortality at lower education levels.” In particular, there is a clear pattern among U.S. white males that fits this hypothesis: among those with the least education, mortality is significantly higher in the United States than in European countries, while among those with the most education, the U.S. mortality rate ranks in the middle of values for Northern and Western European countries. On the other hand, the pattern for U.S. women is somewhat different: mortality rates are higher than in most Northern and Western European countries among both those who are highly educated and the least educated. This generalization for women is similar to that noted for geographic differences, with states in the United States faring relatively poorly compared with OECD countries at comparable points in their respective educational distributions. It is also consistent with comparative educational differentials for women in a different index of mortality—life expectancy at age 65 (see Table 9-2). By contrast, among males in the lowest educational group, those in the United States are not disadvantaged on this index.

It is difficult to draw a precise conclusion about the magnitude of the role of inequality in relative levels and trends in U.S. mortality above age 50. Clearly, if blacks were to achieve the mortality conditions of whites, the gap in life expectancy between the United States and other countries would be reduced; however, the gap exists for white Americans as well. Based on educational gradients in mortality in combination with educational distributions, the RII in the United States is not exceptionally high relative to that of other countries. Unusually high educational gradients in mortality are substantially offset by an unusually attractive educational distribution. It should be noted that had this calculation been performed differently, that is, if relative rather than absolute categories of education had been used, the conclusion might have differed.

With respect to trends, the differences are less clear. While there are reports from around the world of increasing inequality in mortality, the relative magnitude of such changes is not well understood. Black/white differences in life expectancy for women narrowed between 1980 and 2006 and remained roughly constant among men. On the other hand, the geographic differential in mortality increased between 1980 and 2000 in the United States and decreased in some comparison countries. We know that increases in economic inequality were greater in the United States during the period 1980–2000 than in several comparison countries (Krueger et al., 2009). These trends are consistent with the view that rising socioeconomic disparities contributed to the deteriorating longevity position of the United States, but data on trends in inequality are too scattered to permit a firm conclusion about their role.



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