The Contribution of Larger Educational Inequalities in Mortality to the National Mortality Disadvantage of the United States. A Comparison with Seven Western European Countries

Karen van Hedel, Erasmus Medical Centre, Rotterdam
Frank Van Lenthe, Erasmus Medical Centre, Rotterdam
Johan P. Mackenbach, Erasmus Medical Centre, Rotterdam

Life expectancy is lower in the United States than in Western European countries, partly due to higher mortality among lower educated Americans as compared to equivalent Europeans. Data from the U.S. National Health Interview Survey linked to the National Death Index were harmonized with census data linked to national mortality registries in Belgium, Denmark, Finland, France, Norway, Sweden and Switzerland. We estimate the change in U.S. overall mortality and mortality disadvantage that would be achieved if, compared to each Western European country, the U.S. had the same distribution of educational attainment and/or relative risk of mortality associated with lower education. Although the U.S. had the most favorable educational distribution, the difference in mortality between the U.S. and Europe would be either eliminated or reduced substantially if inequalities in mortality by educational attainment in the U.S. would be reduced to the level of those in Western European countries.