State-level educational disparities in mortality in the United States, 2010-2014

The present study examined educational disparities in mortality for 49 states and the District of Columbia in the United States based on the 2010-2014 national mortality data. A total of 3,165,762 deaths at ages 25-74 years were included in analysis. Absolute and relative disparities were estimated as Relative Index of Inequality (RII) and Slope Index of Inequality (SII), respectively, based on age-standardized death rates by education, race/ethnicity sex, and state. We found that educational disparities in mortality existed in every US state with varying magnitude across states and by sex. The disparities were generally larger in men than in women on both absolute and relative scales. Across states, for all races combined, the RII varied in the range of 4.2 to 14.9 in men and 3.2 to 10.1 in women; the SII (1/100,000 persons) ranged from 934.0 to 1633.4 in men and from 333.7 to 672.5 in women. Hispanic origin seems to alter the pattern of educational disparities by state. In non-Hispanic whites, some Midwest states had the smallest disparities on both relative and absolute scales. Maryland, Virginia, and Massachusetts had a large relative disparity but a moderate absolute disparity. In general, southern states had a large absolute disparity but a moderate relative disparity. There was a strong correlation (0.66; 95% CI, 0.46-0.79) between educational disparities in mortality and disparities in combined major risk factors (smoking, obesity, and hypertension) by state. These findings call for tailored interventions among socially disadvantaged populations, especially in high disparity states and among young adults.