Less education as bad as smoking

Evidence from studies suggest that the association between education and mortality is causal

Lacking education may be as deadly as being a smoker, according to a new US study.

Researchers at the University of Colorado, New York University, and the University of North Carolina at Chapel Hill estimated the number of deaths that can be linked to differences in education, and found that variation in the risk of death across education levels has widened considerably.

"In public health policy, we often focus on changing health behaviours such as diet, smoking, and drinking," said Virginia Chang, associate professor of population health at NYU School of Medicine.

"Education - which is a more fundamental, upstream driver of health behaviours and disparities - should also be a key element of US health policy," said Chang.

Evidence from studies including natural experiments consistently show a strong association between education level and mortality and suggest that a substantial part of the association between education and mortality is causal.

Using the Centres for Disease Control and Prevention's National Health Interview Survey, the study team looked at data on more than a million people from 1986 to 2006 to estimate the number of deaths that could be attributed to low levels of education.

They studied people born in 1925, 1935, and 1945 to understand how education levels affected mortality over time, and noted the causes of death, including cardiovascular disease and cancer.

They found "that 145,243 deaths could be saved in the 2010 population if adults who had not completed high school went on to earn a GED or high school degree, which is comparable to the estimated number of deaths that could be averted if all current smokers had the mortality rates of former smokers."

In addition, 110,068 deaths could be saved if adults who had some college went on to complete their bachelor's degree. The disparities in mortality across different levels of education widened substantially over time. For example, mortality rates fell modestly among those with high school degrees, but mortality rates fell much more rapidly among those with college degrees.

As a result, encouraging high school completion among adults who have not finished high school could save twice as many lives among those born in 1945 as compared to those born in 1925, researchers said.

Deaths from cardiovascular disease played a greater role than deaths from cancer in these growing gaps in mortality and improvements in survival for well-educated people, likely due to advances in the prevention and treatment of cardiovascular disease among those with more education.

"Our results suggest that policies and interventions that improve educational attainment could substantially improve survival in the US population, especially given widening educational disparities," said Patrick Krueger from the Department of Health & Behavioural Sciences at the University of Colorado, Denver.The findings were published in the journal PLOS ONE.