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11 Do Americans Have Higher Mortality Than Europeans at All Levels of the Education Distribution?: A Comparison of the United States and 14 European Countries--Mauricio Avendano, Renske Kok, Maria Glymour, Lisa Berkman, Ichiro Kawachi, Anton Kunst, and Johan Mackenbach with support from members of the Eurothine Consortium
Pages 313-332

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From page 313... ... In 2006, the average American man and woman could expect to live 75 and 80 years, respectively, while the average Western European man and woman could expect to live 77 and 83 years, respectively (World Health Organization, 2009; World Health Organization Regional Office for Europe, 2010) Read the entire page →
From page 314... ... If true, one would expect U.S. residents of all education levels to have higher mortality rates than comparable Europeans. Read the entire page →
From page 315... ... For populations with a follow-up period of 5 years or shorter (Belgium and Denmark) , the baseline was ages 30-79, and for populations with cross-sectional data (Eastern European and Baltic countries) Read the entire page →
From page 316... ... population Finland 1990 2000 25,874,201 270,130 National, longitudinal, census-linked mortality study Sweden 1991 2000 43,042,216 393,038 National, longitudinal, census-linked mortality study Norway 1990 2000 19,956,768 213,022 National, longitudinal, census-linked mortality study Denmark 1996 2000 14,619,326 183,281 National, longitudinal, census-linked mortality study England 1991 1999 2,295,029 21,234 National, longitudinal, and Wales census-linked mortality study for a representative sample of 1 percent of the population of England and Wales Belgium 1991 1995 24,860,995 283,325 National, longitudinal, census-linked mortality study Switzerlanda 1990 2000 27,910,587 255,270 National, longitudinal, census-linked mortality study Franceb 1990 1999 2,478,782 20,215 National, longitudinal, census-linked mortality study for a representative sample of 1 percent of population Slovenia 1991 2000 9,647,452 101,557 National, longitudinal, census-linked mortality study Hungary 1999 2002 21,031,348 363,508 National, unlinked, cross national mortality study Czech 1999 2003 25,759,210 344,973 National, unlinked, crossRepublic national mortality study Poland 2001 2003 54,883,245 717,743 National, unlinked, cross national mortality study Lithuania 2000 2002 5,156,703 78,399 National, unlinked, cross national mortality study Estonia 1998 2002 3,435,255 60,794 National, unlinked, cross national mortality study aNon-Swiss nationals are excluded. bResidents of overseas territories, members of the military, and students are excluded. Read the entire page →
From page 317... ... Statistical Analysis All analyses were stratified by sex and education level. Age-adjusted mortality rates were first calculated based on a Poisson regression model, using the 1995 U.S. Read the entire page →
From page 318... ... , the corresponding proportion was 30-50 percent in the Scandinavian countries, the Baltic countries, France, TABLE 11-2 Mortality Ratesa Per 100,000 Person-Years According to Education Level and Population Attributable Fraction (PAF) for Men Ages 30 to 74 in 14 European Countries and the United States Lower Secondary Upper Tertiary or or Less Secondary Higher Total PAFb Rate % Rate % Rate % Rate USA, all 1,840 20 1,339 54 885 26 1,379 39 USA, whites 1,779 19 1,316 54 876 27 1,334 38 USA, blacks 2,264 32 1,658 55 1,198 14 1,903 39 Finland 1,700 49 1,410 30 942 22 1,528 41 Sweden 1,151 40 953 43 706 16 1,026 33 Norway 1,498 30 1,194 48 873 22 1,272 33 Denmark 1,659 43 1,400 38 982 19 1,508 37 England/Walesc 1,128 83 786 7 652 10 1,074 39 Belgium 1,590 61 1,264 22 999 17 1,480 32 Switzerland 1,477 20 1,123 56 831 24 1,165 30 France 1,285 50 955 37 624 13 1,132 51 Slovenia 1,977 37 1,421 50 930 12 1,616 51 Hungary 2,614 65 1,471 21 1,029 14 2,195 58 Czech Republic 2,088 63 1,115 24 732 14 1,699 65 Poland 2,217 61 1,213 28 838 11 1,834 61 Lithuania 2,718 31 1,892 53 1,054 16 2,184 63 Estonia 2,974 32 2,393 50 1,240 17 2,480 63 aRates are directly standardized to the U.S. Read the entire page →
From page 319... ... cEducation levels for England and Wales do not correspond to the International Standard Classification of Education levels. The "lower secondary or less" category includes some individuals with upper secondary education as well. Read the entire page →
From page 320... ... U.S. white women had higher mortality rates than women in all Western European countries but Denmark, while their mortality rate was comparable to that in Eastern European countries, which had the highest rates in Europe (see Table 11-3) Read the entire page →
From page 321... ... Relative Index of Inequality 5.0 4.5 4.0 3.5 3.0 Male 2.5 Female 2.0 1.5 1.0 0.5 France Poland Finland USA all Estonia Norway Sweden Belgium England Hungar y Slovenia Denmark Lithuania USA whites USA blacks Switzerland Czech Republic FIGURE 11-1 Relative index of inequality of mortality by education level for men and women at ages 30 to 74 in 14 European countries and the United States. Fig11-1.eps landscape Read the entire page →
From page 322... ... Correlations were strongly driven by Eastern European countries, which had high mortality rates and large mortality disparities by education. DISCUSSION Previous research indicates that the United States has substantially lower life expectancy than most Western European countries. Read the entire page →
From page 323... ... in men and women at ages 30 to 74 in 14 European countries Fig11-2.eps and the United States. NOTES: BE = Belgium, CH = Switzerland, CZ = Czech Republic, DK = Denmark, EE = Estonia, ENG = England and Wales, FI = Finland, FR = France, HU = Hungary, LT = Lithuania, NO = Norway, PL = Poland, SE = Sweden, SLO = Slovenia, USA = United States. Read the entire page →
From page 324... ... Future studies should expand our descriptive approach by examining in more detail to what extent total mortality rates are determined by the distribution of mortality by education, taking into account the issues described above. We calculated the RII to take into account the position of individuals in the education distribution. Read the entire page →
From page 325... ... . We recoded country-specific levels of education into internationally comparable education levels based on the ISCED international classification. Read the entire page →
From page 326... ... These differences reflect a longer smoking history among Americans compared with most Europeans, particularly for men at the bottom of the education distribution and for women of all education levels. A similar smoking history may also explain why Danes and Americans share similar excess mortality compared with other European countries. Read the entire page →
From page 327... ... A key finding of our study is that among women and in some cases among men, U.S. excess mortality is not limited to the low end of the education distribution, but even highly educated Americans experience higher mortality than comparable Western Europeans. Read the entire page →
From page 328... ... Addressing the fundamental causes of racial disparities in the United States may thus contribute to reducing overall excess mortality. We observed much higher mortality rates and disparities in mortality by education in Eastern European countries than in Western Europe. Read the entire page →
From page 329... ... For example, the United States and Switzerland have achieved very high overall levels of schooling in the population, so that only a relatively small proportion of individuals are being "left behind" in the lowest education categories. These individuals probably represent a selection of the weakest, resulting in a marked health disadvantage associated with low education. Read the entire page →
From page 330... ... popu lation: National Health Interview Survey, 2005. Vital Health Statistics, 0(233) Read the entire page →
From page 331... ... . Mortality experience of the 1986-2000 National Health Interview Survey linked mortality files participants. Read the entire page →
From page 332... ... . World Health Organization Regional Office for Europe. Read the entire page →

From page 313...

... In 2006, the average American man and woman could expect to live 75 and 80 years, respectively, while the average Western European man and woman could expect to live 77 and 83 years, respectively (World Health Organization, 2009; World Health Organization Regional Office for Europe, 2010)