Life expectancy by county and educational attainment in the USA, 2000–19: an observational analysis
Open accessAbstract
BACKGROUND: Educational disparities in life expectancy in the USA have been documented nationally but have not been comprehensively explored at the county level. Such geographical granularity is necessary for determining how these disparities vary across the country, thus highlighting the populations that could benefit most from increased access to educational support. We aim to estimate life expectancy at age 25 years for US counties from 2000 to 2019 for four educational attainment populations: less than high school, high-school graduate (including certificate of high school equivalency or other alternative credentials), some college (including associate degrees and incomplete college), and college graduate (including graduate and professional degrees). METHODS: In this observational analysis, we estimated age-specific mortality by educational attainment, county, sex, age, and year using validated small-area estimation models, and then used standard life table techniques to estimate life expectancy at age 25 years using deaths data from the US National Vital Statistics System and population data from the 2000 decennial census, American Community Survey, and National Center for Health Statistics between Jan 1, 2000, and Dec 31, 2019. Estimates were adjusted for misclassification of educational attainment on death certificates and format changes to how education is captured on death certificates. We masked (ie, did not display) estimates for counties and educational attainment populations with a mean annual population of less than 1000. FINDINGS: Nationally, in all years there was a clear educational gradient in life expectancy at age 25 years where those with higher levels of education had higher life expectancy: individuals who had completed a college degree had higher life expectancy compared with those who had completed some college education (by 0·3 to 2·0 years over the study period), those who had completed some college had higher life expectancy than the high-school graduate population (by 4·1 to 4·9 years over the study period), and those who had graduated high school had higher life expectancy than those with less than a high-school education (by 3·4 to 5·1 years over the study period). From 2000 to 2019, life expectancy increased by 2·5 years (95% uncertainty interval 2·4 to 2·6) for the college graduate population, 0·7 years (0·6 to 0·8) for the population who had completed some college, and 0·3 years (0·3 to 0·4) for the high-school graduate population; there was no net change for those with less than a high-school education (0·0 years [-0·1 to 0·1]). In every educational attainment population, life expectancy increased by more from 2000 to 2010, with diminishing gains or even declines from 2010 to 2019. Life expectancy varied at the county level; eg, in 2019, the IQR for the population with less than a high-school education was 67·4 to 72·1 years, whereas for the college graduate population it was 82·3 to 84·6 years among counties with unmasked estimates. The college graduate population had higher life expectancy than those who had completed some college in 1937 (81·1%) of 2389 counties (47·1% statistically significant), which in turn had higher life expectancy than the high-school graduate population in 2726 (97·7%) of 2791 counties (87·0% statistically significant), which in turn had higher life expectancy than the population with less than a high-school education in 2356 (95·9%) of 2456 counties (91·6%). Over the study period, the gap in life expectancy between the college graduate population and those with less than a high-school education grew in 2594 (84·8%) of 3060 counties. INTERPRETATION: Educational disparities in life expectancy are large, widespread, and increasing, both nationally and in most counties throughout the USA. Further research is needed to determine how both more equitable access to higher education and efforts to mitigate barriers to good health facing people with lower levels of education might result in better health and longer lives. FUNDING: Intramural Research Program, National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; Intramural Research Program, National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research, US National Institutes of Health.
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A 2025 observational analysis estimated life expectancy across 3110 U.S. counties (2000-2019), stratified by educational attainment, and found that life expectancy was 11 years greater for the most educated as compared to the least educated groups.
“For example, a 2025 observational analysis that estimated life expectancy across 3110 U.S. counties (2000–2019), stratified by educational attainment, found that life expectancy was 11 years greater for the most educated as compared to the least educated groups [53].”
From Then, Now, Next: Unpacking the Shifting Trajectory of Social Determinants of Health (2025) · cites this paper as [53]
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Cites
Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century
Case, A., & Deaton, A. (2015) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1518393112 · Cited by 2,759 · see citing works
Racism and health: evidence and needed research
Williams, D. R., Lawrence, J. A., & Davis, B. A. (2019) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-040218-043750 · Cited by 2,398 · see citing works
Understanding differences in health behaviors by education
Cutler, D. M., & Lleras-Muney, A. (2010) · Journal of Health Economics · doi:10.1016/j.jhealeco.2009.10.003 · Cited by 1,920 · see citing works
Guidelines for accurate and transparent health estimates reporting: the GATHER statement
Stevens, G. A., Alkema, L., Black, R. E., Boerma, J. T., Collins, G. S., Ezzati, M., Grove, J. T., Hogan, D. R., Hogan, M. C., Horton, R., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(16)30388-9 · Cited by 1,798 · see citing works
Self-citationThe lasting impact of childhood health and circumstance
Case, A., Fertig, A., & Paxson, C. (2005) · Journal of Health Economics · doi:10.1016/j.jhealeco.2004.09.008 · Cited by 1,738 · see citing works
Demography, Measuring and Modeling Population Processes
Véron, J., Preston, S. H., Heuveline, P., & Guillot, M. (2002) · Population · doi:10.2307/1535065 · Cited by 1,709 · see citing works
Mortality and Morbidity in the 21st Century
Case, A., & Deaton, A. (2017) · Brookings Papers on Economic Activity · doi:10.1353/eca.2017.0005 · Cited by 1,448 · see citing works
Is Racism a Fundamental Cause of Inequalities in Health?
Phelan, J. C., & Link, B. G. (2015) · Annual Review of Sociology · doi:10.1146/annurev-soc-073014-112305 · Cited by 1,363 · see citing works
The Relationship Between Education and Health: Reducing Disparities Through a Contextual Approach
Zajacova, A., & Lawrence, E. M. (2018) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-031816-044628 · Cited by 1,205 · see citing works
Schumacher, A. E., Kyu, H. H., Aali, A., Abbafati, C., Abbas, J., Abbasgholizadeh, R., Abbasi, M. A., Abbasian, M., Abd ElHafeez, S., Abdelmasseh, M., et al. (2024) · The Lancet · doi:10.1016/s0140-6736(24)00476-8 · Cited by 1,045 · see citing works
TMB: Automatic Differentiation and Laplace Approximation
Kristensen, K., Nielsen, A., Berg, C., Skaug, H., & Bell, B. (2015) · Journal of Statistical Software · doi:10.18637/jss.v070.i05 · Cited by 965 · see citing works
Paradox lost: Explaining the hispanic adult mortality advantage
Palloni, A., & Arias, E. (2004) · Demography · doi:10.1353/dem.2004.0024 · Cited by 898 · see citing works
Self-citationThe Gap Gets Bigger: Changes In Mortality And Life Expectancy, By Education, 1981–2000
Meara, E. R., Richards, S., & Cutler, D. M. (2008) · Health Affairs · doi:10.1377/hlthaff.27.2.350 · Cited by 850 · see citing works
Olshansky, S. J., Antonucci, T., Berkman, L., Binstock, R. H., Boersch-Supan, A., Cacioppo, J. T., Carnes, B. A., Carstensen, L. L., Fried, L. P., Goldman, D. P., et al. (2012) · Health Affairs · doi:10.1377/hlthaff.2011.0746 · Cited by 693 · see citing works
Aging, Migration, and Mortality: Current Status of Research on the Hispanic Paradox
Markides, K. S., & Eschbach, K. (2005) · The Journals of Gerontology Series B · doi:10.1093/geronb/60.special_issue_2.s68 · Cited by 567 · see citing works
Kunst, A. E., & Mackenbach, J. P. (1994) · American Journal of Public Health · doi:10.2105/ajph.84.6.932 · Cited by 449 · see citing works
Controlling Disease and Creating Disparities: A Fundamental Cause Perspective
Phelan, J. C., & Link, B. G. (2005) · The Journals of Gerontology Series B: Psychological Sciences and Social Sciences · doi:10.1093/geronb/60.special_issue_2.s27 · Cited by 409 · see citing works
Education and the Inequalities of Place
Roscigno, V. J., Tomaskovic‐Devey, D., & Crowley, M. (2006) · Social Forces · doi:10.1353/sof.2006.0108 · Cited by 373 · see citing works
The Healthy Migrant Effect: New Findings From the Mexican Family Life Survey
Rubalcava, L., Teruel, G., Thomas, D., & Goldman, N. (2007) · American Journal of Public Health · doi:10.2105/ajph.2006.098418 · Cited by 364 · see citing works
Health inequalities in European countries
Schepers, R. M. J. (1990) · Health Policy · doi:10.1016/0168-8510(90)90427-f · Cited by 330 · see citing works
Trends in Life Expectancy and Lifespan Variation by Educational Attainment: United States, 1990–2010
Sasson, I. E. (2016) · Demography · doi:10.1007/s13524-015-0453-7 · Cited by 302 · see citing works
Differential Mortality in the United States: A Study in Socioeconomic Epidemiology.
Preston, S. H., Kitagawa, E. M., & Hauser, P. M. (1974) · Journal of the American Statistical Association · doi:10.2307/2285699 · Cited by 297 · see citing works
US County-Level Trends in Mortality Rates for Major Causes of Death, 1980-2014
Dwyer‐Lindgren, L., Bertozzi-Villa, A., Stubbs, R. W., Morozoff, C., Kutz, M., Huynh, C. K., Barber, R. M., Shackelford, K. A., Mackenbach, J. P., van Lenthe, F. J., et al. (2016) · JAMA · doi:10.1001/jama.2016.13645 · Cited by 291 · see citing works
Self-citationRiosmena, F., Wong, R., & Palloni, A. (2012) · Demography · doi:10.1007/s13524-012-0178-9 · Cited by 268 · see citing works
Dwyer‐Lindgren, L., Kendrick, P., Kelly, Y. O., Sylte, D. O., Schmidt, C., Blacker, B. F., Daoud, F., Abdi, A. A., Baumann, M. M., Mouhanna, F., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(22)00876-5 · Cited by 264 · see citing works
Self-citationHayward, M. D., Hummer, R. A., & Sasson, I. E. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.11.024 · Cited by 222 · see citing works
Epidemiological Sociology and the Social Shaping of Population Health
Link, B. G. (2008) · Journal of Health and Social Behavior · doi:10.1177/002214650804900401 · Cited by 206 · see citing works
Effects of education on adult mortality: A global systematic review and meta-analysis
Balaj, M., Henson, C. A., Aronsson, A., Aravkin, A., Beck, K., Degail, C., Donadello, L., Eikemo, K., Friedman, J., Giouleka, A., et al. (2024) · The Lancet Public Health · doi:10.1016/s2468-2667(23)00306-7 · Cited by 192 · see citing works
Self-citationMontez, J. K., Zajacova, A., Hayward, M. D., Woolf, S. H., Chapman, D. A., & Beckfield, J. (2019) · Demography · doi:10.1007/s13524-018-0750-z · Cited by 185 · see citing works
Case, A. C., & Deaton, A. (2021) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2024777118 · Cited by 180 · see citing works
Widening of Socioeconomic Inequalities in U.S. Death Rates, 1993–2001
Jemal, A., Ward, E., Anderson, R. N., Murray, T., & Thun, M. J. (2008) · PLoS ONE · doi:10.1371/journal.pone.0002181 · Cited by 150 · see citing works
Educational inequalities in longevity among OECD countries around 2016
Murtin, F., & Lübker, C. (2022) · OECD papers on well-being and inequalities · doi:10.1787/5faaa751-en · Cited by 139 · see citing works
Sasson, I. E., & Hayward, M. D. (2019) · JAMA · doi:10.1001/jama.2019.11330 · Cited by 138 · see citing works
Dwyer‐Lindgren, L., Kendrick, P., Kelly, Y. O., Baumann, M. M., Compton, K., Blacker, B. F., Daoud, F., Li, Z., Mouhanna, F., Nassereldine, H., et al. (2023) · The Lancet · doi:10.1016/s0140-6736(23)01088-7 · Cited by 132 · see citing works
Self-citationTime Preference and Health: An Exploratory Study
Fuchs, V. R. (1980) · National Bureau of Economic Research · doi:10.3386/w0539 · Cited by 131 · see citing works
Educational attainment and adult health: Under what conditions is the association causal?
Montez, J. K., & Friedman, E. M. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.12.029 · Cited by 129 · see citing works
Galama, T. J., Lleras‐Muney, A., & van Kippersluis, H. (2018) · National Bureau of Economic Research · doi:10.3386/w24225 · Cited by 125 · see citing works
Education reporting and classification on death certificates in the United States.
Rostron, B. L., Boies, J. L., & Arias, E. (2010) · PubMed · Cited by 120 · see citing works
Self-citationDoes more education lead to better health habits? Evidence from the school reforms in Australia
Li, J., & Powdthavee, N. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.07.021 · Cited by 114 · see citing works
Dowd, J. B., & Hamoudi, A. (2014) · International Journal of Epidemiology · doi:10.1093/ije/dyu120 · Cited by 110 · see citing works
Trends in U.S. life expectancy gradients: the role of changing educational composition
Hendi, A. S. (2015) · International Journal of Epidemiology · doi:10.1093/ije/dyv062 · Cited by 110 · see citing works
Fuchs, V. R. (1983) · Health Care Management Review · doi:10.1097/00004010-198322000-00015 · Cited by 98 · see citing works
(2021) · PubMed · Cited by 95 · see citing works
Self-citationThe Relationship Between Health and Schooling
Grossman, M. B. (2008) · Eastern Economic Journal · doi:10.1057/eej.2008.13 · Cited by 86 · see citing works
Hendi, A. S. (2017) · Demography · doi:10.1007/s13524-017-0574-2 · Cited by 83 · see citing works
Oster, E., Jack, R., Halloran, C., Schoof, J., McLeod, D., Yang, H., Roche, J., & Roche, D. (2021) · MMWR. Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm7026e2 · Cited by 75 · see citing works
The Effect of Schooling on Mortality: New Evidence From 50,000 Swedish Twins
Lundborg, P., Lyttkens, C. H., & Nystedt, P. (2016) · Demography · doi:10.1007/s13524-016-0489-3 · Cited by 72 · see citing works
A Simple Equation for Estimating the Expectation of Life at Old Ages
Horiuchi, S., & Coale, A. J. (1982) · Population Studies · doi:10.1080/00324728.1982.10409034 · Cited by 66 · see citing works
Singh, G. K., & Lee, H. (2020) · International Journal of Maternal and Child Health and AIDS · doi:10.21106/ijma.402 · Cited by 63 · see citing works
Mortality Change among Less Educated Americans
Novosad, P. M., Rafkin, C., & Asher, S. (2022) · American Economic Journal Applied Economics · doi:10.1257/app.20190297 · Cited by 35 · see citing works
The implications of changing education distributions for life expectancy gradients
Hendi, A. S., Elo, I. T., & Martikainen, P. (2021) · Social Science & Medicine · doi:10.1016/j.socscimed.2021.113712 · Cited by 32 · see citing works
Differential Mortality in the United States: A Study in Socioeconomic Epidemiology
Kitagawa, E. M., & Hauser, P. M. (1973) · doi:10.4159/harvard.9780674188471 · Cited by 28 · see citing works
Life Expectancy Among Non–High School Graduates
Begier, B., Li, W., & Maduro, G. A. (2013) · Health Affairs · doi:10.1377/hlthaff.2013.0198 · Cited by 15 · see citing works
The Educational Gradient in Health in China
Chen, Q., Eggleston, K. N., Zhang, W., Zhao, J., & Zhou, S. (2017) · The China Quarterly · doi:10.1017/s0305741017000613 · Cited by 9 · see citing works
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- Authors
- Sylte, D. O., Baumann, M. M., Kelly, Y. O., Kendrick, P., Ali, O. M. M., Compton, K., Schmidt, C. A., Kahn, E., Li, Z., La Motte-Kerr, W., Daoud, F., Gakidou, E., Hay, S. I., Strassle, P. D., Mensah, G. A., Murray, D. M., Arias, E., George, S. M., Pérez-Stable, E. J., Murray, C. J. L., Mokdad, A. H., & Dwyer-Lindgren, L.
- ORCID
- Venue
- The Lancet Public Health
- Publisher
- Elsevier BV
- Published
- 2025-02
- Volume
- 10
- Issue
- 2
- Pages
- e136-e147
- ISSN
- 2468-2667 (ISSN-L)
- PMC
- PMC11922296
- OpenAlex
- W4406748918
- Cited by
- 15
- References
- 52
- Citations by year
- 2026: 10 · 2025: 5
- FWCI
- 16.85
- Type
- journal article
- Language
- en
- Update notices
- erratum (2025-03-01)
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Public Health (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Office of Disease Prevention
- National Heart, Lung, and Blood Institute
- National Institute on Aging
- National Institute on Minority Health and Health Disparities (75N94023C00004)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases
- National Institutes of Health
- National Cancer Institute
- Office of Behavioral and Social Sciences Research (75N94019C00016)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- life expectancy, educational attainment, educational inequality, county-level health disparities, small area estimation, life tables, United States counties
- MeSH terms
- Adult, Aged, Aged, 80 and over, Educational Status, Female, Humans, Life Expectancy, Male, Middle Aged, United States, Health Status Disparities
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