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Primary Submission Category: Mortality
Period and cohort differences in educational mortality disparities: Evidence from Utah’s Wasatch Front, 2000–2023
Authors: David Curtis, Felix Yao,
Presenting Author: David Curtis*
Question: How have educational disparities in adult mortality recently changed, including during the Great Recession and COVID-19 pandemic, after accounting for birth cohort differences?
Significance: National evidence demonstrates widening education gaps, but period effects and compositional differences by cohort are often conflated.
Methods: Using state administrative and vital records linked via the Utah Population Database, mortality was observed over a 24-year-period for 687,828 adults aged 25 to 74 who resided in the urban core of Utah in 2000. Educational attainment was coded as three categories: no high school diploma, high school diploma/some college, and four-year college degree or more. We fit sex-stratified flexible parametric survival models using age as the time scale and included education-by-period interactions that represented four periods (2000-Nov2007; Dec2007-2013; 2014-Feb2020; Mar2020-2023). Models adjusted for race/ethnicity, marital status, adult migration, cohort (1925-44; 1945-54; 1955-64; 1965-75), and education-by-cohort.
Results: In 2000-2007, adults with a college degree had ~40-45% lower mortality hazard than adults without a high school diploma. Adding cohort terms attenuated educational differences and revealed substantially steeper disparities in younger cohorts. Relative educational disparities were stable during the first three periods but narrowed during COVID-19 (e.g., HRs for college degree relative to no high school diploma shifted from 0.60 to 0.73 for women and 0.57 to 0.76 for men), as mortality rose across groups. However, absolute mortality differences remained similar across periods. When allowing education and period associations with mortality to vary by age, educational differences in cumulative mortality widened during COVID-19.
Conclusions: Separating cohort dynamics from period shocks and illustrating relative alongside absolute disparities provides clearer evidence of how educational disparities have changed.