What explains the widening life expectancy gap by education?
Core argument: The US life expectancy gap between adults with and without a college degree widened from 2.6 years in 1992 to 6.3 years in 2019, while mortality inequality across counties rose 30%, accompanied by an increasing rural health penalty.
The education-mortality gradient has increased sharply in the last three decades, with the life expectancy gap btw people with and without a college degree widening from 2.6 years in 1992 to 6.3 years in 2019. During the same period, mortality inequality across counties rose 30%, accompanied by an increasing rural health penalty. Using county- and state-level data from the 1992–2019 period, we demonstrate that these three trends arose due to a fundamental shift in the geographic patterns of mortality among college and non-college populations. First, we find a sharp decline in both mortality rates and geographic inequality for college graduates. Second, the reverse was true for people without a college degree; spatial inequality became amplified. Third, we find that rates of smoking play a key role in explaining all three empirical puzzles, with secondary roles attributed to income, other health behaviors, and state policies. [An objection is that] the non-college smoking rate declined by somewhat more than the college rate from 1992 to 2019. [The resolution is that] college populations gave up smoking decades before non-college populations did. [The key] college/non-college comparison [is] among 55–64 year-olds, the age group for which the smoking mortality penalty is greatest.

