Whether you graduate college has increasing impact on mortality, new paper says

Professors in the School of Public and International Affairs (SPIA) Angus Deaton and Anne Case recently drafted a new paper for the Fall 2023 Brookings Papers on Economic Activity (BPEA) conference documenting the widening mortality gap between Americans with and without a Bachelor’s degree (BA). The study found that adult life expectancy for Americans with a BA in 2021 was 8.5 years longer than for Americans without a BA, who make up two-thirds of the American adult population.

This study comes amid a widespread debate about the changing role of the Bachelor's degree in American society. Only 35 percent of Americans over the age of 25 have a BA. In a recent column from University President Christopher L. Eisgruber ’83 in the Washington Post, he argued that the value of attending college is high and that universities should work to make their institutions accessible to the public. Eisgruber has also repeatedly highlighted expanding access to Princeton as a key goal. Case and Deaton share this sentiment.

Deaton, who is also married to Case, is a 2015 Nobel-prize winning economist for his analysis of consumption, policy, and welfare. Case is prominent for her work linking economic status and health. The pair are renowned for studying middle-class "deaths of despair", deaths tied to the socioeconomic trends that disproportionately hurt the working class. The final version of their paper will be published in the Fall 2023 BPEA issue, and the two do not expect it to change significantly from the conference draft.

Case and Deaton analyzed death certificate information as part of their methodology to measure adult life expectancy. Adult life expectancy is measured in years lived beyond 25 years of age.

Utilizing death certificate data, however, has its limits. Case said that she made use of 80 million death records to conduct this research, but 5 percent of the death records are missing educational attainment, which leads to errors in their calculations.

In 1992, when most states began to include educational status on death records, the gap in adult life expectancy between the two education groups was 2.6 years.

“[The gap] alone is not so surprising,” Case said in an interview with The Daily Princetonian. “That’s the sort of thing found all over the wealthy world, that people with more education, for probably a large number of non-competing reasons were living longer, they were in safer jobs, they had more income, they had better health behaviors, a lot of reasons why we might expect to see a gap, as was found in Europe.”

According to Case, other wealthy countries have not seen the mortality gap increase in the same way as the United States.

Case and Deaton found that by 2019, the gap in adult life expectancy between the two education groups in the U.S. had risen to 6.3 years, and as of 2021, is now 8.5 years.

While those with a BA experienced rising adult life expectancy until the onset of the COVID-19 pandemic in 2020, those without a BA have been experiencing a decline in adult life expectancy since 2010.

Case and Deaton do not explain the widening mortality gap between Americans with and without a BA in their recent paper. However, they do identify the causes of death that contribute most to the widening gap, which include what they termed “deaths of despair” — suicide, drug overdose, and alcoholic liver disease — as well as cancer, cardiovascular disease, chronic lower respiratory diseases, and diabetes.

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Even though there have been significant gains in treatment for chronic illnesses, these gains have not been equitable, according to Case.

“We have made tremendous progress against various cancers, but a lot of the gains went to people with a bachelor’s degree,” she said. She attributes this to the fact that people with a BA are more likely to have access to cancer screening, treatment, and healthcare.

In their 2020 book, Deaths of Despair and the Future of Capitalism, Case and Deaton explore possible reasons why rates of death by suicide, drug overdose, and alcoholic liver disease are increasing in American adults — focusing on middle-aged, white Americans — without a BA, but not in those with a BA. For instance, they found that Americans without a BA are less likely to be married or feel attached to their career and community, which could increase rates of “deaths of despair.”

One question that some economists have is whether the increasing number of Americans with a BA are contributing to the mortality gap. “Is it possible that among the people who used to not get a BA, the healthier people in that sect have joined the college graduates, leaving a less healthy group behind who might be at higher risk for earlier death,” she said. In their paper, Case and Deaton found that this may be contributing to the mortality gap, but it is not large enough to explain the gap in its entirety.

In addition to the widening mortality gap between Americans with and without a BA, the United States’ overall life expectancy is much lower than other wealthy countries. “If this is some marker for how well society is functioning, we are showing that things are not looking very bright,” Case told the ‘Prince.’

Case said that there are two different approaches to narrowing the mortality gap between Americans with and without a BA.

“We think anyone who would like to go college should have the wherewithal to go college,” she said. This can look like lowering information constraints about how to apply to college, making college more affordable, and increasing enrollment in colleges.

The other approach to Case is ensuring that Americans without a BA can still have a stable and meaningful career.

“We have to see what we can do to stop valorizing the BA, and figure out a way to use our K-12 education system to give people the skills that they would need to go out and get a good job, a job with benefits, a job with a ladder up, that they can make a place for themselves and marry and have a family,” Case said.

In their guest essay in The New York Times, Case and Deaton suggest learning from European countries that have “various educational qualifications that fit different kinds of jobs and lack the sharp binary distinction between those with and without college degrees that is so corrosive in the United States.”

This could look like removing the BA requirement for certain jobs, which some states, including Pennsylvania, have already done. They also suggest that improving access to health care, expanding affordable housing, and strengthening unions could help reduce the observed mortality gap. Further analyses focusing on state-specific policies as they pertain to the mortality gap between those with and without a BA merit further study.

In his new book, Economics in America, Deaton critiques economists’ focus on markets and money. “[Economics] has become unmoored from its proper basis, which is the study of human welfare,” Deaton wrote in his book.

Case said that this was one of the main motivations behind conducting this research. “If you measure [human welfare] using GDP or employment or the stock market, we look good. But if you measure it in human terms, it’s not looking as good. So we wanted to get that message out as well,” she said.

Hannah Gabelnick is a News contributor for the ‘Prince.’

Please send any corrections to corrections[at]dailyprincetonian.com.