Some studies suggest that the relationship between education and health strengthens with age (cumulative disadvantage hypothesis), while other studies find that it weakens (age-as-leveler hypothesis). This research addresses this inconsistency by differentiating individual-level changes in health from those occurring at the aggregate level due to selective mortality. Using retrospective and prospective data from a nationally representative sample of U.S. adults, I examine educational differences in age-specific rates of disease prevalence, incidence, and survival. At the aggregate level, I find that educational differences in disease prevalence are largest at mid-life and then decline. At the individual level, however, disease incidence and mortality increase with age at a greater rate for less-educated persons compared to the well educated. These findings suggest that the cumulative disadvantage hypothesis explains how education affects the health of individuals with increasing age, whereas the leveling hypothesis describes the aggregated by-product of these educational disparities in health decline.
Get full access to this article
View all access options for this article.
References
1.
AntonovskyAaron1967.
“Social Class, Life Expectancy and Overall Mortality.”Milbank Memorial Fund Quarterly45:
31–73
2.
BeckettMegan2000.
“ Converging Health Inequalities in Later Life—An Artifact of Mortality Selection?”Journal of Health and Social Behavior41:
106–19
3.
ClevesMario A.GouldWilliam M.GutierrezRoberto G.2004.
An Introduction to Survival Analysis Using Stata:Revised Edition.College Station, TX:
Stata Press
4.
CohenBruce B.BarbanoHelen E.CoxChristine S.FeldmanJacob J.FinucaneFanchon F.KleinmanJoel C.MadansJennifer H.1987.
“Plan and Operation of the NHANES-I Epidemiologic Follow-up Study, 1982–84.”
National Center for Health Statistics. Vital and Health Statistics Report Series 1, No. 22
5.
CrimminsEileen M.YasuhikoSaito2001.
“Trends in Healthy Life Expectancy in the United States, 1970–1990: Gender, Racial, and Educational Differences.”Social Science and Medicine52(11):
1629–41
6.
CrystalStephenDennisShea1990.
“Cumulative Advantage, Cumulative Disadvantage, and Inequality among Elderly People.”The Gerontologist10:
437–43
7.
Diez-RouxAnaLloydChamblessMerkinSharon S.DonnaArnettMarshaEigenbrodtJavierNietoMoysesSzkloPaulSorlie2002.
“Socioeconomic Disadvantage and Change in Blood Pressure Associated with Aging.”Circulation106(6):
703–10
8.
DupreMatthew E.2005.
“Educational Differences in Age-Related Patterns of Disease: An Empirical Test of Cumulative Disadvantage Theory.”
Ph.D. dissertation, Department of Sociology, Duke University, Durham, NC
9.
EloIrma T.PrestonSamuel H.1996.
“Educational Differences in Mortality: United States, 1979–85.”Social Science and Medicine42(1):
47–57
10.
FeldmanJacob J.MakucDiane M.KleinmanJoel C.Cornoni-HuntleyJ.1989.
“National Trends in Educational Differentials in Mortality.”American Journal of Epidemiology129:
919–33
11.
FerraroKenneth F.FarmerMelissa M.1996.
“Double Jeopardy, Age As Leveler, or Persistent Health Inequality? A Longitudinal Analysis of White and Black Americans.”Journal of Gerontology: Social Sciences51B
(6):
s319–28
12.
HeJiangOgdenLorraine G.BazzanoLydia A.SumaVupputuriCatherineLoriaWheltonPaul K.2001.
“Risk Factors for Congestive Heart Failure in U.S. Men and Women.”Archives of Internal Medicine161(7):
996–1002
13.
HouseJames S.KesslerRonald C.HerzogA. Regula1990.
“Age, Socioeconomic Status, and Health.”The Milbank Memorial Quarterly68:
383–411
14.
HouseJames S.LepkowskiJames M.KinneyAnn M.MeroRichard P.KesslerRonald C.HerzogA. Regula1994.
“The Social Stratification of Aging and Health.”Journal of Health and Social Behavior35:
213–34
15.
JakovljevicDimitrijeCinziaSartiJuhaniSiveniusJormaTorppaMurkkuMahonenPirjoImmonen-RaihaEskoKaarsaloKariAlhainenKariKuulasmaaJaakkoTuomilehtoPekkaPuskaVeikkoSalomaa2001.
“Socioeconomic Status and Ischemic Stroke: The FINMONICA Stroke Register.”Stroke32:
1492–98
16.
KaplanGeorge A.KeilJulian E.1993.
“Socioeconomic Factors and Cardiovascular Disease: A Review of the Literature.”Circulation88(4):
1973–98
17.
KaplanGeorge A.SeemanT. E.CohenRichard D.KnudsenL. P.JackGuralnik1987.
“Mortality among the Elderly in the Alameda County Study: Behavioral and Demographic Risk Factors.”American Journal of Public Health77(3):
307–12
18.
KerckhoffAlan C.1993.
Diverging Pathways: Social Structure and Career Deflections.New York:
Cambridge University Press
19.
KitagawaEvelyn M.HauserPhilip M.1973.
Differential Mortality in the United States: A Study of Socioeconomic Epidemiology.Cambridge, MA:
Harvard University Press
20.
LauderdaleDiane S.2001.
“Education and Survival: Birth Cohort, Period, and Age Effects.”Demography38(4):
551–61
21.
LinkBruce G.JoPhelan1995.
“Social Conditions As Fundamental Causes of Disease.”
Journal of Health and Social Behavior
(extra issue):
80–94
22.
LynchScott M.2003.
“Cohort and Life-Course Patterns in the Relationship between Education and Health: A Hierarchical Approach.”Demography40:
309–31
23.
MedalieJack H.PapierC.HermanJ. B.GoldbourtU.TamirS.NeufeldH. N.RissE.1974.
“Diabetes Mellitus among 10,000 Adult Men: Five-Year Incidence and Associated Variables.”Israel Journal of Medical Sciences10:
681–97
24.
MertonRobert K.1968.
“The Matthew Effect in Science.”Science159:
56–63
25.
MirowskyJohnRossCatherine E.1998.
“Education, Personal Control, Lifestyle and Health: A Human Capital Hypothesis.”Research on Aging20(4):
415–49
26.
MurrayChristopher J.L.LopezAlan D.1996.
The Global Burden of Mortality and Disability From Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020.Cambridge, MA:
Harvard University Press
27.
National Center for Health Statistics.1973.
“Plan and Operation of the Health and Nutrition Examination Survey, United States, 1971–1973.”
Vital and Health Statistics. Series 1–Nos. 10A and 10B. DHEW PUB. NO. (HSM)
73–1310
28.
National Center for Health Statistics.2001.
National Vital Statistics Reports.
49(8)
29.
NoymerAndrew2001.
“Mortality Selection and Sample Selection: A Comment on Beckett.”Journal of Health and Social Behavior42:
326–27
30.
O'RandAngela M.1996.
“The Precious and the Precocious: Understanding Cumulative Disadvantage and Cumulative Advantage over the Life Course.”The Gerontologist36(2):
230–38
31.
PampelFred C.RogersRichard G.2004.
“Socioeconomic Status, Smoking, and Health: A Test of Competing Theories of Cumulative Advantage.”Journal of Health and Social Behavior45:
306–21
32.
PeltonenMarkkuMansRosenVivanLundbergKjellAsplund2000.
“Social Patterning of Myocardial Infarction and Stroke in Sweden: Incidence and Survival.”American Journal of Epidemiology151(3):
283–92
33.
PrestonSamuel H.1984.
“Children and the Elderly: Divergent Paths for America's Dependents.”Demography21(4):
435–57
34.
PrestonSamuel H.EloIrma T.1995.
“Are Educational Differentials in Adult Mortality Increasing in the United States?”Journal of Aging and Health7:
476–96
35.
PrestonSamuel H.PaulTaubman1994.
“Socioeconomic Differences in Adult Mortality and Health Status.”
Pp. 279–317 in
Demography of Aging,
edited by MartinLinda G.PrestonSamuel H.Washington, DC:
National Academy Press
36.
RosenbaumJames E.1984.
Career Mobility in a Corporate Hierarchy.New York:
Academic Press
37.
RossCatherine E.Chia-lingWu1995.
“The Links between Education and Health.”American Sociological Review60:
719–45
38.
RossCatherine E.Chia-lingWu1996.
“Education, Age, and the Cumulative Advantage in Health.”Journal of Health and Social Behavior37:
104–20
39.
SorliePaul D.EricBacklundKellerJacob B.1995.
“U.S. Mortality by Economic, Demographic, and Social Characteristics: The National Longitudinal Mortality Study.”American Journal of Public Health85:
949–56
40.
VargasClemencia M.IngramDeborah D.GillumRichard F.2000.
“Incidence of Hypertension and Educational Attainment: The NHANES-I Epidemiologic Followup Study.”American Journal of Epidemiology152(3):
272–78
41.
WinshipChristopherLarryRadbill1994.
“Sampling Rates and Regression Analysis.”Sociological Methods and Research23:
230–57
