Volume 51 - Article 7 | Pages 191–214  

Socio-behavioral factors contributing to recent mortality trends in the United States

By Samuel Preston, Yana Vierboom, Mikko Myrskylä

Abstract

Background: We investigate the contribution of socio-behavioral factors to changes in US adult mortality over the period 1997–2019 using National Health Interview Surveys for the years 1997–2018 linked to death records through 2019. The variables studied include alcohol consumption, cigarette smoking, health insurance coverage, educational attainment, mental distress, obesity, and race/ethnicity. We evaluate the contribution of each socio-behavioral variable to mortality change by estimating the mortality risks associated with each variable in a hazards model and applying the risks to changes in the variable’s distribution.

Results: When all variables are included in the model, we find that reductions in cigarette smoking and increases in educational attainment are the largest contributors to recent mortality improvements, accounting between them for 66% of mortality improvements. The contribution of educational attainment nearly doubles when variables that may be considered downstream to it are omitted from the analysis. In a secondary analysis, we compare two subperiods to investigate whether the variables can account for a widely observed slowdown in the rate of mortality reduction that occurred within the period of study. Rising levels of psychological distress, combined with very high risks associated with distress, contributed substantially to the slowdown. However, most of the slowdown remains unaccounted for.

Contribution: We develop and apply a rigorous method to identify the role of many socio-behavioral factors in recent mortality change in the United States. Results highlight the role of a behavioral change (declines in smoking) and a broad social advance (educational expansion).

Author's Affiliation

• Samuel Preston - University of Pennsylvania, United States of America EMAIL
• Yana Vierboom - Max-Planck-Institut für Demografische Forschung, Germany EMAIL
• Mikko Myrskylä - Max-Planck-Institut für Demografische Forschung, Germany EMAIL

Other articles by the same author/authors in Demographic Research

Projection of US adult obesity trends based on individual BMI trajectories
Volume 51 - Article 13

The contribution of differences in adiposity to educational disparities in mortality in the United States
Volume 37 - Article 54

Reproductive behavior following evacuation to foster care during World War II
Volume 33 - Article 1

The role of smoking on mortality compression: An analysis of Finnish occupational social classes, 1971-2010
Volume 32 - Article 20

Urban fertility responses to local government programs: Evidence from the 1923-1932 U.S.
Volume 32 - Article 16

Age-specific fertility by educational level in the Finnish male cohort born 1940‒1950
Volume 31 - Article 5

Factors responsible for mortality variation in the United States: A latent variable analysis
Volume 31 - Article 2

The effects of shocks in early life mortality on later life expectancy and mortality compression: A cohort analysis
Volume 22 - Article 12

An integrated approach to cause-of-death analysis: cause-deleted life tables and decompositions of life expectancy
Volume 19 - Article 35

Cohort fertility patterns and breast cancer mortality among U.S. women, 1948-2003
Volume 18 - Article 9

Comparative mortality levels among selected species of captive animals
Volume 15 - Article 14

Most recent similar articles in Demographic Research

Excess mortality associated with HIV: Survey estimates from the PHIA project
Volume 51 - Article 38    | Keywords: excess mortality, HIV/AIDS, mortality

A Bayesian model for age at death with cohort effects
Volume 51 - Article 33    | Keywords: age at death, Bayesian approach, cohort effects, Italy, mortality

On the relationship between life expectancy, modal age at death, and the threshold age of the life table entropy
Volume 51 - Article 24    | Keywords: Gompertz law, life expectancy, lifespan variation, longevity, mode, mortality

The role of sex and age in seasonal mortality – the case of Poland
Volume 51 - Article 17    | Keywords: mortality, Poland, seasonality, sex differences

Data errors in mortality estimation: Formal demographic analysis of under-registration, under-enumeration, and age misreporting
Volume 51 - Article 9    | Keywords: age misreporting, data errors, formal demography, mortality