Date of Award

2019

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Graduate Group

Demography

First Advisor

Irma Elo

Abstract

Good health is the cornerstone of a happy and productive life. Unfortunately, health is not distributed evenly among and within populations. This dissertation contains three chapters on adult health and mortality in the contemporary United States, paying special attention to social inequalities therein. Together, the chapters make both substantive and methodological contributions to the field of demography. In the first chapter, I use data from the National Health and Nutrition Examination Survey (NHANES) to consider the role of educational differences in weight history in shaping educational disparities in all-cause mortality over the period 1988-2010. I find that 10-12% of educational mortality differences are driven by the higher likelihood of groups with less formal schooling to have weighed more in the past. In the second chapter, I combine data from vital registration and the National Health Interview Survey (NHIS) to produce the first estimates of alcohol-related mortality rates by educational attainment in the U.S., for years 2000-2017. I find that alcohol-related mortality rates rose for both sexes and all levels of educational attainment. Increases were often larger for less educated groups, exacerbating already existing disparities. In the third chapter, I find that social inequalities shape not only the length of life and the ultimate cause of death, but also the quality of life at its very end. Using the NHIS, I examine trends in end-of-life health for years 1997-2015. People who are less educated, are black, immigrated to the U.S., are residents of the South, and have ever smoked experience longer periods of poor health at the end of life. Together, these three chapters illustrate the intricate nature of health inequalities.

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