Association of education level with mortality in United States - A cross-sectional study

Educational level (EL), an important component for socioeconomic status, can potentially influence health, disease or mortality. Unfortunately, the detailed relationship between educational level and all cause or disease specific mortality in general population has not been elucidated, especially in Americans, which could impact public health policy. Here we analyzed association of EL with mortality in a nationally representative cohort from NHANES. This cohort study used National Health and Nutrition Examination Survey data from 1999 through 2018 and linked mortality information until 2019. Data were analyzed from April 1 through July 15, 2024. This study included 34,673 American adults aged 20-80 years old. During a median (IQR) follow-up of 9.9 (5.2-15.2) years, 5663 deaths were recorded. We found that higher EL was associated with mortality reduction in all cause, CVD, diabetes, Chronic Lower Respiratory Disease (CLRD), cancer and kidney disease mortality. Stratified analysis revealed that in subgroups <65 years, protection of higher EL was greater for all cause, CVD and cancer mortality. Higher EL was associated with reduction in male, while a risk factor in female for Alzheimer Disease, Influenza and Pneumonia Mortality. Higher EL was associated with mortality reduction in <65 subgroup, while a risk factor in ≥65 for Accidents Mortality. We found higher EL was associated with reduction in all cause, CVD, diabetes, Chronic Lower Respiratory Disease (CLRD), cancer and kidney disease mortality in a representative cohort in U.S. This study proved clear association between education level and disease specific mortality in a large nationally representative cohort in U.S., which may impact future public health policy making.