The long arm of childhood policy: Historical schooling laws and COVID-19 pandemic-era mortality

BACKGROUND: Low educational attainment was strongly associated with higher COVID-19 mortality. Whether this association is causal remains controversial. We evaluated the impact of historical state-level compulsory schooling laws (CSLs) on older individuals' pandemic-era mortality via natural experiment. METHODS: We defined the US population of older adults using the 2019 American Community Survey (ACS) and included all US death certificates March 2019-December 2021. We linked each individual to state-level CSLs at school-age. We estimated effects of state-level CSLs on individual-level COVID-19 mortality and all-cause mortality pre-pandemic (March 2019-February 2020), pandemic year 1 (March 2020-February 2021) and pandemic year 2 (March 2021-December 2021), controlling for birth year, sex, race and ethnicity, state-level demographics, and state-of-birth fixed effects. We also examined effect heterogeneity by sex and racial identity. RESULTS: Each additional year of policy-mandated compulsory schooling was associated with lower odds of COVID-19 mortality (pandemic year 1 Odds Ratio [OR] for 8 vs 9 years: 1.16 (95% Confidence Interval [CI]: 1.11 to 1.20); OR for 10 vs 9 years 0.96 (95% CI: 0.93 to 0.98); similar estimates in year 2). The relationship between CSLs and COVID-19 mortality roughly mirrored the relationship with all-cause mortality immediately before and during the pandemic. The gradient was steepest among Black women. CONCLUSIONS: Older adults born into states requiring longer schooling experienced markedly lower mortality during the pandemic, suggesting historic investments in children's education reduced pandemic-era mortality decades later. Our findings support a causal relationship between population-level education policy and long-term population health.