Why is the educational gradient of mortality steeper for men?
OBJECTIVE
It is often documented that the educational gradient of mortality is steeper for men than for women; yet, the explanation remains a matter of debate. We examine gender differences in the gradients within the context of marriage to determine whether overall differences reflect gender differences in health behaviors or a greater influence of men's education on spousal health.


METHODS
We used data from the 1986 through 1996 National Health Interview Survey Linked Mortality Files for non-Hispanic White adults aged 55-84 years at the time of survey. We estimated Cox proportional hazards models to examine the gradients (N = 180,208).


RESULTS
The educational gradient of mortality is marginally steeper for men than for women when aggregating across marital statuses; yet, this reflects a steeper gradient among unmarried men, with low-educated never married men exhibiting high levels of mortality. The gradient among unmarried men is steeper than unmarried women for causes that share smoking as a major risk factor, supporting a behavioral explanation for differences in the gradient. No gender difference in the gradient is observed for married adults.


CONCLUSIONS
Low education and unmarried status exert a synergistic effect on men's mortality. Unmarried, low-educated men may lack social supports that encourage positive health behaviors.
Montez
Jennifer Karas
JK
Population Research Center, University of Texas at Austin, Austin, TX 78712, USA. jennkaras@prc.utexas.edu
Hayward
Mark D
MD
Brown
Dustin C
DC
Hummer
Robert A
RA
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D015233:Models, Statistical; D009026:Mortality; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000706:statistics & numerical data; D012737:Sex Factors; D012944:Social Support; D018454:Spouses; D014481:United States