LATEBREAKER
Social
Historical state compulsory schooling laws and pandemic-era mortality: A quasi-experimental study Whitney Wells* Whitney Wells Yea-Hung Chen Marie-Laure Charpignon Ah-Reum Lee Ruijia Chen Andrew C. Stokes Jacqueline Torres M. Maria Glymour
Low educational attainment is linked to increased COVID-19 mortality, but it remains unclear whether this link is causal or due to confounding factors, e.g. childhood SES. To address this question, we evaluated if older adults’ risk of COVID-19 mortality was associated with historical state-level compulsory schooling laws (CSLs) when they were school-aged. We also evaluated if the impact was unique to COVID-19 or applied to all-cause mortality, before and during the pandemic.
US death certificate data Mar 2019-Dec 2021 were used to define mortality outcomes for people born pre-1964. 2019 American Community Survey data was used to determine the population at risk, representing 78.7 million born pre-1964. We linked individuals to CSLs based on state and year of birth. We estimated intention-to-treat effects of CSLs on mortality using logistic regressions controlling for state-of-birth fixed effects, birth year, sex, race, ethnicity, and state-level factors.
We identified a dose-response relationship between CSLs and mortality. In the first year of the pandemic, people mandated to receive 8 vs 9 (reference) years of education had higher odds of COVID-19 mortality (OR: 1.15; 95% CI: 1.10, 1.19), while those mandated to receive 10 vs 9 (reference) years of education had lower odds of COVID-19 mortality (OR: 0.96; 95% CI: 0.94, 0.98). The association of CSLs with COVID-19 mortality was similar in pandemic years 1 and 2; for all-cause mortality in pandemic years 1 and 2; and for all-cause mortality in the year prior to the pandemic. Results were robust to alternative model specifications.
These findings support a causal benefit of education for reduced mortality during the COVID-19 pandemic. State investments in children’s education may have reduced pandemic-era mortality decades later. Our research has implications beyond the pandemic context, as our results suggest the observed relationship mirrors a pre-existing relationship between CSLs and all-cause mortality.
