Explaining the widening divides in us midlife mortality: Is there a smoking gun?
nber.org
nber.org
By 2020, it had risen to well over a third of Americans who had bachelor's, and 105% more income for those with them. One might expect a dilution in a degree's value, but I think it's just a matter of minimum wage workers still being high school graduates, whereas virtually all professional workers (including the increasingly few manufacturing workers) needing a bachelor's to get past the first stage of HR.
[1] https://educationdata.org/education-attainment-statistics
[2] https://en.wikipedia.org/wiki/Educational_attainment_in_the_...
As someone who grew up upper middle class in a wealthier suburban area, I lived in a bubble where the vast majority of people I went to high school with went off to college and got bachelors degrees. To me, it seemed that that was the norm for most Americans, but that's far from reality.
https://www.npr.org/2025/11/20/nx-s1-5600854/college-costs-h...
takeaway is probably that a lot of not-really-qualified students are going to 4-year schools and probably shouldn't.
It's a smell test thing, basically.
There's also the factor that simply getting a degree screens out many of the people that engaged in such behaviors.
Let’s say currently, every rich person goes to college, so college to non-college lifespan is 80:60.
While in the 90s, let’s say 20% goes to college and every college going person is rich. Then the lifespan of college going person would still be 80 and non-college going person would be more than 60.
So, another way of looking at it is that the non-college going population is getting to be the special demographic whose statistics are getting skewed, though I’m not sure that’s the correct way of looking at it.
Here are the stats for Harvard enrollment of undergrads (1,3), along with US population (2,4) and percent Harvard student (not sure where I get number of people in the workforce with harvard degrees data but maybe this is a decent proxy):
Year - ugrads - US population - % of US pop at harvard
1990 - 22,851 - 248,709,873 - 0.0092%
2000 - 24,279 - 281,421,906 - 0.0086%
2010 - 27,594 - 308,745,538 - 0.0089%
2025 - 24,519 - 343,000,000 - 0.0071%
1. https://nces.ed.gov/programs/digest/d13/tables/dt13_312.20.a...
2. https://www.census.gov/data/tables/time-series/dec/popchange...
I wonder if this trend is due, in part, to college degree holders becoming disproportionately female over time, and women having lower midlife mortality rates? https://www.aei.org/wp-content/uploads/2018/05/degrees-1.png
I suppose it’s possible that the gender ratio change is the cause of half of the mortality decrease, and the other half is a broad decrease in mortality rates. That would cause it to cancel out in non-college degrees holder mortality holders and double in college degree holders.
Kinda like Bill Gates walking into a bar causes bar patron's average net worth jump up a few million. Funny thing, statistics.
It reminds me of a YT video I was watching with similar issues about cancer mortality rates. We've been doing all these treatments, and cancer survival rates have been going up. So everybody cheers about how good the treatments are. But when you control for the fact that earlier detection puts more people into the 'cancer' category earlier, causing 'cancer' people to live statistically longer from diagnosis, then the benefits of the treatments mostly go away (for many but not all types of cancer).
And these kinds of misleading issues are all throughout statistics. See Simpson's paradox, etc.
Let's assume fate has decreed that patient X will die of lung cancer at 70. Detect it at 68, dies in 2 years. Detect it at 64, dies in 6 years. Your early detection "increased" survival by 200%.
And I think there's a lot to his point. Fundamentally, cancer can be divided into three groups:
1) Slow growth. Leave it alone and it probably never harms the patient. Many prostate cancers fall into this category.
2) Fast growth. These are the ones where the oncologists hitting it hard can make a real difference.
3) Fast growth/fast spread. The oncologists don't have a chance. Some tumors can be slowed.
Unfortunately, our ability to figure these out (other than in hindsight) is limited. Both of my parents died of stuff that spread rapidly, in both cases treatment was a negative. (Although there was some palliative stuff for my father.)
Surely women aren't a 30% greater percentage of rural county dwellers than urban county dwellers, though?
Let me take a crack at it: people with college degrees tend to be found in populous places and spaces where smoking is prohibited. Plus, social pressure; lighting up a cigarette in certain company is almost like hurling a racist insult.
Just to get through college with a cigarette habit would have been a pain in the ass. You can't be darting outside N times during lectures or exams to have a smoke. If you can even do that; a lot of colleges nowadays have even outdoor smoking bans, no? That's sort of a place effect: college graduates spend a bunch of time in certain places where smoking would have been inconvenient to the point of making some people quit.
The latter effect, I think, can be explained by an argument that's similar to yours: even for non-college graduates, it's a lot more inconvenient to be a smoker in urban areas than in rural areas. You're much more likely to find smoking banned inside the places you go, and to face social disapproval if you try to smoke outdoors in public spaces.
Starting to wonder if the two are correlated.
We don't get a lot of press. During the first decade of the ACA we didn't exist for anyone reporting on the US healthcare system.
But our visibility has improved and some days we're almost noticed for moments at a time.
The ACA is just a huge transfer of tax payer money to insurance companies.
Suppose you extend Medicaid to those barred by pre-existing conditions--net result is a whole bunch of money moves from the ACA to Medicaid. The spending doesn't go away--if anything it probably increases. This has been an expensive year, nearly 9k in insurance premiums and I hit the stop-loss at nearly 9k. Thus 18k out of pocket that would have been Medicaid spending under your system.
And note that killing those 5% appears to be a Republican *goal*. Eugenics.
>a whole bunch of money moves from the ACA to Medicaid
Not really, Medicaid pays very low rates for treatments. The "ACA" money just goes to insurance companies which are incentivized to pay high rates for everything because their profit is set as a percent of their expenditures by the ACA.
> Under the old system, if you were in the 5% you probably died.
This is also not accurate at all either, you just had to pay more money. You could still get insurance with pre-existing conditions, it just wasn't cheap. ACA plans though are now ~10-15x more than older plans and the deductibles are way higher with much worse coverage.
>This has been an expensive year, nearly 9k in insurance premiums and I hit the stop-loss at nearly 9k. Thus 18k out of pocket that would have been Medicaid spending under your system.
I don't understand this, are you saying you paid 9K in premiums and then hit your MAX OOP at 9K as well?
I'm not sure why you are translating that cost directly to Medicaid, but realistically your insurance actually paid more than the 9K right? But Medicaid simply wouldn't pay out nearly as much. But even then I'm not saying it would be cheap. It would just be far more logical than the ridiculous system set up to preserve insurance company profits. Medicare for all would be even better.
The group that isn't hostile toward helping the vulnerable, they didn't care at all about us once the ACA was there for them.
Take them off the table and there's literally no one left.
I think this problem is very related to Fox News types convincing people to vote against their best interests. Immigrants, minorities keep voting for people like Trump and the Republicans to support them. It's the same deal with somehow people getting convinced that federal government healthcare is really bad for them and they're better just being out there with no healthcare, somehow
Obesity and fentanyl would be my guess.
> People who start smoking at age 18 begin to exhibit higher mortality several decades later, with particularly large effects beginning at ages 45–64 (Lawton et al. 2025). A health-capital model allows the mortality rates of older persons to be determined not only by their current smoking behavior but also by smoking in earlier years. In the United States, smoking rates started falling for college graduates earlier than they did for the non-college population.
...
> [...] with rapidly improving treatments and screening for lung cancer (Howladeret al. 2020), the major impact of smoking over the longer-term—particularly for people aged 55–64 arises from other more-common tobacco-related diseases such as chronic obstructive pulmonary disease (COPD); cardiovascular diseases such as strokes, aneurysms, and heart attacks; diabetes; and other types of cancers (Carter et al. 2015). Perhaps more surprising is that past county-level smoking rates are highly predictive of deaths of despair. This finding, however, is consistent with an emerging literature in biology that points to a causal influence of smoking on drug addiction [...]
Why is college the primary group factor…? Is there some sort of health effect of sitting college classrooms for 5 years? Seems unlikely.
College education is highly associated and predicted by income/access to wealth.
Wealth inequality seems like a more likely explanation. Not seeing how they controlled for that across college vs non-college groups.
Oof
> epigenetic changes making smokers more susceptible to opioid use disorders
This one seems… a bit mystic to me. I would have been much quicker to suggest that a psychological propensity to start smoking mirrors a propensity to start using other drugs vs. arguing for emergent effects of cellular behavior.
Second-Handers love to denigrate the work of Elon Musk and Sam Altman, but these men are solving fundamental problems, you can get your DRAM on the second-hand market after Sam uses it to create AGI. A reasonable man would be very grateful for the existence of these oligarchs. I assume you are just posting unconsciously not unreasonably.
I would, however, not strongly link WFH to college and RTO to non-college. Many companies (as well as governments) have implemented RTO. The key outlier for WFH seems to be contracts and/or good negotiation skills.
Your wager is nonsense by the way.
That's what I did. Groceries are a 10m drive away on a bad day. I've lived the rural life and it's not glamorous so I have no desire to return.
Of course some did make the move out to places like you're mentioning, but my suspicion is that this group is actually not that large and the big splash they made in media (traditional and social) made their numbers seem greater than they are.