Are White women high school dropouts getting sicker?

My Twitter feed lit up yesterday with this story about how life expectancy is falling for White women who have not finished high school. The story was called, “What’s Killing Poor White Women?“, by Monica Potts.

I have complete sympathy for poor people with health problems and high mortality rates. Things are killing them, and that’s bad. They should have better education, better jobs, better health care and more money.

White women without high school degrees have lost five years of life expectancy. Something must be getting worse. But I don’t quite think so. I could be wrong. But I think that as the category White women without high school degrees shrinks, it is the healthier people who are leaving (or never entering) the group. As a result, the group’s average health is declining.

The first thing to realize is that, according to the Census Bureau [spreadsheet link], 95% of non-Hispanic White women ages 25-29 have completed four years of high school or more. So we’re talking about a very (negatively) select population. And it’s getting more select – it was 92% 20 years ago. (Potts’s story revolves around a woman who died at 38.*)

The article doesn’t give any numbers to show that more people are dying, just that the life expectancy of the group has fallen. If this were a group, like race or gender, whose membership doesn’t change much over time, that would be enough to indicate their health status was getting worse. But an education group isn’t like that. It’s membership changes over time. Neither of the two academic articles Potts cites seem to consider this possibility (here and here).

One take

Here’s a try at it. Since 1996, the Current Population Survey has asked an excellent health status question, asking people to rate their own health as excellent, very good, good, fair, or poor. Let’s treat those whose health is “poor” as the group driving the mortality trend (which seems to fit the narrative in the story).

Here is the scary trend: A sharp rise in the proportion of non-Hispanic White women high school dropouts, ages 20-29, who rate their health as “poor.” (All the figures use three-year averages.)

poorhealthThat looks terrible, and it is, of course. But look at the size of the total group (all health statuses) over the same period:

dropoutsSo, the group has shrunk by about 18%, from about 850,000 to less than 700,000. And here is how the group’s population has changed according to health status, using the two endpoints of the trend, 1996-98 and 2010-12:

drophealthSo, there has been, in effect, no change in the number of non-Hispanic White women high school dropouts ages 20-29 in poor health, for the last decade and a half (the numbers shown are population estimates based on a sample size of only a few hundred women in this category per year, so I discount small shifts). In contrast, there has been a decline of those in good health. Result: the average health of the group has declined, but there are not more sick women.

That’s good news, because in Potts’s telling their problems are very serious, and something should be done about it.

*I (or you) could redo this to include more ages. I used young people because, if they have high mortality rates, they’re going to disappear from the sample at relatively young ages and make the group look healthier.




11 thoughts on “Are White women high school dropouts getting sicker?

      1. 😦 😦 😦

        The more and more that I learn about the shoddy “science” of both medical researchers and social scientists, the less and less respect I have for them.

        Maybe I should really blame journalistic sensationalism and incompetence, but doctors, social scientists and University PR departments trumpeting preliminary results is probably worse, since otherwise journalists never would have known of the studies w/o the publicity.


  1. Female mortality also rose in a lot of those counties. It is possible that the shrinking cohort just reveals the worst off women who were always lurking in that group, but it’s also true that a higher proportion of women are dying. Of course, you’re right, but I talked with the researchers about this too and they didn’t think it was the whole story.

    Also, I don’t really say they’re “sicker.” The joblessness study looked at whether it was true that the sickest women were just the ones least likely to go to work, and that didn’t hold up.


    1. Thank you for replying.

      I’m afraid those don’t really address the changing composition/selection issue. Death rates continue to fall, including for White women, nationally (, as their life expectancy overall rises ( So if mortality is rising in some counties it’s falling in others. The Kindig and Cheng paper controls for population change in their models of determinants of mortality change, but they don’t report the results for that variable in the appendix, so we don’t know how much of the county change they discuss is accounted for by population change. Looking at their maps the rising-mortality places, it looks like there is a lot of overlap with an outmigration map ( If it turns out mortality is rising in places people are leaving, that fits the story I’m telling. I’ll ask them if they will share have the full results.


  2. “So, there has been, in effect, no change in the number of non-Hispanic White women high school dropouts ages 20-29 in poor health, for the last decade and a half (the numbers shown are population estimates based on a sample size of only a few hundred women in this category per year, so I discount small shifts). ”

    This seems to be drawing a affirmative conclusion from a null result. Based on your numbers, there is no evidence of a change in white women dropouts in poor health, but that does not mean there is evidence that it has not changed. Indeed, looking at the other bars (which do presumably show affirmative evidence of a decrease in good health), the most parsimonious explanation would be that, if we had to make a bet (in a Bayesian fashion, though not due to any priors other than the evidence from the other bars), it would be reasonable to bet that poor health has increased while good health has decreased. But if that’s going too far, you should at least say that there is evidence that good health has decreased and we can’t say one way or the other about poor health. What you can’t say is that these data suggest that poor health has not increased.


  3. Also, I meant to say this earlier, but the cohort for all the groups is different, and much smaller, than 18 years ago. So even though black and hispanic women are more likely to drop out than white women, fewer drop out today than did in 1990, by about the same percentages, so you would have seen a similar drop for them if that explained the whole decline.


  4. I guess I would be surprised if selection were the entire story behind this divergence. Undoubtedly, it explains some of the pattern, but there are also plenty of other factors that have increasingly disadvantaged women with low education. Indeed, the mortality burden of cigarette smoking has not just diverged across educational groups for women, but has also risen among the least educated, even among those with a high school diploma.

    One thing that would clarify the selection problem would be to look at educational differentials in longevity in a cohort perspective. We can’t do that yet because we don’t have the data (many of the women in these cohorts aren’t dead yet). But if increasing selectivity is an issue, the educational gap should grow across cohorts (as those without a HS diploma are an increasingly select group) instead of just across periods.


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