A new study reveals that the majority of excess deaths in the United States in 2023 occurred among adults without a college degree, pointing to a growing divide in health outcomes tied to educational attainment.
According to research published in JAMA Health Forum and led by a collaboration between Boston University, the University of Helsinki, and the University of Minnesota, more than 525,000 additional deaths occurred in 2023 beyond what would have been expected if pre-2010 trends had continued. Alarmingly, over 90% of those deaths—481,211—were among people without a bachelor’s degree.
This stark disparity reflects deep-rooted challenges in American public health, particularly among people without higher education who are increasingly vulnerable to cardiometabolic diseases like heart disease, stroke, and type 2 diabetes. These conditions, researchers note, have become key drivers of rising mortality over the past 15 years.
While COVID-19 briefly drew national attention to falling life expectancy, the study’s authors emphasize that these trends started well before the pandemic and have not returned to pre-pandemic levels even as COVID-related deaths declined in 2023. “The pandemic exacerbated existing problems,” said lead author Dr. Eugenio Paglino, “but the crisis in mortality was already underway.”
A 26% Rise in Deaths for Those Without a Degree
Between 2011 and 2023, people without a bachelor’s degree experienced a 26% increase in mortality, compared to only 8% among college graduates. These findings were based on data from 47.5 million U.S. deaths among adults aged 35 and older.
For those without a degree, heart disease remained the leading cause of death. But diabetes and drug overdoses were also major contributors—especially among men. Drug overdose deaths were much less common among men with college degrees, highlighting how educational and economic opportunities shape vulnerability to so-called “deaths of despair.”
“These trends reflect not just personal choices, but the environments people live and work in,” said senior author Dr. Andrew Stokes of Boston University. “People without a college degree are more likely to live in rural areas, work in unstable jobs, and have limited access to healthy foods and medical care.”
Education: A Predictor of Long-Term Health
Experts say education is one of the strongest predictors of long-term health. Higher education often leads to better-paying, more stable jobs that provide health insurance, safer working conditions, and the flexibility to prioritize diet, exercise, and preventive care.
“Education structures people’s entire lives,” said Dr. Donald Lloyd-Jones, director of Boston University’s Framingham Center. “It shapes where they live, what food they eat, what jobs they can get, and whether they can avoid harmful exposures.”
Dr. Maria Glymour, a public health expert not involved in the study, agreed. “This work is a clarion call,” she said. “We must look beyond surface-level causes and address the causes of the causes—the structural roots of inequality.”
Some Signs of Progress—but Only for the Educated
While the overall mortality trend is worsening for those without a degree, the study found some positive news among women with a bachelor’s degree: deaths from cancer and external causes (like accidents or violence) decreased in 2023 compared to rates in 2006–2010.
“If we had simply maintained the rate of progress we were making 20 years ago,” said co-author Dr. Elizabeth Wrigley-Field, “over half a million lives could have been saved in 2023 alone. And nearly all of those individuals—92%—didn’t have a college degree.”
Moving Forward: A Call for Policy and Workplace Change
The researchers stress that improving life expectancy and reducing preventable deaths will require policy changes that address education, employment, housing, food access, and healthcare. They also argue that American workplaces must become more supportive of health.
“Workplaces should help, not harm, people’s health,” said Wrigley-Field. “If we want to see lasting improvement, we need to redesign systems so that all Americans—not just the college-educated—have a fair shot at a longer, healthier life.”
In short, this study makes one thing painfully clear: education is a life-or-death issue in America. The growing mortality gap reveals a need for urgent public health and social policy reforms that can close the divide—and save lives.
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The research findings can be found in JAMA Health Forum.
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