The contribution of national disparities to international differences in mortality between the United States and 7 European countries.

Objectives. Life expectancy is lower in the United States (US) than in many Western European countries. A debated, yet untested hypothesis is that the higher US mortality is explained by larger social disparities in mortality in the US than Europe. We estimated the expected US mortality if educational disparities in the US were similar to those in seven European countries. Methods. Poisson models were used to quantify the association between education and mortality for men and women aged 30-74 years in the US, Belgium, Denmark, Finland, France, Norway, Sweden and Switzerland for the period 1989-2003. Results. If Americans had the same distribution of education as their European counterparts, the US mortality disadvantage would be larger. However, if educational disparities in mortality within the US equaled those within Europe, mortality differences between the US and Europe would be reduced by 20%-100%. Conclusions. Larger educational disparities in mortality in the US than Europe partly explain why US adults have higher mortality than their European counterparts. Policies to reduce mortality among the lower educated will be necessary to bridge the mortality gap between the US and European countries.