The Digester

An NBER study using 1992–2019 county mortality and health behavior data finds that past smoking patterns are the dominant driver of widening midlife mortality gaps by education and across places, especially the reversal of the rural health advantage.

Between 1992 and 2019 the life expectancy gap between Americans with and without college degrees widened from 2.6 years to 6.3 years.
College graduate mortality fell sharply and converged across states while non-college mortality showed little average improvement and much greater geographic variation.
County non-college smoking rates are the strongest predictor of changes in non-college midlife mortality and, with initial mortality and rural-urban status, explain nearly half of spatial variation.
A one standard deviation increase in non-college smoking is linked to about 53 extra deaths per 100,000, and a 10 percentage point higher non-college smoking rate in 1992 predicted about 98 more deaths per 100,000 in 2019, while a 10-point decline in smoking over 1992–2019 reduced 2019 mortality by about 137 per 100,000.
Once smoking is included, other factors such as obesity, income, employment, manufacturing decline, China trade exposure, and state policy add little explanatory power for non-college mortality.
Smoking has minimal predictive power for college graduate mortality, and recent declines in smoking among younger non-college adults imply future midlife mortality should improve.

Smoking explains much of the rise in US midlife mortality gaps, NBER finds

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