Cancer mortality rates by educational attainment among U.S. adults aged 25–64 years: A population-based analysis (2021–2023).

Abstract

348 Background: Educational attainment is a key social determinant of health that may influence cancer outcomes through differences in prevention, early detection, treatment access, and health literacy. Contemporary population-based estimates of education-related cancer mortality gradients remain limited. Methods: We performed a population-based cross-sectional analysis using CDC WONDER Multiple Cause of Death data (2021–2023). Cancer deaths were identified using ICD-10 malignant neoplasm codes (C00–C97). Population denominators were derived from American Community Survey (ACS) B15001 1-year estimates pooled across 2021–2023. Mortality rates were calculated within age bands (25–34, 35–44, 45–64) and age-standardized within ages 25–64 using pooled ACS age distribution weights. Analyses were stratified by sex and educational attainment. Results: A strong inverse gradient between educational attainment and cancer mortality was observed in both sexes. Among females, age-adjusted mortality ranged from 45.4 per 100,000 among individuals with graduate/professional degrees to 133.7 per 100,000 among those without a high school diploma. Among males, rates ranged from 36.2 to 163.1 per 100,000 across the same educational extremes. The mortality rate ratio comparing lowest versus highest educational attainment was 2.9 among females and 4.5 among males. Intermediate educational categories demonstrated stepwise increases in mortality, indicating a continuous gradient rather than a threshold effect. Disparities were more pronounced among males and were driven by mortality in the 45–64 age group. Conclusions: Educational attainment is strongly associated with cancer mortality among working-age U.S. adults, with consistent gradients across education levels. These findings demonstrate reproducible education-based cancer mortality disparities using population denominators and highlight structural inequities representing critical targets for cancer prevention and control strategies. Age-adjusted cancer mortality rates by educational attainment among US adults aged 25–64 years, 2021–2023. Educational attainment (ACS) Female AAMR per 100,000 Female RR vs Grad/Prof Male AAMR per 100,000 Male RR vs Grad/Prof Graduate or professional degree (ref) 45.4 1.00 36.2 1.00 Bachelor’s degree 60.3 1.33 49.6 1.37 Some college, no degree 67.0 1.48 64.0 1.77 Associate’s degree 86.7 1.91 77.2 2.13 High school graduate (incl equivalency) 140.0 3.08 145.0 4.01 9th–12th grade, no diploma 133.7 2.95 163.1 4.50 AAMR indicates age-adjusted mortality rate per 100,000; ACS, American Community Survey. Mortality counts derived from CDC WONDER (Multiple Cause of Death). Population denominators obtained from ACS B15001 (1-year) and pooled across 2021–2023. Age adjustment performed across three age bands (25–34, 35–44, 45–64). Estimates represent national population rates.