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New findings by the American Cancer Society (ACS) show disparities in mortality rates by educational attainment as a measure of socio-economic status considerably increased in 2020 compared to prior years. The increase in disparities was likely in part due to a large disturbance in the U.S. health system created by the COVID-19 pandemic disproportionately affecting people of lower socio-economic status. The study was published today in the American Journal for Preventive Medicine (AJPM).

Study authors reviewed 7,123,254 deaths of people over the age of 25 from 2017 to 2020. The leading causes of death examined were heart disease, cancer, cerebrovascular disease (a condition affecting blood flow and the blood vessels in the brain), unintentional injury, chronic lower respiratory disease, diabetes, and Alzheimer’s disease.

All-cause death rates were approximately two times higher among adults with the least education compared to adults with the most education. The disparity had slight annual increases between 2017 and 2019 and was accentuated in 2020. This pattern persisted even after excluding COVID-19 deaths. Disparities in cause-specific mortality by educational attainment were particularly heightened in heart disease, cancer, cerebrovascular, and unintentional injury-related deaths. Similar patterns were observed across race/ethnicity and sex, although Hispanic individuals had the greatest relative increase in disparities.

“The pandemic brought fluctuations in health insurance coverage by abrupt changes in employment and health system disruptions in the U.S. and was particularly impactful for people of lower socio-economic status,” said Dr. Emily Marlow, postdoctoral research fellow, cancer disparity research at the American Cancer Society and lead author of the study. “For example, delays in radiation therapy and cancer surgery occurred more often among people of lower socio-economic status. Delays in cancer screening during the pandemic are also predicted to widen disparities in cancer mortality in the coming years.”

While the study found significantly widening disparities accentuated in 2020, researchers urged further study of the specific impact of COVID-19 to better develop mitigation strategies in future health crises.

“This study shows that the gap in mortality widened by socio-economic status during the pandemic,” said Dr. Farhad Islami, senior scientific director, cancer disparity research at the American Cancer Society and senior author of the study. “Our findings highlight the need for strategies to mitigate widening disparities in mortality and to maintain access to healthcare for people of all races and socio-economic levels during a major healthcare crisis.”

Other ACS authors include: Dr. Ahmedin Jemal, Dr. Blake Thomson, Dr. Daniel Weise, Jingxuan Zhao, and Rebecca Siegel.