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Health Care Use and Health Care‒Amenable Mortality Among US Adults With and Without a Bachelor's Degree, 1996‒2023.

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Title: Health Care Use and Health Care‒Amenable Mortality Among US Adults With and Without a Bachelor's Degree, 1996‒2023.
Authors: Gaffney, Adam, Woolhandler, Steffie, Dickman, Samuel L., Schrier, Elizabeth, McCormick, Danny, Himmelstein, David U.
Source: American Journal of Public Health. May2026, Vol. 116 Issue 5, p692-701. 10p.
Subjects: Mortality prevention, Medical care use, Mortality, Health services accessibility, Cross-sectional method, Poisson distribution, Outpatient services in hospitals, Undergraduate programs, Outpatient medical care, Patient care, Descriptive statistics, Surveys, Death certificates, Health equity, Confidence intervals, Data analysis software, Educational attainment, Patients' attitudes, Medical care costs, Nosology
Geographic Terms: United States
Abstract: Objectives. To describe health care‒related educational divides in 2 dimensions—outpatient care utilization and medically preventable deaths—over the past 25 years. Methods. We examined education-based disparities in ambulatory care utilization by analyzing data on 476 277 respondents aged 25 years or older to the 1996–2022 US Medical Expenditure Panel Survey, and in deaths potentially preventable by medical care (defined by International Classification of Diseases, 10th Revision , code) from 26 092 720 death certificates of individuals aged 25 to 74 years in the United States from 2001 to 2023. Results. In 1996, the share of adults with zero provider visits was higher among those without (26.4%; 95% confidence interval [CI] = 25.3, 27.5) than with (20.2%; 95% CI = 18.5, 22.0) a bachelor's degree, a gap that widened to a nearly 2-fold difference by 2022; the gap in the proportion with no doctor visit also widened. Disparities in health care use were larger after adjustment for health factors. Separately, we observed large and growing education-based gaps in age-adjusted health care‒amenable mortality. Conclusions. Education-based disparities in ambulatory health care utilization have grown since 1996, as have medically preventable deaths. Public Health Implications. Improved health care access for less-educated Americans might help address widening disparities in ambulatory health care use and, potentially, health outcomes. [ABSTRACT FROM AUTHOR]
Copyright of American Journal of Public Health is the property of American Public Health Association and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Health Care Use and Health Care‒Amenable Mortality Among US Adults With and Without a Bachelor's Degree, 1996‒2023.
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  Data: <searchLink fieldCode="JN" term="%22American+Journal+of+Public+Health%22">American Journal of Public Health</searchLink>. May2026, Vol. 116 Issue 5, p692-701. 10p.
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  Data: <searchLink fieldCode="DE" term="%22Mortality+prevention%22">Mortality prevention</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+care+use%22">Medical care use</searchLink><br /><searchLink fieldCode="DE" term="%22Mortality%22">Mortality</searchLink><br /><searchLink fieldCode="DE" term="%22Health+services+accessibility%22">Health services accessibility</searchLink><br /><searchLink fieldCode="DE" term="%22Cross-sectional+method%22">Cross-sectional method</searchLink><br /><searchLink fieldCode="DE" term="%22Poisson+distribution%22">Poisson distribution</searchLink><br /><searchLink fieldCode="DE" term="%22Outpatient+services+in+hospitals%22">Outpatient services in hospitals</searchLink><br /><searchLink fieldCode="DE" term="%22Undergraduate+programs%22">Undergraduate programs</searchLink><br /><searchLink fieldCode="DE" term="%22Outpatient+medical+care%22">Outpatient medical care</searchLink><br /><searchLink fieldCode="DE" term="%22Patient+care%22">Patient care</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Surveys%22">Surveys</searchLink><br /><searchLink fieldCode="DE" term="%22Death+certificates%22">Death certificates</searchLink><br /><searchLink fieldCode="DE" term="%22Health+equity%22">Health equity</searchLink><br /><searchLink fieldCode="DE" term="%22Confidence+intervals%22">Confidence intervals</searchLink><br /><searchLink fieldCode="DE" term="%22Data+analysis+software%22">Data analysis software</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+attainment%22">Educational attainment</searchLink><br /><searchLink fieldCode="DE" term="%22Patients'+attitudes%22">Patients' attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+care+costs%22">Medical care costs</searchLink><br /><searchLink fieldCode="DE" term="%22Nosology%22">Nosology</searchLink>
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– Name: Abstract
  Label: Abstract
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  Data: Objectives. To describe health care‒related educational divides in 2 dimensions—outpatient care utilization and medically preventable deaths—over the past 25 years. Methods. We examined education-based disparities in ambulatory care utilization by analyzing data on 476 277 respondents aged 25 years or older to the 1996–2022 US Medical Expenditure Panel Survey, and in deaths potentially preventable by medical care (defined by International Classification of Diseases, 10th Revision , code) from 26 092 720 death certificates of individuals aged 25 to 74 years in the United States from 2001 to 2023. Results. In 1996, the share of adults with zero provider visits was higher among those without (26.4%; 95% confidence interval [CI] = 25.3, 27.5) than with (20.2%; 95% CI = 18.5, 22.0) a bachelor's degree, a gap that widened to a nearly 2-fold difference by 2022; the gap in the proportion with no doctor visit also widened. Disparities in health care use were larger after adjustment for health factors. Separately, we observed large and growing education-based gaps in age-adjusted health care‒amenable mortality. Conclusions. Education-based disparities in ambulatory health care utilization have grown since 1996, as have medically preventable deaths. Public Health Implications. Improved health care access for less-educated Americans might help address widening disparities in ambulatory health care use and, potentially, health outcomes. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of American Journal of Public Health is the property of American Public Health Association and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.2105/AJPH.2025.308373
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 10
        StartPage: 692
    Subjects:
      – SubjectFull: Mortality prevention
        Type: general
      – SubjectFull: Medical care use
        Type: general
      – SubjectFull: Mortality
        Type: general
      – SubjectFull: Health services accessibility
        Type: general
      – SubjectFull: Cross-sectional method
        Type: general
      – SubjectFull: Poisson distribution
        Type: general
      – SubjectFull: Outpatient services in hospitals
        Type: general
      – SubjectFull: Undergraduate programs
        Type: general
      – SubjectFull: Outpatient medical care
        Type: general
      – SubjectFull: Patient care
        Type: general
      – SubjectFull: Descriptive statistics
        Type: general
      – SubjectFull: Surveys
        Type: general
      – SubjectFull: Death certificates
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      – SubjectFull: Health equity
        Type: general
      – SubjectFull: Confidence intervals
        Type: general
      – SubjectFull: Data analysis software
        Type: general
      – SubjectFull: Educational attainment
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      – SubjectFull: Patients' attitudes
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      – SubjectFull: Medical care costs
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      – SubjectFull: Nosology
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      – SubjectFull: United States
        Type: general
    Titles:
      – TitleFull: Health Care Use and Health Care‒Amenable Mortality Among US Adults With and Without a Bachelor's Degree, 1996‒2023.
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              Text: May2026
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