Inequalities in life expectancy in Australia according to education level: A whole-of-population record linkage study

Abstract Objective Life expectancy in Australia is amongst the highest globally, but national estimates mask within-country inequalities. We estimate education-related inequalities in adult life expectancy in Australia. Design and setting We estimated age-sex-education specific mortality rates using data from 2016 Australian Census linked to 2016-17 Death Registrations and standard life table methodology to calculate life expectancy. Participants 14,565,910 Australian residents aged 25 years and older. Main outcome measure Absolute (in years) and relative (ratios) differences in life expectancy at ages 25, 45, 65 and 85 years by sex and education level (5 levels, from Bachelor’s degree or higher [highest] to no secondary or post-secondary qualification [lowest]). Results At each age, those with lower education had shorter life expectancies. For men, the gap (highest vs lowest education) was 9.1 (95%CI: 8.8, 9.4) years at age 25, 7.3 (7.1, 7.5) years at age 45, 4.9 (4.7, 5.1) years at age 65 and 1.9 (1.8, 2.1) years at age 85. Absolute gaps were smaller for women compared with men but remained substantial: 5.5 (5.1, 5.9) years at age 25, 4.7 (4.4, 5.0) years at age 45, 3.3 (3.1, 3.5) years at 65 and 1.6 (1.4, 1.8) years at age 85. Relative differences were larger for men and increased with age. Conclusion Education-related inequalities in life expectancy from age 25 years in Australia are substantial such that those with the lowest education have a life expectancy equivalent to the national average 15-20 years ago. These vast gaps indicate large potential for further population health gains. The known Life expectancy in Australia has increased over time and is now among the highest in the world, but national estimates mask within-country inequalities and further potential for health gain. Area-level socioeconomic inequalities in health are well documented in Australia, but life expectancy gaps by individual-level socioeconomic position (e.g. highest level of education), a powerful measure of health inequality, have not been routinely available. The new Newly-available national linked data – 2016 Australian Census linked to Death Registrations (2016-17) – show that at each age (from age 25 years), men and women with lower levels of education, have shorter life expectancies. At age 25 years, the life expectancy gap between those with no educational qualifications and those with a university degree was 9.1 years for men and 5.5 years for women. Given lower life expectancy among men than among women, this represents a much larger relative – as well as absolute – gap for men. The implications Education-related gaps in life expectancy are considerable, larger than the OECD average, and mean that those with the lowest education have a life expectancy equivalent to the national average 15-20 years ago. The gaps indicate large potential for further improvements in population health, and health equity.