{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T11:34:21Z","timestamp":1793100861629,"version":"4.5.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Low educational attainment was strongly associated with higher coronavirus disease 2019 (COVID-19) mortality. Whether this association is causal remains controversial. We evaluated the impact of historical state-level compulsory schooling laws (CSLs) on older individuals\u2019 pandemic-era mortality via a natural experiment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We defined the US population of older adults using the 2019 American Community Survey and included all US death certificates from March 2019 to December 2021. We linked each individual to state-level CSLs at school age. We estimated effects of state-level CSLs on individual-level COVID-19 mortality and all-cause mortality pre-pandemic (March 2019\u2013February 2020), pandemic year 1 (March 2020\u2013February 2021), and pandemic year 2 (March 2021\u2013December 2021), controlling for birth year, sex, race and ethnicity, state-level demographics, and state-of-birth fixed effects. We also examined the effect heterogeneity by sex and racial identity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Each additional year of policy-mandated compulsory schooling was associated with lower odds of COVID-19 mortality (pandemic year 1 odds ratio [OR] for 8 vs. 9 years: 1.16 [95% confidence interval [CI]: 1.11, 1.20]; OR for 10 vs. 9 years 0.96 [95% CI: 0.93, 0.98]; similar estimates in year 2). The relationship between CSLs and COVID-19 mortality roughly mirrored the relationship with all-cause mortality immediately before and during the pandemic. The gradient was steepest among Black women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Older adults born into states requiring longer schooling experienced markedly lower mortality during the pandemic, suggesting historic investments in children\u2019s education reduced pandemic-era mortality decades later. Our findings support a causal relationship between population-level education policy and long-term population health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/ede.0000000000002002","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T14:01:02Z","timestamp":1779199262000},"page":"654-661","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["The Long Arm of Childhood Policy: Historical Schooling Laws and COVID-19 Pandemic-era Mortality"],"prefix":"10.1097","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5142-9849","authenticated-orcid":false,"given":"Whitney","family":"Wells","sequence":"first","affiliation":[{"name":"Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yea-Hung","family":"Chen","sequence":"additional","affiliation":[{"name":"Library, University of California San Francisco, San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafeya V.","family":"Raquib","sequence":"additional","affiliation":[{"name":"Department of Global Health, Boston University School of Public Health, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Laure","family":"Charpignon","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Pleasanton, CA"},{"name":"Departments of Biostatistics and Epidemiology, University of California Berkeley School of Public Health, Berkeley, CA"},{"name":"Computational Health Informatics Program, Boston Children\u2019s Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ah-Reum","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruijia","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Boston University School of Public Health, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew C.","family":"Stokes","sequence":"additional","affiliation":[{"name":"Department of Global Health, Boston University School of Public Health, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathew V.","family":"Kiang","sequence":"additional","affiliation":[{"name":"Epidemiology and Population Health, Stanford University, Stanford, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline M.","family":"Torres","sequence":"additional","affiliation":[{"name":"Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Maria","family":"Glymour","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Boston University School of Public Health, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"R1-20261027","doi-asserted-by":"crossref","first-page":"e311","DOI":"10.1016\/S2468-2667(23)00046-4","article-title":"Effectiveness assessment of non-pharmaceutical interventions: lessons learned from the COVID-19 pandemic.","volume":"8","author":"Lison","year":"2023","journal-title":"Lancet Public Health"},{"key":"R2-20261027","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.1377\/hlthaff.2023.00713","article-title":"Why similar policies resulted in different COVID-19 outcomes: how responsiveness and culture influenced mortality rates: study examines why similar policies resulted in different COVID-19 outcomes in using data from more than 100 countries.","volume":"42","author":"Lim","year":"2023","journal-title":"Health Aff (Project Hope)"},{"key":"R3-20261027","doi-asserted-by":"crossref","first-page":"5629","DOI":"10.1038\/s41598-023-31709-2","article-title":"A global analysis of the effectiveness of policy responses to COVID-19.","volume":"13","author":"Agyapon-Ntra","year":"2023","journal-title":"Sci Rep"},{"key":"R4-20261027","doi-asserted-by":"crossref","first-page":"e228406","DOI":"10.1001\/jamanetworkopen.2022.8406","article-title":"Occupation and educational attainment characteristics associated with COVID-19 mortality by race and ethnicity in California.","volume":"5","author":"Matthay","year":"2022","journal-title":"JAMA Netw Open"},{"key":"R5-20261027","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1016\/j.amepre.2022.06.020","article-title":"Excess mortality in California by education during the COVID-19 pandemic.","volume":"63","author":"Chen","year":"2022","journal-title":"Am J Prev Med"},{"key":"R6-20261027","doi-asserted-by":"crossref","first-page":"eadf9742","DOI":"10.1126\/sciadv.adf9742","article-title":"Monthly excess mortality across counties in the United States during the COVID-19 pandemic, March 2020 to February 2022.","volume":"9","author":"Paglino","year":"2023","journal-title":"Sci Adv"},{"key":"R7-20261027","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.puhe.2020.09.016","article-title":"Socio-economic status and COVID-19\u2013related cases and fatalities.","volume":"189","author":"Hawkins","year":"2020","journal-title":"Public Health"},{"key":"R8-20261027","doi-asserted-by":"crossref","first-page":"102649","DOI":"10.1016\/j.jhealeco.2022.102649","article-title":"The association between educational attainment and longevity using individual-level data from the 1940 census.","volume":"84","author":"Lleras-Muney","year":"2022","journal-title":"J Health Econ"},{"key":"R9-20261027","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1111\/0034-6527.00329","article-title":"The relationship between education and adult mortality in the United States.","volume":"72","author":"Lleras-Muney","year":"2005","journal-title":"Rev Econ Stud"},{"key":"R10-20261027","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1007\/s13524-020-00892-6","article-title":"The effects of education on mortality: evidence from linked US Census and administrative mortality data.","volume":"57","author":"Halpern-Manners","year":"2020","journal-title":"Demography"},{"key":"R11-20261027","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1017\/S0022050700025766","article-title":"Education and income in the early twentieth century: evidence from the prairies.","volume":"60","author":"Goldin","year":"2000","journal-title":"J Econ Hist"},{"key":"R12-20261027","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1136\/jech.2006.059469","article-title":"Does childhood schooling affect old age memory or mental status? 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