The Long Arm of Childhood Policy: Historical Schooling Laws and COVID-19 Pandemic-era Mortality

BACKGROUND: 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' pandemic-era mortality via a natural experiment. METHODS: 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-February 2020), pandemic year 1 (March 2020-February 2021), and pandemic year 2 (March 2021-December 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. RESULTS: 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. CONCLUSION: Older adults born into states requiring longer schooling experienced markedly lower mortality during the pandemic, suggesting historic investments in children's education reduced pandemic-era mortality decades later. Our findings support a causal relationship between population-level education policy and long-term population health.