How low education increases COVID-19 mortality: the mediating role of vaccination, distrust in science, and lack of preventative health behavior

Background: Previous research shows the significant correlation between low education and COVID-19 mortality in underprivileged communities, even when accounting for factors like poverty and race. The exact mechanisms by which low education gives rise to COVID-19 mortality, however, are less clear.

Methods: We propose that low education predicts COVID-19 morality because low education gives rise to a less engaged, less agentic approach to one's own healthcare. We operationalize low engagement and low agentic behavior as four variables that mediate the effect of low education on COVID-19 mortality: (i) vaccination, (ii) distrust of science (Republican vote), (iii) poor health, and (iv) prevention. We model COVID-19 mortality in 3108 counties of the United States, using deaths across 60 fortnights.

Main Results: All four indicators of an agentic, engaged approach to health are statistically significant mediators of the relationship between low education and COVID-19 mortality: vaccination [IRR = 1.02; (1.02, 1.03)]; Republican vote [IRR: 1.07; (1.06, 1.09)]; poor health [IRR: 1.01; (1.01, 1.02)]; and prevention [IRR: 1.00, (1.001, 1.003)].

Discussion: These findings suggest that low level of formal education predicts mortality from COVID-19 because low levels of education gives rise to a less engaged and less agentic approach to one's own health.