Exclusionary School Discipline and Black-White Disparities in Mortality through Early-Midlife

In the U.S., Black Americans live significantly shorter lives than White Americans. Prior research has named inequitable social exposures as critical determinants of the Black survival disadvantage during middle- and later-adulthood. Other work documents that unequal educational experiences are precursors to Black-White health disparities later in life. Still, no studies have linked educational exposures to racial disparities in subsequent mortality risk during adolescence and young adulthood. To that end, we use the National Study of Adolescent to Adult Health (Add Health) and Cox proportional hazard models to document the extent of Black-White disparities in all-cause and cause-specific mortality through young adulthood for a nationally representative cohort of Americans who were adolescents in the mid-1990s. We examine whether racially unequal exposure to exclusionary school discipline during adolescence accounts for any of this disparity. Results indicate a strong, positive associations between exclusionary school discipline and mortality from both internal (HR = 1.62) and external (HR = 2.27) causes of death, even after adjustment for socioeconomic and health covariates. We also find that Black-White disparities in mortality are heterogenous by cause of death: there is a large Black disadvantage in internal-cause mortality (HR = 1.74) and a modest Black advantage in external-cause mortality (HR = 0.65). Accounting for exclusionary school discipline in statistical models attenuates the Black-White hazard ratios for both internal and external causes of death. Our fundings underscore the critical need to reform exclusionary disciplinary practices to reduce premature mortality in the United States, particularly among Black Americans.