Health Care Use and Health Care‒Amenable Mortality Among US Adults With and Without a Bachelor's Degree, 1996‒2023.

Abstract

<b>Objectives.</b> To describe health care‒related educational divides in 2 dimensions-outpatient care utilization and medically preventable deaths-over the past 25 years. <b>Methods.</b> We examined education-based disparities in ambulatory care utilization by analyzing data on 476 277 respondents aged 25 years or older to the 1996-2022 US Medical Expenditure Panel Survey, and in deaths potentially preventable by medical care (defined by <i>International Classification of Diseases, 10th Revision</i>, code) from 26 092 720 death certificates of individuals aged 25 to 74 years in the United States from 2001 to 2023. <b>Results.</b> In 1996, the share of adults with zero provider visits was higher among those without (26.4%; 95% confidence interval [CI] = 25.3, 27.5) than with (20.2%; 95% CI = 18.5, 22.0) a bachelor's degree, a gap that widened to a nearly 2-fold difference by 2022; the gap in the proportion with no doctor visit also widened. Disparities in health care use were larger after adjustment for health factors. Separately, we observed large and growing education-based gaps in age-adjusted health care‒amenable mortality. <b>Conclusions.</b> Education-based disparities in ambulatory health care utilization have grown since 1996, as have medically preventable deaths. <b>Public Health Implications.</b> Improved health care access for less-educated Americans might help address widening disparities in ambulatory health care use and, potentially, health outcomes. (<i>Am J Public Health.</i> 2026;116(5):692-701. https://doi.org/10.2105/AJPH.2025.308373).