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Geographic and Racial Variation in Premature Mortality in the US: Analyzing the Disparities

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  • Mark R. Cullen
  • Clint Cummins
  • Victor R. Fuchs
Abstract
Life expectancy at birth, estimated from United States period life tables, has been shown to vary systematically and widely by region and race. We use the same tables to estimate the probability of survival from birth to age 70 (S70), a measure of mortality more sensitive to disparities and more reliably calculated for small populations, to describe the variation and identify its sources in greater detail to assess the patterns of this variation. Examination of the unadjusted probability of S70 for each US county with a sufficient population of whites and blacks reveals large geographic differences for each race-sex group. For example, white males born in the ten percent healthiest counties have a 77 percent probability of survival to age 70, but only a 61 percent chance if born in the ten percent least healthy counties. Similar geographical disparities face white women and blacks of each sex. Moreover, within each county, large differences in S70 prevail between blacks and whites, on average 17 percentage points for men and 12 percentage points for women. In linear regressions for each race-sex group, nearly all of the geographic variation is accounted for by a common set of 22 socio-economic and environmental variables, selected for previously suspected impact on mortality; R2 ranges from 0.86 for white males to 0.72 for black females. Analysis of black-white survival chances within each county reveals that the same variables account for most of the race gap in S70 as well. When actual white male values for each explanatory variable are substituted for black in the black male prediction equation to assess the role explanatory variables play in the black-white survival difference, residual black-white differences at the county level shrink markedly to a mean of -2.4% (+/-2.4); for women the mean difference is -3.7 % (+/-2.3).

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  • Mark R. Cullen & Clint Cummins & Victor R. Fuchs, 2012. "Geographic and Racial Variation in Premature Mortality in the US: Analyzing the Disparities," NBER Working Papers 17901, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:17901
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    7. Melissa P L Chan & Robert S Weinhold & Reuben Thomas & Julia M Gohlke & Christopher J Portier, 2015. "Environmental Predictors of US County Mortality Patterns on a National Basis," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-25, December.
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    9. Abu-Qarn, Aamer & Lichtman-Sadot, Shirlee, 2021. "Older Adult Health Following Greater Access to Secondary Health Care: Evidence from Bus Service Introductions to Arab Towns in Israel," IZA Discussion Papers 14490, Institute of Labor Economics (IZA).
    10. Abu-Qarn, Aamer & Lichtman-Sadot, Shirlee, 2022. "Can greater access to secondary health care decrease health inequality? Evidence from bus line introduction to Arab towns in Israel," Economic Modelling, Elsevier, vol. 106(C).
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    12. Herwartz, Helmut & Schley, Katharina, 2018. "Improving health care service provision by adapting to regional diversity: An efficiency analysis for the case of Germany," Health Policy, Elsevier, vol. 122(3), pages 293-300.
    13. Anneliese N. Luck & Irma T. Elo & Samuel H. Preston & Eugenio Paglino & Katherine Hempstead & Andrew C. Stokes, 2023. "COVID-19 and All-Cause Mortality by Race, Ethnicity, and Age Across Five Periods of the Pandemic in the United States," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 42(4), pages 1-29, August.
    14. Rouven Edgar Haschka & Katharina Schley & Helmut Herwartz, 2020. "Provision of health care services and regional diversity in Germany: insights from a Bayesian health frontier analysis with spatial dependencies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(1), pages 55-71, February.
    15. Jennifer Trudeau & Karen Smith Conway & Andrea Kutinova Menclova, 2016. "Soaking Up the Sun: The Role of Sunshine in the Production of Infant Health," American Journal of Health Economics, MIT Press, vol. 2(1), pages 1-40, January.
    16. Yiqun Chen & Petra Persson & Maria Polyakova, 2019. "The Roots of Health Inequality and The Value of Intra-Family Expertise," NBER Working Papers 25618, National Bureau of Economic Research, Inc.
    17. Kevin M. Fitzpatrick & Don Willis, 2020. "Chronic Disease, the Built Environment, and Unequal Health Risks in the 500 Largest U.S. Cities," IJERPH, MDPI, vol. 17(8), pages 1-8, April.

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    More about this item

    JEL classification:

    • I0 - Health, Education, and Welfare - - General
    • I00 - Health, Education, and Welfare - - General - - - General
    • I10 - Health, Education, and Welfare - - Health - - - General
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I3 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty
    • I31 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - General Welfare, Well-Being

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