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Persistence of death in the United States: The remarkably different mortality patterns between America’s Heartland and Dixieland

Author

Listed:
  • Wesley James

    (University of Memphis)

  • Jeralynn Cossman

    (West Virginia University)

  • Julia Wolf

    (West Virginia University)

Abstract

Background: Geographic disparities in mortality have been analyzed by place in myriad ways. Although the people who live in a place continuously change, the health characteristics of those places tend to stay the same; they are persistent. Our work analyzes persistence of mortality across various geographic designations and uncovers the wide-ranging disparities in death across the United States. Methods: Using 48 years of county-level mortality data, we analyze trends over time and disparities across places using rural–urban distinctions and census-based region and division classifications. Trends in death rates, excess deaths, and rates of mortality improvement are provided. Results: Findings support the hypothesis that persistently high mortality places are disproportionately concentrated in the rural South, particularly the East South Central division of Kentucky, Tennessee, Mississippi, and Alabama. The disparity between this division and urban America is wide and getting wider, and the disparity between this area of the South and the Midwest is alarming. Contribution: Our research moves forward the literature on place-based mortality disparities in two important areas by testing the notion of persistence of poor health in place, and by identifying geographic disparities based on classifications not previously tested.

Suggested Citation

  • Wesley James & Jeralynn Cossman & Julia Wolf, 2018. "Persistence of death in the United States: The remarkably different mortality patterns between America’s Heartland and Dixieland," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 39(33), pages 897-910.
    • Handle: RePEc:dem:demres:v:39:y:2018:i:33
    DOI: 10.4054/DemRes.2018.39.33
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    References listed on IDEAS

    as
    1. Singh, G.K. & Siahpush, M., 2002. "Increasing rural-urban gradients in US suicide mortality, 1970-1997," American Journal of Public Health, American Public Health Association, vol. 92(7), pages 1161-1167.
    2. Cosby, A.G. & Neaves, T.T. & Cossman, R.E. & Cossman, J.S. & James, W.L. & Feierabend, N. & Mirvis, D.M. & Jones, C.A. & Farrigan, T., 2008. "Preliminary evidence for an emerging nonmetropolitan mortality penalty in the United States," American Journal of Public Health, American Public Health Association, vol. 98(8), pages 1470-1472.
    3. Cossman, J.S. & Cossman, R.E. & James, W.L. & Campbell, C.R. & Blanchard, T.C. & Cosby, A.G., 2007. "Persistent clusters of mortality in the United States," American Journal of Public Health, American Public Health Association, vol. 97(12), pages 2148-2150.
    4. Christopher J L Murray & Sandeep C Kulkarni & Catherine Michaud & Niels Tomijima & Maria T Bulzacchelli & Terrell J Iandiorio & Majid Ezzati, 2006. "Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States," PLOS Medicine, Public Library of Science, vol. 3(9), pages 1-12, September.
    5. Cossman, J.S. & James, W.L. & Cosby, A.G. & Cossman, R.E., 2010. "Underlying causes of the emerging nonmetropolitan mortality penalty," American Journal of Public Health, American Public Health Association, vol. 100(8), pages 1417-1419.
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    Cited by:

    1. Nathan T. Dollar & Iliya Gutin & Elizabeth M. Lawrence & David B. Braudt & Samuel Fishman & Richard G. Rogers & Robert A. Hummer, 2020. "The persistent southern disadvantage in US early life mortality, 1965‒2014," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 42(11), pages 343-382.
    2. An, Yuulin & Chin, Sayorn & Miller, Ray, 2025. "Growing old in rural America: Measuring late-life health and economic well-being," The Journal of the Economics of Ageing, Elsevier, vol. 31(C).
    3. Miller, Charlotte E. & Vasan, Ramachandran S., 2021. "The southern rural health and mortality penalty: A review of regional health inequities in the United States," Social Science & Medicine, Elsevier, vol. 268(C).
    4. Shannon M. Monnat, 2020. "Trends in U.S. Working-Age non-Hispanic White Mortality: Rural–Urban and Within-Rural Differences," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 39(5), pages 805-834, October.

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    JEL classification:

    • J1 - Labor and Demographic Economics - - Demographic Economics
    • Z0 - Other Special Topics - - General

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