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


  • Mark R. Cullen
  • Clint Cummins
  • Victor R. Fuchs


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
    Note: AG HE

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    References listed on IDEAS

    1. Leigh, Andrew & Jencks, Christopher, 2007. "Inequality and mortality: Long-run evidence from a panel of countries," Journal of Health Economics, Elsevier, vol. 26(1), pages 1-24, January.
    2. James P. Smith, 2007. "The Impact of Socioeconomic Status on Health over the Life-Course," Journal of Human Resources, University of Wisconsin Press, vol. 42(4).
    3. Deaton, Angus & Lubotsky, Darren, 2003. "Mortality, inequality and race in American cities and states," Social Science & Medicine, Elsevier, vol. 56(6), pages 1139-1153, March.
    4. James Banks & Alastair Muriel & James Smith, 2010. "Disease prevalence, disease incidence, and mortality in the United States and in England," Demography, Springer;Population Association of America (PAA), vol. 47(1), pages 211-231, March.
    5. James Smith, 2004. "Unravelling the SES health connection," IFS Working Papers W04/02, Institute for Fiscal Studies.
    6. Martens, W. J. M., 1998. "Climate change, thermal stress and mortality changes," Social Science & Medicine, Elsevier, vol. 46(3), pages 331-344, February.
    7. repec:aph:ajpbhl:2004:94:6:1043-1048_1 is not listed on IDEAS
    8. Blakely, Tony & Wilson, Nick, 2006. "Shifting dollars, saving lives: What might happen to mortality rates, and socio-economic inequalities in mortality rates, if income was redistributed?," Social Science & Medicine, Elsevier, vol. 62(8), pages 2024-2034, April.
    9. repec:aph:ajpbhl:2001:91:3:385-391_5 is not listed on IDEAS
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    Cited by:

    1. Duncan Gillespie & Meredith Trotter & Shripad Tuljapurkar, 2014. "Divergence in Age Patterns of Mortality Change Drives International Divergence in Lifespan Inequality," Demography, Springer;Population Association of America (PAA), vol. 51(3), pages 1003-1017, June.
    2. 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.

    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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