Geographic morbidity differentials in the late nineteenth-century United States

We use a national cross-sectional database, the 1880 Integrated Public Use Microdata Sample, to examine aggregate patterns and individual-level estimates of chronic-disease morbidity and long-term disability in the United States in the late nineteenth century. Despite higher levels of urban mortality in 1880, morbidity prevalence rates were highest in the rural areas of the country, especially in the western and the southern regions. Equations using microdata show that the estimated risk of chronic disease and impairment was highest for males and females who were older, of lower socioeconomic status, or from rural areas. This era was marked by geographically uneven but significant levels of endemic chronic disease, likely the outcomes of prior episodes of infectious disease and exposure to conditions generated by human action, such as the Civil War and migration.