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Explaining large mortality differences between adjacent counties: a cross-sectional study
M Schootman1,2, L Chien3, S Yun4
1Department of Epidemiology, Saint Louis University College for Public Health and Social Justice, 3545 Lafayette Avenue, St. Louis, MO, 63104, USA. schootm@slu.edu.
BMC Public Health
|August 4, 2016
Summary
Geographic disparities in mortality rates between adjacent counties are significant. Risk factors like poverty and inability to afford care contribute to these differences, guiding targeted public health interventions.
Area of Science:
- Spatial epidemiology
- Public health research
- Biostatistics
Background:
- Geographic variations in health outcomes are extensive.
- Global health measures often overlook disparities between adjacent areas with differing mortality rates.
- Advanced spatial analysis can reveal localized health outcome differences.
Purpose of the Study:
- To quantify mortality rate differences between adjacent counties.
- To identify risk factors associated with these localized mortality differences.
- To determine if identified risk factors explain observed mortality variations.
Main Methods:
- Cross-sectional study in Missouri (2005-2009).
- Used age-adjusted all-cause mortality rates as the outcome.
- Employed multi-level Gaussian models and Bayesian approaches for analysis.
Main Results:
- Average mortality difference between adjacent counties was -3.27 per 100,000.
- Significant risk factors included inability to obtain medical care due to cost, hospital discharge rates, prevalence of fair/poor health, hypertension, and poverty.
- Poverty prevalence showed the strongest association with mortality differences.
Conclusions:
- Analyzing adjacent county mortality differences offers granular insights.
- Identified risk factors can inform targeted public health interventions.
- Reducing geographic disparities in health outcomes requires localized strategies.
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