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Understanding Geographic Disparities in Mortality.

Jason M Fletcher1, Michal Engelman2, Norman J Johnson3

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Early life conditions significantly impact health outcomes. Analyzing mortality by state of birth, not just residence, reveals migration mitigates geographic health disparities.

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Area of Science:

  • Social Epidemiology
  • Public Health
  • Demography

Background:

  • Early-life conditions are known determinants of later-life health and migration.
  • Geographic disparities in mortality often overlook the influence of early-life environment and migration history, focusing solely on current residence.

Purpose of the Study:

  • To investigate how geographic disparities in mortality outcomes are affected by the aggregation method used (state of birth vs. state of residence).
  • To determine if interstate migration patterns mitigate or exacerbate baseline geographic inequalities in life expectancy.

Main Methods:

  • Utilized the Mortality Disparities in American Communities data set, linking 2008 American Community Survey respondents to death records.
  • Calculated the unweighted mean absolute deviation of the difference in life expectancy at age 50 between state of birth and state of residence.
  • Analyzed spatial clustering of disparities and the influence of in-migration, out-migration, and nonmigration on mortality measures.

Main Results:

  • Significant differences in life expectancy were observed based on state of birth versus state of residence (0.58 years for men, 0.40 years for women).
  • Regional inequality in life expectancy was higher when based on state of birth, suggesting interstate migration lessens geographic mortality disparities.
  • State-specific migration patterns complicate the interpretation of mortality disparities by state of residence.

Conclusions:

  • Geographic mortality disparities are influenced by whether state of birth or state of residence is used for analysis.
  • Interstate migration appears to play a role in mitigating baseline geographic inequalities in life expectancy.
  • Current methods for measuring geographic mortality disparities may be confounded by migration and early-life environmental factors.