Social Vulnerability and Disparities in All-Cause Mortality in the United States

People living in areas of lower socioeconomic status experience worse health outcomes. Less is known about how specific measures of area-level socioeconomic influence mortality, and how these effects are modified by race, geography, and gender in the United States.

We obtained data on deaths from all causes in the United States from 1999 to 2020 from the Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research database. We combined county-level age-adjusted mortality rates (AAMRs) and population counts from the CDC WONDER database with the overall SVI score, both for the overall population and for sociodemographic subgroups. We divided the SVI into quartiles and compared death rates across groups by SVI quartile.

Higher SVI scores were significantly associated with higher all-cause mortality rates in the overall population (p < 0.001) and across all sociodemographic subgroups. Significant mortality disparities were observed across all subgroups. Notably, Black-White disparities were not significant in the least vulnerable quartile (AAMR ratio = 1.10, 95% CI: 0.96-1.25, p = 0.16) but remained significant in all other quartiles and for the overall population.

In this national analysis, higher SVI was consistently linked to increased mortality across all population subgroups. While sociodemographic disparities were significant across SVI quartiles, they tended to widen with increasing SVI. The lack of significant Black-White disparities in the least vulnerable quartile suggests that reducing social vulnerability may help mitigate racial health disparities, though it alone may not be sufficient. These findings highlight the potential for targeted interventions to reduce social deprivation, particularly to benefit Black Americans.