Community occupational structure, basic services, and coronary mortality in Washington state, 1980-1994

Area of Science:

• Public Health
• Epidemiology
• Sociology

Background:

• Geographic disparities in coronary heart disease (CHD) mortality exist.
• County-level socioeconomic factors may influence CHD rates.
• Understanding these associations is crucial for targeted public health interventions.

Purpose of the Study:

• To investigate the relationship between county occupational structure and CHD mortality in Washington State (1980-1994).
• To examine the role of public expenditures, services availability, and risk factor prevalence in this association.

Main Methods:

• Classified 39 Washington counties into three occupational structure categories based on managerial, professional, and technical employment percentages.
• Calculated age-adjusted CHD mortality rates (35-64 years), per capita expenditures, services, and CHD risk factor prevalence for each category.
• Utilized vital statistics, Census data, state revenue data, U.S. Statistical Abstracts, and Behavioral Risk Factor Surveillance System (BRFSS) data.

Main Results:

• CHD mortality rates and risk factor prevalence were inversely associated with occupational structure (higher-skilled jobs correlated with lower rates).
• Counties with higher occupational structure (Category III) had significantly higher per capita expenditures for health, social, employment services, and schools/recreation compared to lower-skilled counties (Category I).
• Category III counties also showed greater availability of child care, job training, employment, exercise, school, and medical services.

Conclusions:

• Occupational structure is linked to geographic variations in premature CHD mortality.
• Improved community living conditions and reduced economic disparities between counties are potential strategies to mitigate CHD mortality differences.
• Public services and resource availability appear to play a mediating role in the observed associations.