Relationship between Premature Mortality and Socioeconomic Factors in Black and White Populations of US Metropolitan Areas

• Published in: Public health reports (1974) Vol. 116; no. 5; pp. 464 - 473
• Main Authors: Cooper, Richard S., Joan F. Kennelly, Durazo-Arvizu, Ramon, Hyun-Joo Oh, George Kaplan, Lynch, John
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.09.2001; SAGE PUBLICATIONS, INC; Association of Schools of Public Health
• Subjects: Adolescent; Adult; African Americans; African Americans - statistics & numerical data; Black white relations; Censuses; Child; Child, Preschool; European Continental Ancestry Group - statistics & numerical data; Health Services Accessibility; Household income; Housing; Humans; Income inequality; Inequality; Infant; Infant, Newborn; Median income; Metropolitan areas; Middle Aged; Mortality; Poverty - ethnology; Prejudice; Premature mortality; Public health; Racism; Regression Analysis; Residential segregation; Segregation; Small-Area Analysis; Socioeconomic Factors; Socioeconomics; United States - epidemiology; Urban Health; White people; United States
• ISSN: 0033-3549; 1468-2877
• DOI: 10.1016/S0033-3549(04)50074-2

Objective: This ecologic study examined the association of mortality with selected socioeconomic indicators of inequality and segregation among blacks and whites younger than age 65 in 267 US metropolitan areas. The primary aim of the analysis was to operationalize the concept of institutional racism in public health. Methods: Socioeconomic indicators were drawn from Census and vital statistics data for 1989-1991 and included median household income; two measures of income inequality; percentage of the population that was black; and a measure of residential segregation. Results: Age-adjusted premature mortality was 81% higher in blacks than in whites, and median household income was 40% lower. Income inequality, as measured by the Gini coefficient, was greater within the black population (0.45) than within the white population (0.40; p < 0.001). To confirm that the proxy socioeconomic variables were relevant markers of population health status, regression analysis was performed initially on data for the total population. These variables were all independently and significantly related to premature mortality (p ≤ 0.01; R2= 0.74). Income inequality for the total population was significantly correlated with premature mortality (r = 0.33). Black (r = 0.26) and white (r = 0.20) population-specific correlations between income inequality and premature mortality, while still significant, were smaller. Residential segregation was significantly related to premature mortality and income inequality for blacks (r = 0.38 for both); among whites, however, segregation was modestly correlated with premature mortality (r = 0.19) and uncorrelated with income inequality. Regional analyses demonstrated that the association of segregation with premature mortality was much more pronounced in the South and in areas with larger black populations. Conclusion: Social factors such as income inequality and segregation strongly influence premature mortality in the US. Ecologic studies of the relationships among social factors and population health can measure attributes of the social context that may be relevant for population health, providing the basis for imputing macro-level relationships.