Increasing inequalities in all-cause and cardiovascular mortality among US adults aged 25-64 years by area socioeconomic status, 1969-1998.
BACKGROUND
This study examined the extent to which areal socio-economic gradients in all-cause and cardiovascular disease (CVD) mortality among US men and women aged 25-64 years increased between 1969 and 1998.


METHODS
Using factor analysis 17 census tract variables were used to develop an areal index of socio-economic status that was used to stratify all US counties into five socio-economic categories. By linking the index to county-level mortality data from 1969 to 1998, we calculated annual age-adjusted mortality rates for each area socio-economic group. Poisson regression models were fitted to estimate areal socio-economic gradients in mortality over time.


RESULTS
Areal socio-economic gradients in all-cause and cardiovascular mortality have increased substantially over the past three decades. Compared to men in the highest area socio-economic group, rates of all-cause and CVD mortality among men in the lowest area socio-economic group were 42% and 30% greater in 1969-1970 and 73% and 79% greater in 1997-1998, respectively. The gradients in mortality among women were steeper for CVD than for all causes. Compared to women in the highest area socio-economic group, rates of all-cause and CVD mortality among women in the lowest area socio-economic group were 29% and 49% greater in 1969-1970 and 53% and 94% greater in 1997-1998, respectively.


CONCLUSIONS
Although US all-cause and cardiovascular mortality declined for all area socio-economic groups during 1969-1998, the gradient increased because of significantly larger mortality declines in the higher socio-economic groups. Increasing areal inequalities in mortality shown here may be related to increasing temporal differences in the material and social living conditions between areas.
Singh
Gopal K
GK
National Institutes of Health, National Cancer Institute, Division of Cancer Control and Population Sciences, 6116 Executive Blvd, Suite 504, MSC 8316, Bethesda, MD 20892-8316, USA. gopal_singh@nih.gov
Siahpush
Mohammad
M
D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality*; D019352:Censuses; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D012044:Regression Analysis; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology