title: Variability and vulnerability at the ecological level: implications for understanding the social determinants of health.
abstract: OBJECTIVE
  We examined variability in disease rates to gain understanding of the complex interactions between contextual socioeconomic factors and health.
  
  
  METHODS
  We compared mortality rates between New York and California counties in the lowest and highest quartiles of socioeconomic status (SES), assessed rate variability between counties for various outcomes, and examined correlations between outcomes' sensitivity to SES and their variability.
  
  
  RESULTS
  Outcomes with mortality rates that differed most by county SES were among those whose variability across counties was high (e.g., AIDS, homicide, cirrhosis). Lower-SES counties manifested greater variability among outcome measures.
  
  
  CONCLUSIONS
  Differences in health outcome variability reflect differences in SES impact on health. Health variability at the ecological level might reflect the impact of stressors on vulnerable populations.
authors.affiliation: Department of Population and International Health, Harvard School of Public Health, Boston, Mass, USA. aek3@cdc.gov
authors.forename: Adam
authors.initials: A
authors.lastname: Karpati
authors.forename: Sandro
authors.initials: S
authors.lastname: Galea
authors.forename: Tamara
authors.initials: T
authors.lastname: Awerbuch
authors.forename: Richard
authors.initials: R
authors.lastname: Levins
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D004194:Disease / Q000145:classification / Q000191:economics; D004522:Educational Status; D006305:Health Status Indicators; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D009026:Mortality; D009518:New York / Q000453:epidemiology; D011203:Poverty / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D012923:Social Class; D012959:Socioeconomic Factors; D014478:Unemployment / Q000706:statistics & numerical data