title: Special healthcare taxing districts: association with population health status.
abstract: BACKGROUND
  Locally generated special healthcare taxes are an important component of community infrastructure, but their impact on the health status of populations has not been systematically addressed.
  
  
  METHODS
  Florida counties were segmented on the basis of the use/nonuse of locally generated tax dollars for health care during the 1992-1996 period and analyzed in 2004. Linear mixed-effects regression analysis was used to test a model in which taxing behavior served as the primary predictor variable for total age-adjusted and selected cause-specific mortality. Race/ethnicity, rurality, poverty, access to a public hospital, and physician availability were controlled.
  
  
  RESULTS
  Local taxation was associated with lower total age-adjusted mortality, and lower mortality for the major causes of death, except stroke, when compared to the state mean. Local taxation is protective relative to total age-adjusted mortality (odds ratio [OR]=0.63, 95% confidence interval [CI]=0.40-0.98) and age-adjusted mortality from chronic obstructive lung disease (OR=0.50, CI=0.32-0.79), cancers (OR=0.53, CI=0.34-0.084), and intentional injury (OR=0.50, CI=0.38-0.92).
  
  
  CONCLUSIONS
  Locally generated tax revenues used for the provision of healthcare services are consistently associated with improved health outcomes of major public health importance. The means by which this advantage is achieved will require additional research.
authors.affiliation: College of Health and Human Services, Department of Health Behavior and Administration, University of North Carolina, Charlotte, North Carolina 28223-0001, USA. jstudnic@email.uncc.edu
authors.forename: James
authors.initials: J
authors.lastname: Studnicki
authors.forename: Linda S
authors.initials: LS
authors.lastname: Gipson
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Berndt
authors.forename: John W
authors.initials: JW
authors.lastname: Fisher
authors.forename: Matthew
authors.initials: M
authors.lastname: Callandar
authors.forename: Etienne
authors.initials: E
authors.lastname: Pracht
authors.forename: Barbara
authors.initials: B
authors.lastname: Langland-Orban
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003695:Delivery of Health Care / Q000191:economics; D005431:Florida / Q000453:epidemiology; D006305:Health Status Indicators; D006801:Humans; D008875:Middle Aged; D008962:Models, Theoretical; D011159:Population Surveillance; D013660:Taxes