title: Disparities in premature mortality between high- and low-income US counties.
abstract: BACKGROUND
  Several well-established determinants of health are associated with premature mortality. Using data from the 2010 County Health Rankings, we describe the association of selected determinants of health with premature mortality among counties with broadly differing levels of income.
  
  
  METHODS
  County-level data on 3,139 US counties from the 2010 County Health Rankings were linked to county mortality data from the Centers for Disease Control and Prevention Compressed Mortality database. We divided counties into 3 groups, defined by sample median household income levels: low-income (≤25th percentile, $29,631), mid-income (25th-75th percentile, $29,631-$39,401), and high-income (≥75th percentile, ≥$39,401). We analyzed group differences in geographic, sociodemographic, racial/ethnic, health care, social, and behavioral factors. Stratified multivariable linear regression explored the associations of these health determinants with premature mortality for high- and low-income groups.
  
  
  RESULTS
  The association between income and premature mortality was stronger among low-income counties than high-income counties. We found differences in the pattern of risk factors between high- and low-income groups. Significant geographic, sociodemographic, racial/ethnic, health care, social, and behavioral disparities exist among income groups.
  
  
  CONCLUSIONS
  Geographic location and the percentages of adult smokers and adults with a college education were associated with premature mortality rates in US counties. These relationships varied in magnitude and significance across income groups. Our findings suggest that population health policies aimed at reducing mortality disparities require an understanding of the socioeconomic context within which modifiable variables exist.
authors.affiliation: Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 North Walnut St, Office 527, Madison, WI 53726, USA. ercheng@wisc.edu
authors.forename: Erika R
authors.initials: ER
authors.lastname: Cheng
authors.forename: David A
authors.initials: DA
authors.lastname: Kindig
mesh_terms: D054624:Health Status Disparities; D006801:Humans; D061213:Mortality, Premature / Q000208:ethnology; D012044:Regression Analysis; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology