Skip to main content
PMC home page
Public Health Reports logoLink to Public Health Reports
. 2001 Sep-Oct;116(5):464–473. doi: 10.1093/phr/116.5.464

Relationship between premature mortality and socioeconomic factors in black and white populations of US metropolitan areas.

R S Cooper 1, J F Kennelly 1, R Durazo-Arvizu 1, H J Oh 1, G Kaplan 1, J Lynch 1
PMCID: PMC1497360  PMID: 12042610

Abstract

OBJECTIVE: 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 < or = 0.01; R(2) = 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.

Full Text

The Full Text of this article is available as a PDF (93.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arber S., Ginn J. Gender and inequalities in health in later life. Soc Sci Med. 1993 Jan;36(1):33–46. doi: 10.1016/0277-9536(93)90303-l. [DOI] [PubMed] [Google Scholar]
  2. Bird S. T., Bauman K. E. The relationship between structural and health services variables and state-level infant mortality in the United States. Am J Public Health. 1995 Jan;85(1):26–29. doi: 10.2105/ajph.85.1.26. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Brewster K. L. Neighborhood context and the transition to sexual activity among young black women. Demography. 1994 Nov;31(4):603–614. [PubMed] [Google Scholar]
  4. Cooper R. S. Health and the social status of blacks in the United States. Ann Epidemiol. 1993 Mar;3(2):137–144. doi: 10.1016/1047-2797(93)90126-o. [DOI] [PubMed] [Google Scholar]
  5. Diez-Roux A. V. Bringing context back into epidemiology: variables and fallacies in multilevel analysis. Am J Public Health. 1998 Feb;88(2):216–222. doi: 10.2105/ajph.88.2.216. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Geronimus A. T., Bound J., Waidmann T. A., Hillemeier M. M., Burns P. B. Excess mortality among blacks and whites in the United States. N Engl J Med. 1996 Nov 21;335(21):1552–1558. doi: 10.1056/NEJM199611213352102. [DOI] [PubMed] [Google Scholar]
  7. Geronimus A. T., Bound J., Waidmann T. A. Poverty, time, and place: variation in excess mortality across selected US populations, 1980-1990. J Epidemiol Community Health. 1999 Jun;53(6):325–334. doi: 10.1136/jech.53.6.325. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Geronimus A. T. To mitigate, resist, or undo: addressing structural influences on the health of urban populations. Am J Public Health. 2000 Jun;90(6):867–872. doi: 10.2105/ajph.90.6.867. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Jenkins C. D., Tuthill R. W., Tannenbaum S. I., Kirby C. R. Zones of excess mortality in Massachusetts. N Engl J Med. 1977 Jun 9;296(23):1354–1356. doi: 10.1056/NEJM197706092962315. [DOI] [PubMed] [Google Scholar]
  10. Kaplan G. A., Lynch J. W. Is economic policy health policy? Am J Public Health. 2001 Mar;91(3):351–353. doi: 10.2105/ajph.91.3.351. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Kennedy B. P., Kawachi I., Lochner K., Jones C., Prothrow-Stith D. (Dis)respect and black mortality. Ethn Dis. 1997 Autumn;7(3):207–214. [PubMed] [Google Scholar]
  12. Koopman J. S., Longini I. M., Jr The ecological effects of individual exposures and nonlinear disease dynamics in populations. Am J Public Health. 1994 May;84(5):836–842. doi: 10.2105/ajph.84.5.836. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Krieger N., Rowley D. L., Herman A. A., Avery B., Phillips M. T. Racism, sexism, and social class: implications for studies of health, disease, and well-being. Am J Prev Med. 1993 Nov-Dec;9(6 Suppl):82–122. [PubMed] [Google Scholar]
  14. Kunst A. E., Mackenbach J. P. The size of mortality differences associated with educational level in nine industrialized countries. Am J Public Health. 1994 Jun;84(6):932–937. doi: 10.2105/ajph.84.6.932. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Lynch J. W., Kaplan G. A., Pamuk E. R., Cohen R. D., Heck K. E., Balfour J. L., Yen I. H. Income inequality and mortality in metropolitan areas of the United States. Am J Public Health. 1998 Jul;88(7):1074–1080. doi: 10.2105/ajph.88.7.1074. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. McCord C., Freeman H. P. Excess mortality in Harlem. N Engl J Med. 1990 Jan 18;322(3):173–177. doi: 10.1056/NEJM199001183220306. [DOI] [PubMed] [Google Scholar]
  17. McMichael A. J. Prisoners of the proximate: loosening the constraints on epidemiology in an age of change. Am J Epidemiol. 1999 May 15;149(10):887–897. doi: 10.1093/oxfordjournals.aje.a009732. [DOI] [PubMed] [Google Scholar]
  18. Osborne N. G., Feit M. D. The use of race in medical research. JAMA. 1992 Jan 8;267(2):275–279. [PubMed] [Google Scholar]
  19. Polednak A. P. Trends in US urban black infant mortality, by degree of residential segregation. Am J Public Health. 1996 May;86(5):723–726. doi: 10.2105/ajph.86.5.723. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Roberts E. M. Neighborhood social environments and the distribution of low birthweight in Chicago. Am J Public Health. 1997 Apr;87(4):597–603. doi: 10.2105/ajph.87.4.597. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Ross N. A., Wolfson M. C., Dunn J. R., Berthelot J. M., Kaplan G. A., Lynch J. W. Relation between income inequality and mortality in Canada and in the United States: cross sectional assessment using census data and vital statistics. BMJ. 2000 Apr 1;320(7239):898–902. doi: 10.1136/bmj.320.7239.898. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Sampson R. J., Raudenbush S. W., Earls F. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science. 1997 Aug 15;277(5328):918–924. doi: 10.1126/science.277.5328.918. [DOI] [PubMed] [Google Scholar]
  23. Susser M. The logic in ecological: I. The logic of analysis. Am J Public Health. 1994 May;84(5):825–829. doi: 10.2105/ajph.84.5.825. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Waitzman N. J., Smith K. R. Phantom of the area: poverty-area residence and mortality in the United States. Am J Public Health. 1998 Jun;88(6):973–976. doi: 10.2105/ajph.88.6.973. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Williams D. R., Lavizzo-Mourey R., Warren R. C. The concept of race and health status in America. Public Health Rep. 1994 Jan-Feb;109(1):26–41. [PMC free article] [PubMed] [Google Scholar]
  26. Wright E. O. The class analysis of poverty. Int J Health Serv. 1995;25(1):85–100. doi: 10.2190/WYRM-630N-8M6V-7851. [DOI] [PubMed] [Google Scholar]
  27. Yen I. H., Kaplan G. A. Poverty area residence and changes in physical activity level: evidence from the Alameda County Study. Am J Public Health. 1998 Nov;88(11):1709–1712. doi: 10.2105/ajph.88.11.1709. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Public Health Reports are provided here courtesy of SAGE Publications

RESOURCES