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. 2010 Aug;100(8):1417-9.
doi: 10.2105/AJPH.2009.174185. Epub 2010 Jun 17.

Underlying causes of the emerging nonmetropolitan mortality penalty

Jeralynn S Cossman  1 , Wesley L James, Arthur G Cosby, Ronald E Cossman
Affiliations

Underlying causes of the emerging nonmetropolitan mortality penalty

Jeralynn S Cossman et al. Am J Public Health. 2010 Aug.

Abstract

The nonmetropolitan mortality penalty results in an estimated 40 201 excessive US deaths per year, deaths that would not occur if nonmetropolitan and metropolitan residents died at the same rate. We explored the underlying causes of the nonmetropolitan mortality penalty by examining variation in cause of death. Declines in heart disease and cancer death rates in metropolitan areas drive the nonmetropolitan mortality penalty. Future work should explore why the top causes of death are higher in nonmetropolitan areas than they are in metropolitan areas.

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Figures

FIGURE 1
FIGURE 1
Metropolitan-to-nonmetropolitan mortality rate ratio: National Center for Health Statistics Compressed Mortality File, 1968–2015. Note. Heart disease deaths were included if the International Classification of Diseases, Adapted for Use in the United States, Eighth Revision (ICDA-8), recode was between 310 and 400 (1968–1978), if the International Classification of Diseases, Ninth Revision (ICD-9), recode was between 320 and 410, or if the International Classification of Diseases, 10th Revision (ICD-10), recode was between 53 and 68. Comparable recodes for stroke were 410 to 480 (ICDA-8), 420 to 490 (ICD-9), and 70 to 75 (ICD-10). For cancer deaths, the recodes were 15 to 240 (ICDA-8), 160 to 250 (ICD-9), and 19 to 44 (ICD-10).
See this image and copyright information in PMC

References

    1. Cossman JS, Cossman RE, James WL, Campbell CR, Blanchard TC, Cosby AG. Persistent clusters of mortality in the United States. Am J Public Health 2007;97:2148–2150 - PMC - PubMed
    1. Murray CJL, Kulkarni SC, Michaud C, et al. Eight Americas: investigating mortality disparities across races, counties, and race-counties in the United States [published erratum appears in PLoS Med. 2006;3(12):e545] PLoS Med 2006;3(9):e260. - PMC - PubMed
    1. Shaw M, Orford S, Brimblecombe N, Dorling D. Widening inequality in mortality between 160 regions of 15 European countries in the early 1990s. Soc Sci Med 2000;50:1047–1058 - PubMed
    1. Cosby AG, Neaves TT, Cossman RE, et al. Preliminary evidence for an emerging nonmetropolitan mortality penalty in the United States. Am J Public Health 2008;98:1470–1472 - PMC - PubMed
    1. National Center for Health Statistics Compressed Mortality File. Available at: http://www.cdc.gov/nchs/products/elec_prods/subject/mcompres.htm. Accessed August 2008