Understanding US Regional Health and Mortality Disparities: A Life Course Approach

Regional differences in health and mortality in the U.S. have been observed in numerous studies, but these differences remain largely unexplained. Understanding the mechanisms that account for regional differences is important for determining how to reduce health disparities. This study focuses on determining the full extent of regional differences in health by (1) applying more refined measures of region along with a broader array of health outcomes than previously utilized, and (2) employing a life course perspective and methods to more precisely differentiate the pathways via which region may affect health.  

The study evaluates the full extent of regional health disparities using longitudinal statistical methods applied to three nationally-representative, large sample data sets: The General Social Survey, the Health and Retirement Study and the National Health Epidemiologic Follow-up Surveys. These data are augmented via the collection of region-year contextual variables like physician density, climate, etc. Collectively, these surveys contain a wide variety of health measures—including self-rated health, physical functioning, depressive symptoms, mortality, and diabetes—as well as refined regional measures (i.e., the nine-category Census measure). These three surveys also contain at least one measure of region of residence in early life (birth and adolescence), which, from a life course perspective, helps distinguish the difference between the role of early life socialization into regional culture from the role of regional structural characteristics in influencing health. In addition, the study promotes more extensive research into how health influences regional mobility, a largely ignored research area.  The study uses basic descriptive methods, typical regression models, multistate life table methods for both panel and cross-sectional data and hierarchical growth models (including autoregressive latent trajectory models) to examine the extent of regional differences in health and the mechanisms that account for them.

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