摘要：Objectives. We compared the strength of association between average 5-year county-level mortality rates and area-level measures, including air quality, sociodemographic characteristics, violence, and economic distress. Methods. We obtained mortality data from the National Vital Statistics System and linked it to socioeconomic and demographic data from the Census Bureau, air quality data, violent crime statistics, and loan delinquency data. We modeled 5-year average mortality rates (1998–2002) for all-cause, cancer, heart disease, stroke, and respiratory diseases as a function of county-level characteristics using ordinary least squares regression models. We limited analyses to counties with population of 100 000 or greater (n = 458). Results. Demographic and socioeconomic characteristics, particularly the percentage older than 65 years and near poor, were top predictors of all-cause and condition-specific mortality, as were a high concentration of construction and service workers. We found weaker associations for air quality, mortgage delinquencies, and violent crimes. Protective characteristics included the percentage of Hispanics, Asians, and married residents. Conclusions. Multiple factors influence county-level mortality. Although county demographic and socioeconomic characteristics are important, there are independent, although weaker, associations of other environmental characteristics. Future studies should investigate these factors to better understand community mortality risk. Community characteristics have been linked to mortality risks. Previous research has documented associations between area-level poverty, education, and racial residential segregation with all-cause and condition-specific mortality rates. 1–4 Although these studies highlight the relationship between social context and mortality, they typically focus on a limited set of indicators. Furthermore, these studies rarely examine social factors in conjunction with other area-level factors. For example, a distinct line of research has emerged on the role of air quality in health and mortality. These studies have found significant associations between airborne carbon monoxide, ozone, and fine particulate matter (PM) with cardiovascular symptoms, cancer, and deaths. For instance, the probability of emergency department admissions for cardiovascular disease increases 0.96% for every 1 part-per-billion increase in peak daily carbon monoxide. 5 A 10 part-per-billion increase in ozone levels for 1 week increases cardiovascular and respiratory mortality by 0.64%. 6 Additionally, a 10-microgram increase in airborne fine PM has been shown to increase admissions for respiratory and cardiovascular conditions by similar magnitudes. 7 Finally, there are characteristics, such as financial distress, that have demonstrated associations with health outcomes at the individual level, 8–11 but their roles as independent community-level predictors of mortality have not been examined. We address this gap in the literature by simultaneously modeling and examining the relative strength of association between average 5-year mortality rates and a diverse set of county-level characteristics, including air quality, sociodemographics, violence, and housing distress, that have emerged from different lines of research that typically do not intersect.
