摘要：Objectives. We estimated how many deaths would be averted if the entire population of Virginia experienced the mortality rates of the 5 most affluent counties or cities. Methods. Using census data and vital statistics for the years 1990 through 2006, we applied the mortality rates of the 5 counties/cities with the highest median household income to the populations of all counties and cities in the state. Results. If the mortality rates of the reference population had applied to the entire state, 24.3% of deaths in Virginia from 1990 through 2006 (range = 21.8%–28.1%) would not have occurred. An annual mean of 12 954 deaths would have been averted (range = 10 548–14 569), totaling 220 211 deaths from 1990 through 2006. In some of the most disadvantaged areas of the state, nearly half of deaths would have been averted. Conclusions. Favorable conditions that exist in areas with high household incomes exert a major influence on mortality rates. The corollary—that health suffers when society is exposed to economic stresses—is especially timely amid the current recession. Further research must clarify the extent to which individual-level factors (e.g., earnings, education, race, health insurance) and community characteristics can improve health outcomes. An extensive literature documents the profound influence of socioeconomic status on life expectancy. 1 – 4 The notion that social conditions affect health is intuitive to policymakers and the public, but the magnitude of this effect may not be fully appreciated, and our previous work has sought to put it in perspective. For example, we have previously demonstrated on the basis of vital statistics that correcting mortality disparities by race and educational status would save 5 and 8 lives, respectively, for every 1 life saved by biomedical advances. 5 , 6 Social determinants exert influences on health through individual and household circumstances as well as through concurrent environmental conditions that exist in areas where people reside. 7 – 11 People with good jobs, higher incomes, an advanced education, or historically favored racial or ethnic backgrounds experience better health not only because of these personal characteristics but also because of their surroundings. Access to safe neighborhoods, supermarkets with healthy foods, places to exercise, good schools, health care facilities, and clean air and water affects health outcomes. 12 – 16 Area-based measures of economic status can act as a proxy for this package of interrelated social (individual and community) conditions. 8 – 11 Virginia offers an interesting setting for contrasting the health effects of disparate socioeconomic environments. Since 2000, 1 or more counties in northern Virginia have been among the 10 counties in the United States with the highest median household income. 17 – 21 Conversely, Virginia also encompasses areas of deep poverty, such as the Appalachian region, and counties with large populations of minorities and adults with limited education. We took advantage of this setting to explore the association between health status and median area household income, the latter acting as a proxy for the combination of individual, household, and community conditions that exist in these areas. We posed the following research question: How many deaths would be averted in Virginia if every county and city experienced the mortality rates of the most affluent areas? We estimated averted deaths in aggregate for the state, for each county and city, and for specific demographic subgroups.
