摘要：Objectives. This study examined age-, sex-, and race-specific gradients in US mortality by area deprivation between 1969 and 1998. Methods. A census-based area deprivation index was linked to county mortality data. Results. Area deprivation gradients in US mortality increased substantially during 1969 through 1998. The gradients were steepest for men and women aged 25 to 44 years and those younger than 25 years, with higher mortality rates observed in more deprived areas. Although area gradients were less pronounced for women in each age group, they rose sharply for women aged 25 to 44 and 45 to 64 years. Conclusions. Areal inequalities in mortality widened because of slower mortality declines in more deprived areas. Future research needs to examine population-level social, behavioral, and medical care factors that may account for the increasing gradient. Studies involving individual social class data have shown increasing socioeconomic inequalities in US infant and adult mortality rates. 1– 3 However, these studies have compared social class inequalities in mortality at only 2 distant time points (e.g., 1960 and 1986). This limitation is primarily because of limited availability of socioeconomic information in US mortality statistics, which generally include only educational attainment and usual occupation/industry of the decedent. 4– 9 Moreover, analyses of socioeconomic differentials in mortality are hampered by incomplete and poorly reported socioeconomic data on death certificates as well as by the lack of relevant denominator data. 5, 7, 9, 10 Whereas US mortality statistics are frequently provided by age, sex, race, and cause of death, temporal analyses of socioeconomic differentials in mortality are less common. 1– 3, 5, 6, 9, 10 Similarly, although a substantial number of ecological studies have examined the cross-sectional association between areal social conditions and US mortality, 8, 11– 20 temporal analyses of mortality differentials in relation to area-based deprivation or inequality measures remain scarce. 9, 21– 28 Area-based composite deprivation indices have been used extensively in analyzing and monitoring health and mortality differentials in Europe, Australia, and New Zealand. 29– 38 Despite the lack of a consensus deprivation index in the United States, it is possible to construct a comprehensive, composite census-based socioeconomic index that, when linked to mortality data at an aggregate geographic level (e.g., county), could allow the monitoring of population health inequalities across time and space. 8, 9, 21 In this article, I use census tract data to describe a composite area–based deprivation index for the United States. By linking the index to national mortality data, I examine the extent to which differentials in all-cause mortality rates by area deprivation have changed over time. Specifically, I use the areal index to stratify all 3097 US counties into 5 area deprivation groups and examine trends in areal gradients in mortality between 1969 and 1998 for men and women of all ages as well as for those in specific age groups (less than 25 years, 25–44 years, 45–64 years, and 65 years or older).
