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US County-Level Trends in Mortality Rates for Causes of Death
Study Questions:
What are the county-level estimates for annual mortality rates in the United States (US) between 1980 and 2014?
Methods:
The National Vital Statistics System was used to collect information on deaths, which were grouped by county of residence and cause of death. Redistribution methods for garbage codes (implausible or insufficiently specific cause of death codes) and small area estimation methods (statistical methods for estimating rates in small subpopulations) were applied to death registration to estimate annual county-level mortality rates for 21 causes of death. These estimates were ranked (scaled along multiple dimensions) to ensure consistency between causes and with existing national-level estimates. Geographic patterns in the age-standardized mortality rates in 2014 and in the change in the age-standardized mortality rates between 1980 and 2014 for the 10 highest-burden causes were determined. The primary outcome of interest was cause-specific age-standardized mortality rates.
Results:
Between January 1, 1980 and December 31, 2014, a total of 80,412,524 deaths were recorded in the US. Of these, 19.4 million deaths were assigned garbage codes. Mortality rates were analyzed for 3,110 counties or groups of counties. Large between-county disparities were evident for every cause, with the gap in age-standardized mortality rates between counties in the 90th and 10th percentiles varying from 14.0 deaths per 100,000 population (cirrhosis and chronic liver diseases) to 147.0 deaths per 100,000 population (cardiovascular diseases). Geographic regions with elevated mortality rates differed among causes: for example, cardiovascular disease mortality tended to be highest along the southern half of the Mississippi River, while mortality rates from self-harm and interpersonal violence were elevated in southwestern counties, and mortality rates from chronic respiratory disease were highest in counties in eastern Kentucky and western West Virginia. Counties also varied widely in terms of the change in cause-specific mortality rates for 1980 and 2014.
Conclusions:
The authors concluded that in this analysis of US cause-specific county-level mortality rates from 1980 through 2014, there were large between-county differences for every cause of death, although geographic patterns varied substantially by cause of death. The approach to county-level analyses with small area models used in this study has the potential to provide novel insights into US disease-specific mortality time trends and their differences across geographic regions.
Perspective:
The authors use a novel method for estimating mortality rates in the US. By examining causes of death by US counties, these data will be valuable for understanding where health care resources best fit population needs.
Keywords: Cardiovascular Diseases, Cause of Death, Liver Cirrhosis, Liver Diseases, Mortality, Primary Prevention, Respiratory Tract Diseases, Self-Injurious Behavior, Violence, Vital Statistics
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