Explaining the geographic pattern in U.S. women’s mortality trends

Jennifer Karas Montez, Case Western Reserve University
Anna Zajacova, University of Wyoming
Mark D. Hayward, University of Texas at Austin

The United States is experiencing a crisis in women’s mortality. Since 1992, women’s all-cause mortality increased in over 40 percent of U.S. counties, with the largest increases occurring in Southern U.S states. The reasons for these geographically-patterned trends are unclear but structural characteristics of the states likely play an important role. In this study, we investigate how state-level characteristics (economic, sociopolitical, infrastructural, tobacco) influence these trends. We hypothesize that women’s mortality trends were most disconcerting in states with poor economic performance, regressive social policies, physical infrastructure that burdens the economically disadvantaged, and high tobacco consumption. We use data from the 1979-2008 National Longitudinal Mortality Study on women aged 35-84 years. We estimate multilevel models to partition the geographic variation in women’s mortality trends due to state-level characteristics versus individual-level characteristics, especially educational attainment. The results will highlight strategies from the best performing states that may be implemented in underperforming states.