The health transition derailed: an analysis of inter-state variations in adult mortality patterns in the United States since 1959

Nadine Ouellette, Institut National d'Études Démographiques (INED)
Magali Barbieri, Institut National d'Études Démographiques (INED) and University of California, Berkeley
Celeste Winant, University of California, Berkeley

In this paper, we use series of death counts by sex, age and underlying cause available through the National Center for Health Statistics for each state of the United States (and the District of Columbia) for years 1959-2011 to document discontinuities in adult mortality trends and their geographic variations. We particularly investigate differences by state in achieving three major epidemiologic transitions corresponding to the successive control of infectious diseases, cardiovascular diseases, and cancer. By identifying the age groups and causes of death that have most contributed to discontinuities in trends across U.S. states, we question whether the failure to progress along a single transition path explains current geographic inequalities in mortality. We also assess how much of the inability of various states to latch on these three major epidemiologic transitions is responsible for the continuous deterioration of the U.S. position in international ranking on life expectancy at birth.