TY - JOUR
T1 - Explaining inequalities in women's mortality between U.S. States
AU - Montez, Jennifer Karas
AU - Zajacova, Anna
AU - Hayward, Mark D.
N1 - Funding Information:
This study was funded in part by the Fund for the Advancement of the Discipline Award supported by the American Sociological Association and the National Science Foundation (PI: Jennifer Karas Montez); grants R24AG045061 (PI: James P. House) and 1 R01 AG040248-02 (PI: Lisa F. Berkman) from the National Institute on Aging ; and grant 5 R24 HD042849 (PI: Mark D. Hayward) awarded to the Population Research Center at The University of Texas at Austin by the Eunice Kennedy Shriver National Institute of Child Health and Human Development . The authors thank three anonymous reviewers for their helpful and insightful comments.
Publisher Copyright:
© 2016 The Authors
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Inequalities in women's mortality between U.S. states are large and growing. It is unknown whether they reflect differences between states in their population characteristics, contextual characteristics, or both. This study systematically examines the large inequalities in women's mortality between U.S. states using a multilevel approach. It focuses on “fundamental” social determinants of mortality at the individual and state levels as potential explanations. We analyze data from the 2013 public-use National Longitudinal Mortality Study on women aged 45–89 years and estimate multilevel logistic regression models. The models include women's personal characteristics (age, race/ethnicity, education, employment, income, and marriage) and states’ contextual characteristics (economic environment, social cohesion, sociopolitical orientation, physical infrastructure, and tobacco environment). We found that variation in women's mortality across states was significant (p<0.001). Adjusting for women's personal characteristics explained 30% of the variation. Additionally adjusting for states’ contextual characteristics explained 62% of the variation; the most important characteristics were social cohesion and economic conditions. No significant mortality differences between any two states remained after accounting for individual and contextual characteristics. Supplementary analyses of men indicate that state contexts have stronger and more pernicious consequences for women than men. Taken together, the findings underscore the importance of ‘bringing context back in’ and taking a multilevel approach when investigating geographic inequalities in U.S. mortality.
AB - Inequalities in women's mortality between U.S. states are large and growing. It is unknown whether they reflect differences between states in their population characteristics, contextual characteristics, or both. This study systematically examines the large inequalities in women's mortality between U.S. states using a multilevel approach. It focuses on “fundamental” social determinants of mortality at the individual and state levels as potential explanations. We analyze data from the 2013 public-use National Longitudinal Mortality Study on women aged 45–89 years and estimate multilevel logistic regression models. The models include women's personal characteristics (age, race/ethnicity, education, employment, income, and marriage) and states’ contextual characteristics (economic environment, social cohesion, sociopolitical orientation, physical infrastructure, and tobacco environment). We found that variation in women's mortality across states was significant (p<0.001). Adjusting for women's personal characteristics explained 30% of the variation. Additionally adjusting for states’ contextual characteristics explained 62% of the variation; the most important characteristics were social cohesion and economic conditions. No significant mortality differences between any two states remained after accounting for individual and contextual characteristics. Supplementary analyses of men indicate that state contexts have stronger and more pernicious consequences for women than men. Taken together, the findings underscore the importance of ‘bringing context back in’ and taking a multilevel approach when investigating geographic inequalities in U.S. mortality.
KW - Gender
KW - Inequality
KW - Mortality
KW - Multilevel
KW - Social determinants
KW - U.S. states
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U2 - 10.1016/j.ssmph.2016.07.004
DO - 10.1016/j.ssmph.2016.07.004
M3 - Article
AN - SCOPUS:84983035857
SN - 2352-8273
VL - 2
SP - 561
EP - 571
JO - SSM - Population Health
JF - SSM - Population Health
ER -