Diet, exercise, genetics…many factors affect human mortality rates, but rarely do people think of how location may play a life-and-death role. Lynne Cossman, a research fellow at Mississippi State’s Social Science Research Center, chronicles study findings on location and mortality rate in the American Journal of Public Health.

 

Where are the best and worst places to live, according to morbidity rates? The Mississippi Delta, Appalachia, Coastal Plains along the East Coast, and northern Nevada revealed clusters of counties with the most alarming mortality rates in the country. The healthiest places to live, according to the research, turned out to be in the Upper Great Plains, which boasted clusters of counties with the lowest mortality rates.

 

Cossman and her study team were inspired to examine location and mortality, because, says the medical sociologist, “When we arrived in Mississippi we were interested as to why the Mississippi Delta was such an ‘unhealthy place’ and we set out to see if there were other ‘unhealthy places’ in the United States.”

 

The research took into account all causes of death, including accidental and illness-related, Cossman says. Research indicating the results by region includes a map of “an all-cause death rate; so it includes all deaths,” Cossman explains. “We have completed some cause-specific maps (heart disease, stroke and diabetes) and the general patterns are similar for those causes.”

 

As for life span, how long people live as opposed to whether they live or die, Cossman says,

“We haven't tested life span, but Christopher Murray at Harvard has completed similar maps for life expectancy. His research addresses this question.”

 

Murray found that America’s life span disparities are so great that we can actually divide the county into “eight different Americas.” A 2006 Harvard News Gazette discusses Murray’s findings, which stated that “White middle America and black middle America are different from each other (whites live longer than blacks) and from low-income white America, Southern low-income rural black America, Northern low-income rural white America, high-risk urban black America, and Asian America.” Murray’s research examined the roles of violence, AIDS and other diseases, and economics. Overall, the Harvard research concluded that “the best-off people, like Asian women in Bergen County, N.J., have a life expectancy 33 years longer than the worst-off, Native American males in some South Dakota counties—91 versus 58 years,” reported the Gazette.

 

Cossman tells demo dirt that rural versus urban communities had no significant bearing on results, nor did differences in access to medical care between the two types of counties. For instance, access to medical care is “much lower in rural areas,” yet this factor had no effect on findings. “The most fascinating result is that rural places have both concentrations of high mortality counties and concentrations of low mortality counties,” Cossman reports. “So, if the answer were access to care, it doesn't work in the Upper Great Plains where it's quite rural (frontier counties) and death rates are low.”

  

Cossman and her team have not yet tested regional diet, water or air contamination or pollution as possible elements affecting death rate, but future research will focus on the potential effects of prescription drug rates on morbidity.

 

“Since we completed this work, we were funded to map prescription drug rates at the county-level. Those analyses indicated substantial variations between treatment rates and death rates (sometimes high prescription rates are correlated with high death rates, sometimes with low death rates),” Cossman states.

 

Cossman and her team will examine foreign data to further their studies. “We are now in the process of getting data from a Sicilian province that will include very small area diagnosis rates, prescription rates and death rates for a ten year period,” she explains. “With this data, we can better understand the links between the three and the appropriate lag for examining the relationships between the three. Given that, we want to come back to the US, make assumptions about access and use the prescription data to estimate small-area morbidity.”