Volume 31 - Article 2 | Pages 27–70  

Factors responsible for mortality variation in the United States: A latent variable analysis

By Christopher Tencza, Andrew C. Stokes, Samuel Preston

Abstract

Background: Factors including smoking, drinking, substance abuse, obesity, and health care have all been shown to affect health and longevity. The relative importance of each of these factors is disputed in the literature, and has been assessed through a number of methods.

Objective: This paper uses a novel approach to identify factors responsible for interstate mortality variation. It identifies factors through their imprint on mortality patterns and can therefore identify factors that are difficult or impossible to measure directly, such as sensitive health behaviors.

Methods: The analysis calculates age-standardized death rates by cause of death from 2000-2009 for white men and women separately. Only premature deaths between ages 20-64 are included. Latent variables responsible for mortality variation are then identified through a factor analysis conducted on a death-rate-by-state matrix. These unobserved latent variables are inferred from observed mortality data and interpreted based on their correlations with individual causes of death.

Results: Smoking and obesity, substance abuse, and rural/urban residence are the three factors that make the largest contributions to state-level mortality variation among males. The same factors are at work for women but are less vividly revealed. The identification of factors is supported by a review of epidemiologic studies and strengthened by correlations with observable behavioral variables. Results are not sensitive to the choice of factor-analytic method used.

Conclusions: The majority of interstate variation in mortality among white working-age adults in the United States is associated with a combination of smoking and obesity, substance abuse and rural/urban residence.

Author’s Affiliation

• Christopher Tencza - University of Pennsylvania, United States of America EMAIL
• Andrew C. Stokes - Boston University, United States of America EMAIL
• Samuel Preston - University of Pennsylvania, United States of America EMAIL

Other articles by the same author/authors in Demographic Research

Socio-behavioral factors contributing to recent mortality trends in the United States
Volume 51 - Article 7

An integrated approach to cause-of-death analysis: cause-deleted life tables and decompositions of life expectancy
Volume 19 - Article 35

Cohort fertility patterns and breast cancer mortality among U.S. women, 1948-2003
Volume 18 - Article 9

Comparative mortality levels among selected species of captive animals
Volume 15 - Article 14

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