Volume 39 - Article 33 | Pages 897–910 Editor's Choice

Persistence of death in the United States: The remarkably different mortality patterns between America’s Heartland and Dixieland

By Wesley James, Jeralynn Cossman, Julia Wolf

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Date received:19 Jan 2018
Date published:23 Oct 2018
Word count:2456
Keywords:mortality, persistence, rural areas, United States of America


Background: Geographic disparities in mortality have been analyzed by place in myriad ways. Although the people who live in a place continuously change, the health characteristics of those places tend to stay the same; they are persistent. Our work analyzes persistence of mortality across various geographic designations and uncovers the wide-ranging disparities in death across the United States.

Methods: Using 48 years of county-level mortality data, we analyze trends over time and disparities across places using rural–urban distinctions and census-based region and division classifications. Trends in death rates, excess deaths, and rates of mortality improvement are provided.

Results: Findings support the hypothesis that persistently high mortality places are disproportionately concentrated in the rural South, particularly the East South Central division of Kentucky, Tennessee, Mississippi, and Alabama. The disparity between this division and urban America is wide and getting wider, and the disparity between this area of the South and the Midwest is alarming.

Contribution: Our research moves forward the literature on place-based mortality disparities in two important areas by testing the notion of persistence of poor health in place, and by identifying geographic disparities based on classifications not previously tested.

Author's Affiliation

Wesley James - University of Memphis, United States of America [Email]
Jeralynn Cossman - West Virginia University, United States of America [Email]
Julia Wolf - West Virginia University, United States of America [Email]

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