July 2003, Vol 93, No. 7 American Journal of Public Health 1137-1143




© 2003 American Public Health Association

RESEARCH AND PRACTICE

Area Deprivation and Widening Inequalities in US Mortality, 1969-1998

Gopal K. Singh, PhD, MS, MSc

The author is with the National Cancer Institute, Division of Cancer Control and
Population Sciences, National Institutes of Health, Bethesda, Md.

Correspondence: Requests for reprints should be sent to Gopal K. Singh, PhD, MS,
MSc,
National Cancer Institute, Division of Cancer Control and Population Sciences,
6116
Executive Blvd, Suite 504, MSC8316, Bethesda, MD 20892-8316
e-mail:[log in to unmask]).

Objectives. This study examined age-, sex-, and race-specific gradients in US
mortality by area deprivation between 1969 and 1998.

Methods. A census-based area deprivation index was linked to county mortality
data.

Results. Area deprivation gradients in US mortality increased substantially
during 1969 through 1998. The gradients were steepest for men and women aged 25
to 44 years and those younger than 25 years, with higher mortality rates
observed in more deprived areas. Although area gradients were less pronounced
for women in each age group, they rose sharply for women aged 25 to 44 and 45 to
64 years.

Conclusions. Areal inequalities in mortality widened because of slower mortality
declines in more deprived areas. Future research needs to examine
population-level social, behavioral, and medical care factors that may account
for the increasing
gradient.