Does regional variation affect ecological mortality research? An examination of mortality, income inequality and health infrastructure in the Mississippi Delta
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Mortality research has often focused on individual-level, socioeconomic, and demographic factors indicating health outcomes. Consistent with a recent trend in the public health field, this research examines mortality at the aggregate, contextual level. Based on Wilkinson’s relative income hypothesis, specifically being manifest through an underinvestment in social goods including health infrastructure, the focus of this study is a regional examination in the effects of income inequality on mortality at the county level. Health infrastructure is included as a mediating variable in the relationship between income inequality and mortality, relating back to Wilkinson’s work. Unlike previous research, regional differences in this relationship are examined to identify variation at the county level in health outcomes. The Mississippi Delta is an adequate test bed to examine the relationship between these variables based on its socioeconomic, demographic, and high inequality characteristics. It is hypothesized that Delta-designated counties within the three-state Delta region distinguish a significant positive relationship between income inequality and mortality, that this relationship is stronger than in non-Delta classified counties, and that health infrastructure significantly mediates the relationship between income inequality and mortality.
- Aday, L. A., Quill, B. E., & Reyes-Gibby, C. C. (2001). Equity in rural health, health care. In S. Loue, & B. E. Quill (Eds.), Handbook of rural health (pp. 44–72). New York: Kluwer Academic/Plenum Publishers.
- Ashton, C. M., Peterson, N. J., Souchek, J., Menke, T. J., Yu, H.-J., Pietz, K., Eigenbrodt, M. L., Barbour, G., Kizer, K. W., & Wray, N. P. (1999). Geographic variations in utilization rates in veterans affairs hospitals and clinics. New England Journal of Medicine, 340(1), 32–39. CrossRef
- Bond Huie, S. A. (2001). The concept of neighborhood in health and mortality research. Sociological Spectrum, 21, 341–358. CrossRef
- Blanchard, T. C., Cossman, J. S., & Levin, M. L. (2004). Multiple meanings of minority concentration: Incorporating contextual explanations into the analysis of individual-level U.S. black mortality outcomes. Population Research and Policy Review, 23(3), 309–326. CrossRef
- Cossman, R. E., Cossman, J. S., Jackson, R., & Cosby, A. (2003). Mapping high or low mortality places across time in the U.S.: A research note on a health visualization and analysis project. Health and Place, 9(4), 361–369. CrossRef
- Daly, M. C., Duncan, G., Kaplan, G. A., & Lynch, J. W. (1998). Macro-to-micro linkages in the relationship between income inequality and mortality. The Milbank Quarterly, 76(3), 315–339. CrossRef
- Department of Health and Human Services. Compressed mortality file summary 1979–1998. Centers for Disease Control and Prevention, National Center for Health Statistics.
- Ellison, G. T. H. (2002). Letting the Gini out of the bottle? Challenges facing the relative income hypothesis. Social Science and Medicine, 54, 561–576. CrossRef
- Farmer, F. L., Stokes, C. S., Fiser, R. H., & Papini, D. P. (1991). Poverty, primary care and age-specific mortality. The Journal of Rural Health, 7(2), 153–169. CrossRef
- Feinstein, J. S. (1993). The relationship between socioeconomic status and health: A review of the literature. The Milbank Quarterly, 71(2), 279–322. CrossRef
- Franzini, L., Ribble, J., & Spears, W. (2001). The effects of income inequality and income level on mortality vary by population size in Texas counties. Journal of Health and Social Behavior, 42, 373–387. CrossRef
- Hummer, R. A., Rogers, R. G., & Eberstein, I. W. (1998). Sociodemographic differentials in adult mortality: A review of analytic approaches. Population and Development Review, 24(3), 553–578. CrossRef
- Kahn, R. S., Wise, P. H., Kennedy, B. P., & Kawachi, I. (2000). State income inequality, household income, and maternal mental and physical health: Cross sectional national survey. British Medical Journal, 321(25), 1311–1315. CrossRef
- Kaplan, G. A., Pamuk, E. R., Lynch, J. W., Cohen, R. D., & Balfour, J. L. (1996). Inequality in income and mortality in the US: Analysis of mortality and potential pathways. British Medical Journal, 312, 999–1003.
- Kawachi, I., & Kennedy, B. P. (1999). Income inequality and health: Pathways and mechanisms. Health Services Research, 34(1), 215.
- Lynch, J. W., & Kaplan, G. A. (1997). Understanding how inequality in the distribution of income affects health. Journal of Health Psychology, 2(3), 297–314.
- McLaughlin, D. K. (2002). Changing income inequality in nonmetropolitan counties, 1980 to 1990. Rural Sociology, 67(4), 512–533. CrossRef
- Politzer, R. M., Harris, D. L., Gaston, M. H., & Mullan, F. (1991). Primary care physician supply and the medically underserved: A status report and recommendations. Journal of the American Medical Association, 266(1), 104–109. CrossRef
- Ricketts, T. C. (2000). The changing nature of rural health care. Annual Review of Public Health, 21, 639–657. CrossRef
- Rogers, R. G., Hummer, R. A., & Nam, C. B. (2000). Living and dying in the USA: Behavioral, health, and social differentials of adult mortality. San Diego CA: Academic Press.
- Seccombe, K., & Amey, C. (1995). Playing by the rules and losing: Health insurance and the working poor. Journal of Health and Social Behavior, 36(2), 168–181. CrossRef
- Shi, L. (1994). Primary care, specialty care, and life chances. International Journal of Health Services, 24(3), 431–458. CrossRef
- Shi, L., Starfield, B., Kennedy, B., & Kawachi, I. (1999). Income inequality, primary care, and health indicators. The Journal of Family Practice, 48(4), 275–284.
- Siegel, J. S., & Swanson, D. A. (2004). Studies in population: The methods and materials of demography. San Diego CA: Academic Press.
- Starfield, B. (1992). Primary care and health: A cross-national comparison. Journal of the American Medical Association, 266(16), 2268–2271. CrossRef
- Subramanian S. V., Kawachi I., & Kennedy B. P. (2001). Does the state you live in make a difference? Multilevel analysis of self-rated health in the US. Social Science and Medicine, 53, 9–19 CrossRef
- Tobler, W. R. (1970). A computer movie simulating urban growth in the Detroit region. Economic Geography, 46, 234–240. CrossRef
- Welch, W. P., Miller, M. E., Welch, H. G., Fisher, E. S., & Wennberg, J. E. (1993). Geographic variation in expenditures for physicians’ services in the U.S. The New England Journal of Medicine, 328(9), 621–627. CrossRef
- Wilkinson, R. G. (1992). Income distribution and life expectancy. British Medical Journal, 304(18), 165–168. CrossRef
- Wilkinson, R. G. (1997). Health inequalities: Relative or absolute material standards. British Medical Journal, 314(22), 591–595.
- Wilkinson, R. G. (1999). Two pathways, but how much do they diverge? British Medical Journal, 319, 956–957.
- Does regional variation affect ecological mortality research? An examination of mortality, income inequality and health infrastructure in the Mississippi Delta
Population Research and Policy Review
Volume 25, Issue 2 , pp 175-195
- Cover Date
- Print ISSN
- Online ISSN
- Kluwer Academic Publishers
- Additional Links
- Income inequality
- Industry Sectors