Premature Death Rates Vary 2-fold Across United States

Ricki Lewis, PhD

December 31, 2013

A study following trends in premature death rates to indicate population health has revealed 2-fold differences between some states. The report was published in the December 26 issue of Preventing Chronic Disease.

Trends in population health outcomes may reflect the effectiveness of healthcare systems, the authors note. The impetus to examine population health by state came from the ranking of the United States as 37th in the world in 2000.

Before 2010, America's Health Rankings assessed the entire country with a health composite measure. The current method, used to rank health in each county in the United States, is based on an approach implemented in Wisconsin in 2003 to rank the health status of its 72 counties.

In the current study, Patrick L. Remington, MD, MHP, from the Population Health Institute, Department of Population Heath Sciences, University of Wisconsin School of Medicine and Public Health, Madison, and colleagues analyzed premature death rates taken from the Web site of the Centers for Disease Control and Prevention (Wide-ranging Online Data for Epidemiological Research [WONDER]) to measure overall health outcomes in all 50 states.

The researchers defined premature mortality as dying before age 75 years. They compared and contrasted 4 measures to assess age-adjusted premature death rates: current rates (from 2009), baseline trends (from the 1990s), follow-up trends (from the 2000s), and changes in trends between baseline and follow-up.

The results were striking. For the entire United States, in 2009, the age-adjusted premature death rate was 346 deaths per 100,000. Premature death rates vary 2-fold by state: Minnesota has the lowest rate (268 deaths per 100,000), and Mississippi has the highest (482 deaths per 100,000). "States with the lowest rates were in the Northeast, Midwest, and West, and states with the highest rates were in the South," the researchers write.

Premature death rates for the entire country declined with an annual rate of change of −1.49% in the 1990s, dropping to −1.59% annually in the 2000s. Rates improved the most in New York during the baseline period (−3.05% per year) and in New Jersey during the follow-up period (−2.87% per year). Oklahoma ranked last in the trends during baseline (−0.30% per year) and follow-up (+0.18% per year). The surveyed trends worsened the most in New Mexico and improved the most in Connecticut.

The researchers conclude, "[T]he highest ranking places can serve as exemplars to those ranking lower and can stimulate action and investment for improvement."

The authors also point out the importance of monitoring trends in improvement. For example, New Jersey lead in rate of improvement and Oklahoma improved the least, yet both states had similar premature death rates in 1990. Today, New Jersey's rate is nearly 40% lower than Oklahoma's, opening up an area of research into causes of the divergence.

Trends in premature death rates among states can inform policy makers when evaluating the effect of broad healthcare, behavioral, social, and economic investments on population health, the researchers write.

The study has several limitations, including that the differences between some states are not statistically significant and that the reasons for disparities and causes of death are not discussed.

The authors have disclosed no relevant financial relationships.

Prev Chronic Dis. 2013;10:130210. Full text

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