Poverty, time, and place: variation in excess mortality across selected USpopulations, 1980-1990

Study objective-To describe variation in levels and causes of excess mortal ity and temporal mortality change among young and middle aged adults in a r egionally diverse set of poor local populations in the USA. Design-Using standard demographic techniques, death certificate and census data were analysed to make sex specific population level estimates of 1980 and 1990 death rates for residents of selected areas of concentrated povert y. For comparison, data for whites and blacks nationwide were analysed. Setting-African American communities in Harlem, Central City Detroit, Chica go's south side, the Louisiana Delta, the Black Belt region of Alabama, and Eastern North Carolina. Non-Hispanic white communities in Cleveland, Detro it, Appalachian Kentucky, South Central Louisiana, Northeastern Alabama, an d Western North Carolina. Participants-All black residents or all white residents of each specific co mmunity and in the nation, 1979-1981 and 1989-1991. Main results-Substantial variability exists in levels, trends, and causes o f excess mortality in poor populations across localities. African American residents of urban/northern communities suffer extremely high and growing r ates of excess mortality. Rural residents exhibit an important mortality ad vantage that widens over the decade. Homicide deaths contribute little to t he rise in excess mortality, nor do AIDS deaths contribute outside of speci fic localities. Deaths attributable to circulatory disease are the leading cause of excess mortality in most locations. Conclusions-Important differences exist among persistently impoverished pop ulations in the degree to which their poverty translates into excess mortal ity. Social epidemiological inquiry and health promotion initiatives should be attentive to local conditions. The severely disadvantageous mortality p rofiles experienced by urban African Americans relative to the rural poor a nd to national averages call for understanding.