Increasing inequalities in all-cause and cardiovascular mortality among US adults aged 25–64 years by area socioeconomic status, 1969–1998

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Abstract
Background This study examined the extent to which areal socio-economic gradients in all-cause and cardiovascular disease (CVD) mortality among US men and women aged 25–64 years increased between 1969 and 1998. Methods Using factor analysis 17 census tract variables were used to develop an areal index of socio-economic status that was used to stratify all US counties into five socio-economic categories. By linking the index to county-level mortality data from 1969 to 1998, we calculated annual age-adjusted mortality rates for each area socio-economic group. Poisson regression models were fitted to estimate areal socio-economic gradients in mortality over time. Results Areal socio-economic gradients in all-cause and cardiovascular mortality have increased substantially over the past three decades. Compared to men in the highest area socio-economic group, rates of all-cause and CVD mortality among men in the lowest area socio-economic group were 42% and 30% greater in 1969–1970 and 73% and 79% greater in 1997–1998, respectively. The gradients in mortality among women were steeper for CVD than for all causes. Compared to women in the highest area socio-economic group, rates of all-cause and CVD mortality among women in the lowest area socio-economic group were 29% and 49% greater in 1969–1970 and 53% and 94% greater in 1997–1998, respectively. Conclusions Although US all-cause and cardiovascular mortality declined for all area socio-economic groups during 1969–1998, the gradient increased because of significantly larger mortality declines in the higher socio-economic groups. Increasing areal inequalities in mortality shown here may be related to increasing temporal differences in the material and social living conditions between areas.