Relationship of County-Level Social Determinants of Health and Life Expectancy, 2009 Community Health Status Indicators (CHSI), United States

Background: In October 2011, the World Health Assembly pledged to act on health inequities through social determinants of health. Recommended actions include monitoring health inequities and assessing health policies. To assess current health inequities at the US county level, the relationship between selected social determinants of health and life expectancy were examined. Methods: An ecological study was conducted using the 2009 Community Health Status Indicators (CHSI) dataset. CHSI, nationally available health indicators at the county level, were derived from cross-sectional studies. We examined the correlation of life expectancy and educational, income, and racial/ethnic indicators in 3141 counties. Bivariate and multivariate analyses were performed using SAS. Multivariate models were adjusted for social factors and mortality and morbidity indicators. Results: Among counties, life expectancy negatively correlated with percentage of adults aged >=25 years without a high school diploma (r = -0.64, p<0.05), percentage of persons living below the federal poverty level (r = - 0.65, p<0.05), and percentage of African Americans (r= - 0.56, p<0.05). In contrast, life expectancy was positively correlated with percentage of White Americans living in the county (r = 0.51, p<0.05). In multivariate models, the percentage of African Americans living in the county was the only social factor independently correlated with life expectancy (r = - 0.82, p<0.05). Conclusions: County-level educational, poverty and race indicators are moderately to strongly associated with life expectancy. Counties with high life expectancy should be examined further to identify policies and resources for education, the economy, social relationships, the physical environment and health care that explain better health.