Socioeconomic Deprivation and Vulnerability to Premature Death: Disparities in All Cause and Coronary Related Mortality among U.S. Counties

This paper applies a social determinant of health framework to analyze differential vulnerability to premature death. The study analyzes national mortality statistics focusing on all causes and coronary cause of death, for all ages and the midlife cohort of 35 to 64 years for counties in the United States (1999-2008). Two measures of nonchemical stressors related to vulnerability, the Townsend Index of socioeconomic deprivation (SED) and the Index of Neighborhood Concentrated Disadvantage (NCD), are used to model to analyze how the baseline range in premature all cause and coronary mortality shifts with level of socioeconomic deprivation after adjustment for urbanization at the county level, as measured by population size, population density, and regional economic activity. Urbanization is conceptualized as the concentration of residential population and economic activity, and is measured by county population size and density and number employed per residential population. There is a significant positive association between both measures of SED and mortality rates, after adjustment for urbanization measures. Counties in the top quintile of SED have between 38%-60% higher midlife mortality than the bottom quintile. This study demonstrates the value of SED as a risk measure for identifying vulnerable populations, and the value of social epidemiological methods for cumulative risk assessment.