Female Mortality in the U.S. Varies by State: Context Matters

Despite the high cost of health care in the U.S., life expectancy lags behind almost all other rich nations. Two key trends are embedded in this, however: (1) there is considerable variability from state to state; and (2) women are lagging more than men. A new paper published in the on-line open access journal Social Science and Medicine-Population Health sheds some new and interesting light on what's going on. Today's New York Times summarizes the findings.

A team of researchers has now come up with an important clue: Where women live matters just as much as who they are. In fact, in a study to be published this week in SSM Population Health, they found that many common demographic traits — whether a woman is rich, poor, unemployed, working, single or married — might not be as important as the state in which she lives.

Using new state-by-state data collected by the federal government, researchers found that a state’s economic and social environment — from its welfare policy and tobacco tax rate, to the strength of social ties through sports clubs and churchgoing, to the level of economic inequality — had a significant effect on women’s life spans.

Here is what the state level variability looks like:

The single most important characteristic of a state was what the authors call "social cohesion":

This factor describes the level of social and economic integration and equality within a state. It is comprised of four variables: (1) Gini coefficient of income inequality, (2) unemployment rate, (3) violent crime rate, and (4) the state-level social capital index developed by Putnam (2000). The index includes 14 components such as involvement in community organizations and social trust. The fact that income inequality and unemployment cluster with crime and social capital more so than with the variables in the economic environment latent factor indicates that these measures capture social and economic integration, and relative well-being, more so than absolute economic well-being.

Higher levels of social cohesion in a state were more important than individual-level characteristics such as education. "Our findings imply that divergent social and economic policies across states have played an important role in shaping the inequalities in women's mortality." Context matters when it comes to health, just as it does in most other things in life.