Rich death, poor death

A new paper in the American Journal of Public Health, by Steven Woolf and colleagues, illustrates the difference in mortality experienced by rich versus poor parts of Virginia. It’s a powerful projection of inequality in the most basic of outcomes.

They identified the richest five counties or cities in the state for the years 1990-2006, and looked at the death records from those areas. From these, they calculated death rates for each age group and sex. Then they compared those specific death rates to the actual death rates in the rest of the state. The difference between the two sets of numbers – the real number of deaths and the deaths that would have occurred if the whole state shared the rich areas death rates – are called “avertable deaths.”

They conclude that 24% of all deaths in the state were “avertable” – that is, would not have occurred if the whole state had the death rates of the richest areas. Those deaths are heavily concentrated in the state’s rural counties:

The figure shows the percentage of deaths in each county that occurred in excess of the death rates in the “reference population” – the richest areas in the D.C. suburbs.

In some counties, more than 40% of all deaths are in excess of what would be expected if the whole state shared the rich area death rates. This doesn’t mean those individual deaths could have been prevented, but it shows how much these poor areas bear the burden of the state’s health inequality.

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