Explaining Inequalities in Women's Mortality among U.S. States

Jennifer Karas Montez, Case Western Reserve University
Mark D. Hayward, University of Texas at Austin

Since the early 1980s geographic disparities in mortality within the U.S. have significantly widened, especially among women. By 2000 the disparity in mortality among U.S. states exceeded the disparity between high-income countries. This study investigates the reasons behind the mortality disparities across U.S. states using a multilevel approach and focusing on women. It partitions the contribution of individual-level characteristics (women’s race, education, employment, poverty, marital status) and state-level characteristics (economic, sociopolitical, infrastructure, tobacco, collective social functioning, composition). We use data from the 2013 National Longitudinal Mortality Study on women aged 30-89 years and estimate multilevel logistic regression models. Variation in women’s mortality across states was significant (p<0.001). Adjusting for women’s individual-level characteristics reduced the variation by 36% but it remained significant (p<0.05). Additionally adjusting for state-level characteristics reduced the variation to statistical non-significance. The findings highlight strategies and policies from low-mortality states that may be implemented in high-mortality states.