The primary research objective is to investigate the relationship of community socioeconomic (SE) structure to cardiovascular disease (CVD) and all cause mortality trends in the United States. SE structure refers to aspects of communities -- their industries, physical resources, occupational and income distributions -- that create the conditions for changes in health-related exposures, behaviors, and availability of quality medical care. Preliminary studies suggest growing inequalities in ischemic heart disease (IHD) mortality in communities at different levels of SE structure that probably reflect both differences in timing of onset decline and rate of decline of mortality. Prevention strategies should take account of these processes not only to achieve a more equitable distribution of health but to target populations with the greatest excess risk available for reduction. Relationships will be investigated using mortality data from NCHS and population and socioeconomic data from the Census Bureau. The secondary objectives are to provide innovative methods for analyzing and displaying geographical data on mortality levels, trends and changes in trends, and to provide descriptive maps and tables of use to health researchers and planners. Specific studies will investigate the timing of onset of decline of IHD in women and blacks and its relationship to SE structure; the association between onset of decline and rate of decline of IHD; SE structure and the decline of stroke mortality, both in magnitude and timing of onset or acceleration of decline; and the comparative value of different measures of SE structure in studying mortality trends. A special series of investigations will focus on the U.S. South. This region has been undergoing rapid differentiation in economic development, and has historically experienced some of the highest CVD and all cause mortality rates in the U.S. The South's large black population offers the opportunity to study the impact of SE structure on black-white mortality differentials. The long-term objective of the work is to increase understanding of the impact of socioeconomic development on mortality with the goal of providing information on health consequences relevant to decision-making in economic development policy.
| Barnett, E; Strogatz, D; Armstrong, D et al. (1996) Urbanisation and coronary heart disease mortality among African Americans in the US South. J Epidemiol Community Health 50:252-7 |
| Carter, L R; Walton, S E; Knowles, M K et al. (1992) Social inequality of stroke mortality among US black populations, 1968 to 1987. Ethn Dis 2:343-51 |
| Wing, S; Barnett, E; Casper, M et al. (1992) Geographic and socioeconomic variation in the onset of decline of coronary heart disease mortality in white women. Am J Public Health 82:204-9 |
| Casper, M; Wing, S; Strogatz, D et al. (1992) Antihypertensive treatment and US trends in stroke mortality, 1962 to 1980. Am J Public Health 82:1600-6 |
| Casper, M; Wing, S; Strogatz, D (1991) Variation in the magnitude of black-white differences in stroke mortality by community occupational structure. J Epidemiol Community Health 45:302-6 |
