35 Years Of American Death Mortality rates for

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35 Years Of American Death

Mortality rates for leading causes of death in every U.S. county from 1980 to 2014.

https://projects.fivethirtyeight.com/mortalit...ed-states/

Researchers have long argued that where we live can help predict how we die. But how much our location affects our health is harder to say, because death certificates, the primary source for mortality data, are not always complete. They frequently contain what public health experts call “garbage codes”: vague or generic causes of death that are listed when the specific cause is unknown.

Garbage codes make it difficult to track the toll of a disease over time or to look for geographical patterns in how people die. The data shown in the map above represents one research group’s effort to fill in these gaps.

That group — the Institute for Health Metrics and Evaluation — designed a statistical model that uses demographic and epidemiological data to assign more specific causes of death to the records containing garbage codes in the National Vital Statistics System, which gathers death records (and other information such as births) from state and local jurisdictions into a national database.

The institute also age-standardized the data so that places with larger populations of older people, who die at higher rates, do not have inflated numbers. The result is a set of more complete estimates of mortality across the country, one revealing regional and local variations in causes of death.



Such regional trends are evident in the list of the 20 counties or parishes with the highest mortality rates. Rural Appalachia stands out; nine counties in Kentucky and three in West Virginia make the list. Rising cancer rates and increased deaths from substance abuse in Appalachia have kept mortality rates high there, even while overall mortality rates in the U.S. have gone down.

After Appalachia, the region that features most heavily is the Dakotas. All of the counties in North and South Dakota in the top 20 (Buffalo, Oglala Lakota and Todd counties in South Dakota and Sioux County in North Dakota) are entirely or almost entirely made up of American Indian reservation lands.

American Indian populations have historically suffered from poor health outcomes and challenges in health care access, contributing to high mortality rates.

Still, some outliers are simply anomalies. The county with the highest overall estimated mortality rate in 2014 was Union County, Florida. Union stands out from its neighbors in North Florida for a particular reason: It’s home to the Union Correctional Institution and the Florida Department of Corrections Reception and Medical Center, which provides inpatient medical care for state prisoners across Florida. These prisoners artificially raise Union County’s mortality rate.1



As for the counties with the lowest mortality rates, 18 out of 20 fall west of the Mississippi. Colorado appears most often on the list, with six counties, including the three healthiest: Summit, Pitkin and Eagle. These counties lie adjacent to each other west of Denver, among the peaks of the Rocky Mountains. Many ski resorts and recreational areas fall within their borders.

Many of the counties with the lowest mortality rates are sparsely populated (the other two counties in the top five, Billings County in North Dakota and Hinsdale County in Colorado, both feature large swaths of federally protected land and in the 2010 census had fewer than 1,000 people), and others are particularly wealthy. Fairfax County, Virginia, and Los Alamos County, New Mexico, both had median household incomes above $100,000 in 2015.

Differing mortality rates between counties is only part of the story this data tells — we can also use it to determine how common a cause of death is. While rates for each cause vary significantly across the U.S., overall, Americans are much more likely to die from some causes than others.



The causes of death are ranked from most to least common in the table above. They range widely in impact: Cardiovascular diseases, the largest cause of death, resulted in about 250 deaths per 100,000 people in 2014, while there were fewer than 0.1 deaths per 100,000 from neglected tropical diseases.

But the most recent mortality rate is only part of the story for any given cause of death. Deaths from cardiovascular disease in the U.S. have declined steadily since 1980, while deaths from other causes, such as neurological disorders (which include diseases such as Alzheimer’s and dementia) and mental and substance abuse disorders, have risen significantly. On the chart, the trend lines show which causes are on the rise and which are declining.

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