Residence and Income Inequality: Effects on Mortality Among U.S. Counties

Abstract Despite lower average incomes, greater percentages living in poverty, lower levels of health insurance, less preventive health care, and poorer health status, nonmetropolitan residents have been found to experience lower mortality than their metropolitan counterparts. Several pathways through which residence influences mortality have been proposed. The objective of this study is to examine the effects of income inequality on residential differentials in mortality. Using data from the Compressed Mortality File for counties in the coterminous United States for 1990, we estimate weighted least squares models of total mortality for 3,067 counties, and separately for metropolitan and nonmetropolitan counties. Mortality is lower in nonmetropolitan counties than in metropolitan counties, once rates are standardized for age, sex, and race. Moreover, income inequality exerts stronger effects in nonmetro counties, an effect that persists when per capita income, median household size, and racial composition are controlled. The percentage of the population that is black exerts an independent effect on mortality in both metro and non‐metro counties.