Dollar Nathan T, Gutin Iliya, Lawrence Elizabeth M, Braudt David B, Fishman Samuel H, Rogers Richard G, Hummer Robert A
University of North Carolina at Chapel Hill, USA.
University of Nevada, Las Vegas, USA.
Demogr Res. 2020 Jan-Jun;42:343-382. doi: 10.4054/demres.2020.42.11. Epub 2020 Feb 25.
Recent studies of US adult mortality demonstrate a growing disadvantage among southern states. Few studies have examined long-term trends and geographic patterns in US early life (ages 1 to 24) mortality, ages at which key risk factors and causes of death are quite different than among adults.
This article examines trends and variations in early life mortality rates across US states and census divisions. We assess whether those variations have changed over a 50-year time period and which causes of death contribute to contemporary geographic disparities.
We calculate all-cause and cause-specific death rates using death certificate data from the Multiple Cause of Death files, combining public-use files from 1965-2004 and restricted data with state geographic identifiers from 2005-2014. State population (denominator) data come from US decennial censuses or intercensal estimates.
Results demonstrate a persistent mortality disadvantage for young people (ages 1 to 24) living in southern states over the last 50 years, particularly those located in the East South Central and West South Central divisions. Motor vehicle accidents and homicide by firearm account for most of the contemporary southern disadvantage in US early life mortality.
Our results illustrate that US children and youth living in the southern United States have long suffered from higher levels of mortality than children and youth living in other parts of the country. Our findings also suggest the contemporary southern disadvantage in US early life mortality could potentially be reduced with state-level policies designed to prevent deaths involving motor vehicles and firearms.
近期关于美国成年人死亡率的研究表明，南部各州的劣势在不断加剧。很少有研究考察美国早年（1至24岁）死亡率的长期趋势和地理模式，在这个年龄段，关键风险因素和死亡原因与成年人有很大不同。
本文考察美国各州和人口普查分区早年死亡率的趋势和差异。我们评估这些差异在50年时间里是否发生了变化，以及哪些死亡原因导致了当代的地理差异。
我们使用多死因档案中的死亡证明数据计算全因死亡率和特定原因死亡率，将1965 - 2004年的公开使用档案与2005 - 2014年带有州地理标识符的受限数据相结合。州人口（分母）数据来自美国十年一次的人口普查或两次普查之间的估计。
结果表明，在过去50年里，居住在南部各州的年轻人（1至24岁）一直存在死亡率劣势，特别是那些位于东中南部和西中南部分区的年轻人。机动车事故和枪支杀人占当代美国早年死亡率中南部劣势的大部分。
我们的结果表明，生活在美国南部的儿童和青少年长期以来死亡率高于美国其他地区的儿童和青少年。我们的研究结果还表明，通过旨在预防涉及机动车和枪支死亡的州级政策，有可能降低当代美国早年死亡率中的南部劣势。
