Characteristics of persistently unhealthy counties: A comparison of white and black mortality over time.

This research examines differences in white and black persistence of mortality in the United States over a period of nearly 50 years. Using data from the National Center for Health Statistics Compressed Mortality File, we calculated race-specific, all-cause age-adjusted mortality rates for ten time periods from 1968 to 2015. Counties ranking in the top 20% of mortality in at least half of the time periods are classified as persistently unhealthy. Race-specific mortality persistence is mapped illustrating geographic disparities in the clustering of unhealthy places. Persistence of white mortality is clustered in several distinct Southern regions, while black persistent mortality is evenly distributed geographically. Socioeconomic characteristics of white and black persistently unhealthy places are also examined, with a focus on rural-urban differences.