All-Cause and Cause-Specific Mortality among US Youth: Socioeconomic and Rural–Urban Disparities and International Patterns

Abstract

We analyzed international patterns and socioeconomic and rural-urban disparities in all-cause mortality and mortality from homicide, suicide, unintentional injuries, and HIV/AIDS among US youth aged 15-24 years. A county-level socioeconomic deprivation index and rural-urban continuum measure were linked to the 1999-2007 US mortality data. Mortality rates were calculated for each socioeconomic and rural-urban group. Poisson regression was used to derive adjusted relative risks of youth mortality by deprivation level and rural-urban residence. The USA has the highest youth homicide rate and 6th highest overall youth mortality rate in the industrialized world. Substantial socioeconomic and rural-urban gradients in youth mortality were observed within the USA. Compared to their most affluent counterparts, youth in the most deprived group had 1.9 times higher all-cause mortality, 8.0 times higher homicide mortality, 1.5 times higher unintentional-injury mortality, and 8.8 times higher HIV/AIDS mortality. Youth in rural areas had significantly higher mortality rates than their urban counterparts regardless of deprivation levels, with suicide and unintentional-injury mortality risks being 1.8 and 2.3 times larger in rural than in urban areas. However, youth in the most urbanized areas had at least 5.6 times higher risks of homicide and HIV/AIDS mortality than their rural counterparts. Disparities in mortality differed by race and sex. Socioeconomic deprivation and rural-urban continuum were independently related to disparities in youth mortality among all sex and racial/ethnic groups, although the impact of deprivation was considerably greater. The USA ranks poorly in all-cause mortality, youth homicide, and unintentional-injury mortality rates when compared with other industrialized countries.

Widening Rural–Urban Disparities in All-Cause Mortality and Mortality from Major Causes of Death in the USA, 1969–2009

“…Similar patterns have been observed previously for the USA, with both rural-urban continuum and area deprivation contributing independently to variations in cancer, HIV/AIDS, and youth mortality. [17][18][19][20]27 When both race and area poverty are taken into account, the inequalities are found to be even more marked, with poor blacks in nonmetropolitan areas experiencing two to three times higher risks of all-cause and premature mortality than affluent blacks and whites in metropolitan areas. Remarkably, the current mortality experience of rural blacks is similar to the mortality experience of urban and rural whites in the mid-1970s.…”

“…[16][17][18][19][24][25][26] The rural-urban continuum variable, developed by the US Department of Agriculture, classifies all US counties into nine distinct groups according to decreasing urbanization levels or increasing levels of rurality, based on the population size of the counties and their proximity to metropolitan areas. [17][18][19][24][25][26][27] This rural-urban variable defines the degree of urban (city-like) or rural character of a particular geographic area. The variable further subdivides non-metropolitan areas into small-urban towns and completely rural areas in terms of population size, commuting flows, and the degree to which they are socioeconomically integrated with the larger metropolitan areas.…”

“…The number of counties in these five rural-urban groups were 414, 325, 351, 1,381, and 670, respectively. 19,26,27 The five rural-urban groups accounted for 53.4, 20.1, 10.0, 14.8, and 1.7 % of the total US population in 2010, respectively. 26 The broad metropolitan category included large metropolitan counties with population ≥1 million and smaller metropolitan counties of population G250,000.…”

Adolescent and Young Adult Male Health: A Review

“…Although males have seen marked improvements over the past 20 years, their mortality remains unacceptably high, with the United States having the sixth highest adolescent male mortality among high-income countries. 27 Compared with females, males in high-income countries such as the United States are more likely to…”

“…28 Unintentional injury alone, which includes motor vehicle injuries, unintentional poisoning, drowning, and unintentional discharge of a firearm, account for 75% of all mortality. 27 Marked gender differences also exist in violence-related mortality, with adolescent and young adult males over twice as likely to die of violence as females. 29 Morbidity from intentional/violencerelated and unintentional injury (without mortality) is similarly more common in males.…”