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Identifying County-Level All-Cause Mortality Rate Trajectories and Their Spatial Distribution Across the United States
ORIGINAL RESEARCH — Volume 16 — May 2, 2019
PEER REVIEWED
Figure 1.
Age-adjusted mortality rate trajectories for US counties for 8 groups of counties based on group-based trajectory models, 1999–2016. The outcome measure used to generate rate trajectories was the yearly, age-adjusted, all-cause mortality rate of the county. Solid lines correspond to model-predicted values for rates; dotted lines are confidence intervals for the predicted values.
| Year | Group 1 | Group 2 | Group 3 | Group 4 | Group 5 | Group 6 | Group 7 | Group 8 |
|---|---|---|---|---|---|---|---|---|
| 1999 | 609.1 (579.8–638.4) | 758.6 (751.9–765.4) | 818.1 (811.9–824.4) | 895.2 (889.5–900.9) | 966.0 (959.3–972.7) | 1,024.7 (1,017.5–1,031.9) | 1,098.9 (1,089.6–1,108.1) | 1,266.1 (1,249.8–1,282.3) |
| 2000 | 590.7 (566.6–614.8) | 742.3 (736.74–747.8) | 808.7 (804.0–813.5) | 887.3 (883.0–891.7) | 961.1 (955.6–966.7) | 1,025.6 (1,020.0–1,031.2) | 1,105.4 (1,098.5–1,112.4) | 1,259.2 (1,246.1–1,272.2) |
| 2001 | 573.3 (552.9–593.7) | 726.9 (722.2–731.6) | 798.8 (794.5–803.0) | 878.2 (874.3–882.1) | 954.4 (949.1–959.7) | 1,023.6 (1018.5–1028.8) | 1,108.09 (1102.1–1114.1) | 1,252.8 (1242.1–1263.5) |
| 2002 | 556.9 (538.8–575.1) | 712.4 (708.2–716.6) | 788.4 (784.2–792.7) | 868.05 (864.1–872.00) | 946.2 (940.9–951.5) | 1,019.3 (1014.1–1024.6) | 1,107.36 (1101.4–1113.3) | 1,247.0 (1237.8–1256.3) |
| 2003 | 541.6 (524.3–558.8) | 698.9 (694.9–702.9) | 777.9 (773.7–782.2) | 857.2 (853.2–861.3) | 936.9 (931.6–942.3) | 1013.07 (1,007.6–1,018.5) | 1,103.83 (1,097.8–1,109.9) | 1,241.8 (1,233.1–1,250.5) |
| 2004 | 527.2 (510.0–544.5) | 686.4 (682.4–690.4) | 767.5 (763.2–771.8) | 846.0 (842.0–850.1) | 926.8 (921.6–932.1) | 1,005.4 (999.9–1011.0) | 1,098.08 (1,092.0–1,104.2) | 1,237.2 (1,228.3–1246.0) |
| 2005 | 513.9 (496.2–531.6) | 674.8 (670.7–678.9) | 757.2 (753.1–761.4) | 834.8 (830.8–838.8) | 916.3 (911.2–921.4) | 996.8 (991.2–1,002.3) | 1,090.69 (1,084.8–1,096.6) | 1,23315 (1,223.8–1,242.3) |
| 2006 | 501.6 (483.4–519.7) | 664.1 (659.9–668.4) | 747.4 (743.4–751.4) | 823.8 (819.8–827.7) | 905.7 (900.9–910.6) | 987.6 (982.1–993.2) | 1,082.23 (1,076.5–1,088.0) | 1,229.5 (1,219.8–1,239.2) |
| 2007 | 490.2 (471.8–508.7) | 654.4 (650.05–658.8) | 738.2 (734.3–742.1) | 813.3 (809.4–817.2) | 895.4 (890.7–900.0) | 978.4 (972.8–984.0) | 1,073.3 (1,067.7–1,078.9) | 1,226.5 (1,216.47–1,236.56) |
| 2008 | 479.9 (461.5–498.4) | 645.6 (641.3–650.0) | 729.8 (725.9–733.7) | 803.7 (799.8–807.6) | 885.6 (881.17–890.2) | 969.6 (963.9–975.3) | 1,064.4 (1,058.8–1,070.1) | 1,224.1 (1,213.9–1,234.3) |
| 2009 | 470.6 (452.5–488.8) | 637.8 (633.5–642.2) | 722.4 (718.5–726.4) | 795.3 (791.3–799.3) | 876.8 (872.3–881.4) | 961.7 (955.8–967.6) | 1,056.2 (1,050.43–1,062.01) | 1,222.2 (1,212.0–1,232.5) |
| 2010 | 462.4 (444.7–480.0) | 631.0 (626.7–635.3) | 716.2 (712.2–720.3) | 788.4 (784.3–792.6) | 869.3 (864.7–873.9) | 955.2 (949.1–961.3) | 1,049.3 (1,043.3–1,055.3) | 1,220.9 (1,210.9–1,231.1) |
| 2011 | 455.1 (437.8–472.3) | 625.1 (620.8–629.3) | 711.45 (707.3–715.6) | 783.3 (779.0–787.6) | 863.43 (858.7–868.2) | 950.4 (944.2–956.6) | 1,044.1 (1,038.0.0–1,050.3) | 1,220.1 (1,209.9–1,230.3) |
| 2012 | 448.8 (431.6–466.0) | 620.07 (615.73–624.41) | 708.26 (704.09–712.44) | 780.30 (775.99–784.61) | 859.54 (854.69–864.39) | 947.91 (941.73–954.08) | 1041.39 (1035.21–1047.57) | 1219.93 (1209.44–1230.41) |
| 2013 | 443.56 (425.44–461.69) | 616.1 (611.5–620.7) | 706.9 (702.7–711.0) | 779.7 (775.4–784.0) | 858.0 (853.0–862.9) | 948.2 (942.1–954.2) | 1,041.6 (1,035.5–1,047.7) | 1,220.3 (1,209.0–1,231.5) |
| 2014 | 439.3 (419.0–459.7) | 613.0 (607.8–618.1) | 707.5 (703.3–711.7) | 781.9 (777.5–786.3) | 859.1 (853.9–864.3) | 951.6 (945.7–957.5) | 1,045.4 (1039.1–1051.7) | 1,221.2 (1,208.5–1,233.9) |
| 2015 | 436.1 (412.0–460.2) | 610.9 (604.9–616.9) | 710.3 (705.5–715.0) | 787.1 (782.3–791.9) | 863.2 (857.3–869.1) | 958.7 (952.6–964.8) | 1,053.31 (1,045.9–1,060.7) | 1,222.7 (1,207.7–1,237.77) |
| 2016 | 433.88 (404.64–463.12) | 609.69 (602.53–616.85) | 715.44 (709.23–721.65) | 795.70 (789.68–801.71) | 870.72 (863.32–878.13) | 969.93 (962.45–977.41) | 1065.92 (1055.95–1075.90) | 1224.7 (1206.67–1242.73) |
In Panel A, the Southeast is characterized by counties in trajectory groups with high mortality rates, whereas counties in low mortality trajectory groups tended to be in the Northeast, the upper Midwest, and the West Coast. Clusters of counties with the worst rate trajectory were in Appalachia, the Mississippi Delta, and the Dakotas. In Panel B, clusters of low–low and high–low counties were in the northern, midwestern, and western regions. Clusters of high–high and low–high counties were predominantly in the South.
Figure 2.
Trajectories of age-adjusted all-cause mortality in US counties using group-based trajectory models, 1999–2016. The outcome measure used to generate rate trajectories was the yearly, age-adjusted, all-cause mortality rate of the county. Panel A: Trajectories of all-cause mortality rates for US counties. Panel B: Local clusters of mortality trajectories in US counties detected by using local indicators of spatial association (LISA). The 4 categories of significant spatial clusters (P< .05): 1) high–high clusters representing all counties with high mortality, the worst trajectory group; 2) high–low outliers representing counties in the worst trajectory groups near counties in the most favorable trajectory groups (at-risk counties doing worse than those around them); 3) low–high outliers representing counties in the best trajectory groups near counties in the worst trajectory groups (resilient counties doing better than those around them); and 4) low–low clusters of counties in the most favorable trajectory groups. Source: 1999–2016 Compressed Mortality File, Centers for Disease Control and Prevention (14).
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