Steven H. Woolf ^1*, Resa M. Jones ¹, Robert E. Johnson ¹, Robert L. Phillips Jr², M. Norman Oliver ³, Andrew Bazemore ², Anushree Vichare ⁴

¹ Virginia Commonwealth University
² Robert Graham Center of the American Academy of Family Physicians
³ University of Virginia
⁴ Virginia Department of Health

^* To whom correspondence should be addressed. E-mail: swoolf{at}vcu.edu.

	Abstract

Objectives. We estimated how many deaths would be averted if the entire population of Virginia experienced the mortality rates of the 5 most affluent counties or cities.

Methods. Using census data and vital statistics for the years 1990 through 2006, we applied the mortality rates of the 5 counties/cities with the highest median household income to the populations of all counties and cities in the state.

Results. If the mortality rates of the reference population had applied to the entire state, 24.3% of deaths in Virginia from 1990 through 2006 (range=21.8%–28.1%) would not have occurred. An annual mean of 12954 deaths would have been averted (range=10548–14569), totaling 220211 deaths from 1990 through 2006. In some of the most disadvantaged areas of the state, nearly half of deaths would have been averted.

Conclusions. Favorable conditions that exist in areas with high household incomes exert a major influence on mortality rates. The corollary—that health suffers when society is exposed to economic stresses—is especially timely amid the current recession. Further research must clarify the extent to which individual-level factors (e.g., earnings, education, race, health insurance) and community characteristics can improve health outcomes.

Key Words: Epidemiology, Geography, Social Science, Socioeconomic Factors, Mortality