In 2004–2005, age-standardized amenable mortality by state within the
US ranged from a low of 63.9 deaths per 100 000 persons under age 75
in Minnesota to highs of 142.0 in Mississippi and 158.3 in the District
of Columbia. Rates were highest in southern states and a band ranging
from Texas to New York (Figure 1). The North Central, Mountain, and
Pacific regions had lower rates. The variation in amenable mortality
rates within the US is more extensive than that seen in 19 OECD
countries in 2002–2003, which ranged from a low of 65 for France to a
high of 110 for the US.3
The bivariate regressions (Table 1) show strong associations between
state-level amenable mortality rates and poverty and race, as well as
various health system-related indicators. Of the two socio-demographic
variables, poverty had the stronger association. The bivariate coefficients,
based on natural logarithm transformed data, can be interpreted
as elasticities or comparative rates of change; for example, a 10 per centincrease in poverty rate is associated with an average 9.3 per cent
higher state amenable mortality rate.
Health care-related variables most strongly associated with mortality
amenable to health care in the bivariate analyses include ones related to
asthma and other ambulatory care such as preventive care for diabetics,
access to a source of care when needed, hospital readmissions, and
publicly reported hospital quality measures (Table 1). The percentage
of the population that is uninsured was significantly but less strongly
associated with amenable mortality compared with other health system
variables, income, or race.
As Table 2 illustrates, many of the health system variables are also
significantly correlated with poverty and black race. These include the
expected strong associations of rates of poverty and uninsurance with
rates of persons reporting going without care because of costs. There is
also a striking correlation between state poverty rates and the per cent
of adults age 50 and older who received recommended screening and
preventive care and the per cent of diabetics receiving recommended
care.