The distribution of states with the highest mortality changed dramatically between 1965-2004. In 1965, the states with the highest mortality (Rhode Island, Alaska, Delaware, Pennsylvania, and New Hampshire) were spread across geographic regions. By 2004, however, the states with the highest mortality were geographically contiguous, and located in the south. The Central South (Alabama, Kentucky, Mississippi, and Tennessee) had the highest mortality rates in the United States. A new study by Andrew Fenelon of Brown University explores the possibility that smoking behaviors account for this situation.
Fenelon used US mortality data from vital statistics on cause of death for the period 1965-2004 and, for the purposes of this study, considered lung cancer deaths to be indicative of cigarette smoking. In the US, more than 90 percent of lung cancer deaths among men and more than 80 percent among women result from smoking. Although the prevalence of smoking declined in all states in that time period, southern states, particularly Kentucky, have maintained overall high levels of smoking.
Fenelon found that in the Central South, mortality attributable to smoking peaked later than in other regions and at a significantly higher death rate, indicating a greater and more persistent burden of smoking. By 2004, the gap in mortality attributable to smoking between the Central Southern states and states in other regions was exceptionally large: among men, smoking explained as much as 75 percent of the difference between the Central South and other US regions.
This study highlights geographic inequalities in health and mortality within the US and underscores the importance of narrowing these gaps as a public policy goal.