Graduate Theses, Dissertations, and Problem Reports 2017 Exploring the Power of County-Level Regional Classifications on Predicting Sex-Specific All-Cause Mortality in the United States Julia Kay Wolf Follow this and additional works at: https://researchrepository.wvu.edu/etd Recommended Citation Wolf, Julia Kay, "Exploring the Power of County-Level Regional Classifications on Predicting Sex-Specific All-Cause Mortality in the United States" (2017). Graduate Theses, Dissertations, and Problem Reports. 6968. https://researchrepository.wvu.edu/etd/6968 This Thesis is protected by copyright and/or related rights. It has been brought to you by the The Research Repository @ WVU with permission from the rights-holder(s). You are free to use this Thesis in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you must obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/ or on the work itself. This Thesis has been accepted for inclusion in WVU Graduate Theses, Dissertations, and Problem Reports collection by an authorized administrator of The Research Repository @ WVU. For more information, please contact [email protected]. Exploring the Power of County-Level Regional Classifications on Predicting Sex-Specific All-Cause Mortality in the United States Julia Kay Wolf Thesis submitted to the Eberly College of Arts and Sciences at West Virginia University in partial fulfillment of the requirements for the degree of Master of Arts in Sociology Jeralynn S. Cossman, Ph.D., Chair Christopher P. Scheitle, Ph.D. Douglas J. Myers, Sc.D. Department of Sociology and Anthropology Morgantown, West Virginia 2017 Keywords: Garreau, mortality, regional classification, sex-specific, smoking, US Census Divisions, Woodard Copyright 2017 Julia Kay Wolf ABSTRACT Exploring the Power of Different Regional Classifications on Predicting Sex-Specific All-Cause Mortality in the United States Julia Kay Wolf Sex-specific mortality rates have been found to differ across regions of the United States; however, these areas are typically the broad Census Bureau regions (i.e., Midwest, Northeast, South, and West) that do not consider sociological factors known to affect health. By testing the predictive capabilities of theoretically driven regional classifications distinguished at county- level, I explore whether there are more accurate ways of assessing mortality differences across the United States. Specifically, I use the US Census Bureau divisions and regional groupings produced by Joel Garreau (1981) and Colin Woodard (2011) to predict sex-specific, age- adjusted, all-cause mortality for 2008-2012 (centered on 2010). Garreau’s Nine Nations of North America uses the economic activities and priorities of various regions to divide the US while Woodard’s American Nations: A History of the Eleven Rival Regional Cultures of North America uses the historical settlement of the US to generate culturally different nations. I examine the mediating effects of several county-level contextual and demographic factors, health behavior characteristics (including smoking), and socioeconomic measures (including labor force participation). Results suggest that Woodard’s “American Nations” slightly outperform the other regional classifications, but the differences are negligible once other mediating factors are taken into account. Findings demonstrate that daily smoking behavior is the strongest predictor of county-level mortality variation for males and females. Researchers and policymakers should continue to find ways to reduce smoking, particularly in the south. iii Table of Contents Abstract ………………………………………………………………………………………ii Table of Contents …………………………………………………………………………….iii List of Tables …………………………………………………………………………………v List of Figures ………………………………………………………………………………...vi Introduction …………………………………………………………………………………..1 Review of the Literature ……………………………………………………………………...2 Mortality Disparities: People vs. Place ……………………………………………….2 Sex-Specific Disparities in Mortality …………………………………………………4 Measuring Mortality Disparities ……………………………………………………...6 Regional Definitions ……………………………………………………………….....8 US Census Bureau Divisions …………………………………………………8 Woodard’s American Nations: A History of the Eleven Rival Regional Cultures of North America …………………………………………………...10 Garreau’s The Nine Nations of North America ………………………………13 Applying Regional Classifications to Sex-Specific Mortality Disparities …………………...16 Preliminary Findings …………………………………………………………………16 Hypotheses …………………………………………………………………………...18 Methods ………………………………………………………………………………………18 Data …………………………………………………………………………………...18 Dependent Variables ………………………………………………………….19 Mediators ……………………………………………………………………...19 Regional Classifications ………………………………………………………21 Analyses ………………………………………………………………………………21 Maps …………………………………………………………………………………..22 Results ………………………………………………………………………………………...22 Descriptives …………………………………………………………………………...22 Model 1a and 1b: Male and Female Mortality without Mediators ……………………25 Model 2a and 2b: Male and Female Mortality with “Place” Mediators ………………26 Model 3a and 3b: Male and Female Mortality with “People” Mediators ……………..27 iv Model 4a and 4b: Male and Female Mortality with Mediators (except Smoking and Labor Force Participation) ………………………………………………………...29 Model 5a and 5b: Male and Female Mortality with All Mediators ……………………31 Comparison of Models for US Census Divisions ……………………………………...34 Maps …………………………………………………………………………………...35 Discussion ……………………………………………………………………………………..36 Hypothesis One ………………………………………………………………………..36 Hypothesis Two ………………………………………………………………………..38 Hypothesis Three ………………………………………………………………………39 Exploratory Maps ……………………………………………………………………...40 Limitations ……………………………………………………………………………………..40 Future Research ………………………………………………………………………………..41 Conclusion ……………………………………………………………………………………..42 References ……………………………………………………………………………………...43 Appendix ……………………………………….………………………………………………51 v List of Tables Table 1. Comparison of Model Fit from Preliminary Analyses ...……….….…………………51 Table 2. Hypotheses and Results ………………………………………………………………52 Table 3a. Descriptives of US Census Bureau Divisions ………………………………………53 Table 3b. Descriptives of US Census Bureau Divisions – Male ………………………………54 Table 3c. Descriptives of US Census Bureau Divisions – Female …………………………….55 Table 4a. Descriptives of Woodard’s American Nations ……………………………...............56 Table 4b. Descriptives of Woodard’s American Nations – Male ……………………………...58 Table 4c. Descriptives of Woodard’s American Nations – Female …………………................59 Table 5a. Descriptives of Garreau’s Nine Nations ……………………………………………..60 Table 5b. Descriptives of Garreau’s Nine Nations – Male …………………………………….61 Table 5c. Descriptives of Garreau’s Nine Nations – Female …………………………………..62 Table 6. Model 1a: Male Mortality without Mediators ………………………………………...63 Table 7. Model 1b: Female Mortality without Mediators ……………………………………...64 Table 8. Model 2a: Male Mortality with “Place” Mediators …………………………………...65 Table 9. Model 2b: Female Mortality with “Place” Mediators ………………………………...67 Table 10. Model 3a: Male Mortality with “People” Mediators ………………………………...69 Table 11. Model 3b: Female Mortality with “People” Mediators ……………………………...71 Table 12. Model 4a: Male Mortality with Mediators (except Smoking and Labor Force Participation) …………………………………………………………………………...73 Table 13. Model 4b: Female Mortality with Mediators (except Smoking and Labor Force Participation) …………………………………………………………………………...75 Table 14. Model 5a: Male Mortality with All Mediators ……………………………................77 Table 15. Model 5b: Female Mortality with All Mediators …………………………................80 Table 16. Male Mortality Models: Census ……………………………………………………..83 Table 17. Female Mortality Models: Census …………………………………………………..86 vi List of Figures Regional Classifications Figure 1. US Census Bureau Divisions ………………………………….….………….89 Figure 2. Woodard’s “American Nations” …………………………….…….…………90 Figure 3. Garreau’s “Nine Nations” ………………………………….……….………..91 ArcGIS Maps with Mortality Figure 4. Female Age-Adjusted All-Cause US Mortality with Census Divisions ..……92 Figure 5. Male Age-Adjusted All-Cause US Mortality with Census Divisions ..………93 Figure 6. Female Age-Adjusted All-Cause US Mortality with Woodard’s “American Nations” ………………………………………...…………………….………...94 Figure 7. Male Age-Adjusted All-Cause US Mortality with Woodard’s “American Nations” ………………………………………………..…………….…………95 Figure 8. Female Age-Adjusted All-Cause US Mortality with Garreau’s “Nine Nations”…………………………………………………………………………96 Figure 9. Male Age-Adjusted All-Cause US Mortality with Woodard’s “American Nations” ...…………………………………….………………………………...97 Figure 10. Female Age-Adjusted All-Cause US Mortality with Woodard, Garreau, and Census Classification ………………………………..………..……….………..98 Figure 11. Female Age-Adjusted All-Cause US Mortality with Woodard, Garreau, and Census Classification …………………………….……………………………..99 1 Research has found “persistent clusters” of high and low mortality rates across the United States from 1968 to 2002 (Cossman et al. 2007). Sex-specific mortality rates have been found to differ among US regions as well (Ezzati et al. 2008; Kindig and Cheng 2013; Montez and Berkman 2014); however, these areas are typically colloquially named regions without long-term definitive boundaries (e.g., Appalachia) or are the broad Census Bureau regions (i.e., Midwest, Northeast,