Spatial and temporal inequalities in mortality in the USA, 1968–2016

Previous UK and European research has highlighted important variations in mortality between populations after adjustment for key determinants such as poverty and deprivation. The aim here was to establish whether similar populations could be identified in the US, and to examine changes over time. We employed Poisson regression models to compare county-level mortality with national rates between 1968 and 2016, adjusting for poverty, education, race (a proxy for exposure to racism), population change and deindustrialisation. Results are presented by means of population-weighted cartograms, and highlight widening spatial inequalities in mortality over time, including an urban to rural, and south-westward, shift in areas with the highest levels of such unexplained ‘excess’ mortality. There is a need to understand the causes of the excess in affected communities, given that it persists after adjustment for such a broad range of important health determinants. •For the first time, trends in ‘excess’ (adjusted) mortality in the US are analysed.•Population-weighted cartograms are used to present and explore county-level trends.•Maps highlight widening spatial inequalities over time in this form of mortality.•We identify urban and rural changes in excess mortality over c.50 years (1968–2016).•Policy-relevant analyses identify areas with highest levels of excess mortality.