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Graham Center Study Documents Effect of Socioeconomic Factors on Health and Avertable Death Rates
"This study demonstrated that approximately one out of four deaths in Virginia from 1990 through 2006 would have been averted if the entire state had experienced the mortality rates of the reference population, in which the median household income was high," says the study. "The predicted effect was substantial: the average number of lives saved per year (approximately 13,000) rivals the number of cancer deaths in the state."
The study notes that areas of the state with deep poverty levels had high mortality rates. However, just increasing income isn't enough, say the authors, because "income is deeply interrelated with other social determinants of health, such as education, race and ethnicity." For example, "Adults with no education beyond high school accounted for 75 percent of avertable deaths," says the study.
"A confluence of interrelated socioeconomic variables -- poverty, low graduation rates and large minority populations -- affects the regions of Virginia where we observed the highest rates, such as the Southwest and Southside areas," say the study authors.
At the same time, areas with lower rates of avertable mortality, such as campus towns and affluent suburbs, have populations with more education, higher incomes and lower minority representation, according to the study.
Researchers determined avertable deaths for each calendar year for each county and city and aggregated them to arrive at the total number of avertable deaths for the state. The number of avertable deaths for either a county or city was determined by applying the reference population mortality rate for each age-gender subgroup to the population count of the corresponding age-gender subgroup of the county and city and then subtracting this projected death count from the actual number of deaths for that age-gender subgroup.
Expanding the Results
Virginia also is similar to other diverse states, such as New Jersey and California, so the study's findings have relevance for other parts of the country, especially during the ongoing recession, according to the study's lead author Steven Woolf, M.D., M.P.H., a family physician and director of the Virginia Commonwealth University Center on Human Needs in Richmond.
"If we were to repeat the study in another state or on a national level, we might get slightly different numbers," Woolf said in an interview with AAFP News Now. "But the basic message still holds." The study shows that "socioeconomic policy is health policy; economic conditions and other living conditions that go along with it have a big influence on health status."
According to Woolf, "economic policy is an important tool for dealing with health outcomes." An improvement in economic conditions will reduce chronic disease levels and lead to lower costs.
Woolf predicted that the current recession and economic difficulties families are facing are going to have an impact on their health in the future. "The writing is on the wall, and research, such as this, is fair warning that these economic conditions and all of the consequences that spill out from it are going to translate into higher disease rates and costs associated with care for those diseases," he said.
The Physician Effect
Physicians can have a major effect on a patient's health by addressing socioeconomic conditions. Family physicians in particular are in an ideal position to address these issues and concerns because of their training, said Woolf. "In family medicine, this understanding about the importance of community and living conditions is woven into the very ethos of our training. We have been taught that living conditions matter, and there is an ethic in the specialty to be concerned about the larger environment that people live in and its relationship to health."
Graham Center Commentary Urges Greater Prevention Role for Medicare