Population Health

At a Glance Projects Publications Team


Spatial Inequalities in Health and Mortality

Kieron Barclay, Yana Catherine Vierboom, Mathias Lerch; in Collaboration with Samuel H. Preston (University of Pennsylvania, Philadelphia, USA)

Detailed Description

One of the major stories of the 20th century has been the remarkable and steady increase in life expectancy, driven first by declines in infant and child mortality and later by declines in mortality at advanced ages. However, these improvements, typically documented at the national level, obscure important urban-rural differences in population health improvements and more general regional disparities in life expectancy. Regional variations in population health are driven by factors such as regional differences in rates of economic development, the socioeconomic characteristics of the constituent populations of each region, local health systems, and legislative differences between regions in federal systems of government. In recent years, spatial variation in population health has received increasing attention. For example, researchers have highlighted the stark regional differences in the geographical distribution of the opium epidemic in the United States, and the media is also rampant with speculation about the extent to which regional disparities in health are linked to the political turbulence observed in Western Democracies since the Great Recession in 2008.

To date, this project has primarily focused on the United States and Switzerland. To study regional variation in mortality in the United States, we used data from the Census and National Center for Health Statistics, and for Switzerland looked at data from the Census and at regional mortality data from the Swiss Federal Statistical Office. We examined mortality from all causes combined as well as cause-specific mortality, and we applied decomposition and regression methods to estimate the contributions of different causes of death to changes and inequalities in measures of life expectancy.

For the United States, we have found that spatial inequality in life expectancy and all-cause mortality above age 25 rose between the early 2000s and 2016 for both men and women: The standard deviation in life expectancy at birth increased by 19% for males and by 44% for females. Areas that had higher life expectancy at the beginning of the period enjoyed larger gains in life expectancy. Non-metropolitan areas and the interior of the country lagged far behind other parts of the United States and also when related to life expectancy patterns observed in a wide range of OECD comparison countries. Spatial inequality in mortality from the combination of drug overdose, alcohol use, and suicide, often dubbed deaths of despair, increased at ages 30–34, but declined at ages 50–54 and 70–74. For Switzerland, we have discovered that although there was a consistent urban mortality advantage over rural areas in the early 20th century, over time this shifted towards a pattern where mortality is higher in both city centers and the countryside in comparison to urban agglomeration belt areas.

Research Keywords:

Aging, Mortality and Longevity, Health Care, Public Health, Medicine, and Epidemiology, Internal Migration, Housing, Urbanisation

Region keywords:

Switzerland, USA


Stelter, R.; De la Croix, D.; Myrskylä, M.:
Demography. accepted. (2021)
Vierboom, Y. C.; Preston, S. H.:
Journals of Gerontology, Series B: Psychological Sciences and Social Sciences 75:5, 1093–1103. (2020)    
Vierboom, Y. C.; Preston, S. H.; Hendi, A.:
SSM-Population Health 9:100478, 1–14. (2019)    
Lerch, M.; Oris, M.; Wanner, P.:
Population: English Edition 72:1, 93–122. (2017)
The Max Planck Institute for Demographic Research (MPIDR) in Rostock is one of the leading demographic research centers in the world. It's part of the Max Planck Society, the internationally renowned German research society.