Date of Award
5-12-2024
Degree Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Sociology
Advisor(s)
Shannon Monnat
Second Advisor
Jennifer Karas Montez
Keywords
air pollution;cardiovascular disease;geographic disparities;industry structure;mortality;state policy
Subject Categories
Social and Behavioral Sciences | Sociology
Abstract
Geographic disparities in cardiovascular disease (CVD) mortality in the United States are significant and have grown over time. The overarching objective of this dissertation is to explain geographic disparities in CVD mortality from air pollution, counties’ industry structures, and states’ environmental policies. Understanding the associations between these physical environments and CVD mortality is important because it can help to inform strategies for reducing geographic disparities in CVD mortality and promoting population health. In the first empirical chapter, I examine the associations between air pollution and county-level CVD mortality for the years 2016 to 2018 and how these associations vary across rural and urban counties. To answer these questions, I merge county-level data from multiple sources and apply spatial models. Air pollution is measured by the concentration of fine particulate matter with diameters of 2.5 μm and smaller (PM 2.5). I find that higher concentrations of PM 2.5 are associated with higher CVD mortality rates, net of important county-level confounders such as socioeconomic and racial/ethnic composition. Moreover, PM 2.5 concentration is more strongly associated with CVD mortality in rural than in urban areas. These findings reveal the importance of air quality for reducing the CVD burden in the United States. Reducing PM 2.5 concentration could not only reduce geographic disparities in CVD deaths but could also reduce the rural mortality penalty. In the second empirical chapter, I examine the associations between counties’ industry structures (defined based on shares of employment in farming, mining, and manufacturing) and CVD mortality in the United States for 2016-2018, and explore the environmental, economic, and health care mechanisms that may explain these associations. Using Ordinary Least Squares regressions and Karlson-Holm-Breen mediation analysis, I find that counties with larger shares of employment in farming, mining, and manufacturing have higher CVD mortality rates. The relationships between certain industry employment shares and CVD mortality rates can be partially explained by higher concentration of air pollutants, worse economic wellbeing, and fewer health care resources in counties with larger shares of employment in these industries. However, the importance of these mechanisms varies by industry. In manufacturing-dominant counties, air pollution, median household income, and the physician rate help explain higher CVD mortality rates. In counties with larger shares of employment in farming, median household income and the physician rate are crucial. In counties with larger shares of mining, the physician rate is important. These findings reveal how local industry structures function as institutions that produce and exacerbate multiple place-level disadvantages and how these disadvantages contribute to CVD mortality. In the third empirical chapter, I examine the associations between states’ environmental policy contexts (using an index of eight policies) and county-level CVD mortality rates for the years 2000-2014 and how these associations vary by counties’ sociodemographic composition, including race/ethnicity, income, and unemployment rate. Using data from multiple sources and multilevel mixed-effect linear regression models, I find that more liberal state environmental policy scores were associated with lower county-level CVD mortality rates, net of covariates. However, this association was stronger among counties with larger shares of non-Hispanic Black and low-income residents. Consequently, disparities in CVD mortality across counties of different racial/ethnic and income composition were largest in states with conservative environmental policy scores and smallest in states with liberal environmental policy scores. These findings underscore the significance of states’ environmental policy contexts in predicting CVD mortality rates and shed light on the population heterogeneity in the association between states’ environmental policy contexts and CVD mortality. The findings highlight the potentially important role of state environmental policies on CVD mortality and show that conservative environmental policy contexts are most adversely associated with CVD mortality in counties with the largest non-Hispanic Black and low-income population shares.
Access
Open Access
Recommended Citation
Sun, Yue, "EXPLAINING GEOGRAPHIC DISPARITIES IN CARDIOVASCULAR DISEASE MORTALITY: THE ROLES OF PHYSICAL ENVIRONMENT, INDUSTRY STRUCTURES, AND STATE POLICIES" (2024). Dissertations - ALL. 1939.
https://surface.syr.edu/etd/1939
