Original ReportsCommunity Occupational Structure, Medical and Economic Resources, and Coronary Mortality among U.S. Blacks and Whites, 1980–1988
Introduction
Despite dramatic declines in coronary heart disease (CHD) in recent decades, CHD continues to be the leading cause of premature adult mortality. Considerable research describing geographic distributions of CHD mortality has been conducted to identify areas where populations have higher CHD mortality rates and slower declines relative to other areas 1, 2, 3, 4, 5, 6. Geographic patterns of CHD, especially those describing minority and gender specific groups, continue to be complex and poorly understood 7, 8. A recent approach involved grouping U.S. counties according to the proportion of a county labor force in white-collar occupations (as an indicator of occupational structure) and examining differences in CHD mortality between the categories [9].
Occupational structure (i.e., the set of occupations which exist in a community) is an aspect of the industrial structure and division of labor of a population and reflects the position of a local population in the larger national and international economies. Occupational structure has been used as an indicator of overall community economic resources and the quality of local living conditions including the availability and quality of education, transportation, housing, recreation, medical care [10], and conditions that affect CHD risk behaviors and treatment [9]. In a study by Wing and colleagues, which included only white men and women, during 1968–1982, lower CHD mortality rates were observed in counties with greater percentages of white-collar workers.
This study expands on previous research by examining the association between occupational structure and CHD mortality among blacks and whites in the U.S., during 1980–88. The associations are examined separately because access to community resources may differ for blacks and whites, which may relate to a differential risk of CHD in these populations. Furthermore, to document community conditions that are related to occupational structure, this study measures the availability of medical care and examines selected indicators of economic resources in counties categorized by occupational structure.
Section snippets
Methods
The proportion of the civilian labor force in white-collar occupations in 1980 was used to represent the occupational structure of each U.S. county. White-collar workers include professional and technical workers, managers and administrators (except those working on farms), and sales and clerical workers. Information on white-collar employment was obtained from the U.S. Census Equal Employment Opportunity Special file [11].
We ranked the 3077 U.S. counties by the percent of the labor force in
Characteristics of Occupational Structure Categories
In 1980, the proportion of the labor force in white-collar occupations in U.S. counties ranged from 15% to 81% (Table 1). Occupational structure category I represented counties with the smallest proportions of white-collar workers, 15–31%, while category V represented counties with the largest proportions, 56–81%. Residents in category I counties lived mainly in small urban or rural communities; in contrast, 80% of residents in category V counties lived in major metropolitan areas. More than
Discussion
Community environments may adversely affect the cardiovascular health of local populations at multiple points along a continuum, from the prevalence of health behaviors, to the development of heart disease and premature death from CHD. The quality and availability of community services and opportunities, as well as stresses associated with living in less affluent communities, may affect levels of overall health and fitness, the development of atherosclerosis, the occurrence of myocardial
Conclusions
A positive association was observed between occupational structure and distributions of capital and economic resources in U.S. counties. A strong local economy involves both the magnitude of the tax-base as well as the types and diversity of industries; in general greater diversity allows a local economy to better survive routine fluctuations of larger economies. Results showing an association between occupational structure and CHD mortality suggest potential direct public health benefits of
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