Elsevier

Annals of Epidemiology

Volume 8, Issue 3, April 1998, Pages 184-191
Annals of Epidemiology

Original Reports
Community Occupational Structure, Medical and Economic Resources, and Coronary Mortality among U.S. Blacks and Whites, 1980–1988

https://doi.org/10.1016/S1047-2797(97)00202-0Get rights and content

Abstract

PURPOSE: To examine the association between coronary heart disease (CHD) mortality, economic and medical resources, and county occupational structure.

METHODS: U.S. counties were classified into five occupational structure categories based on the percentage of workers in white-collar occupations. Directly age-adjusted CHD mortality rates (from vital statistics and Census data) and economic and medical care data (from Census and Area Resource File data) were calculated for each occupational structure category. Participants were black and white, men and women, aged 35–64 years, in the U.S. during 1980–88. CHD mortality rates and economic and medical care data were compared across occupational structure categories.

RESULTS: Among blacks, CDH rates were highest in counties with intermediate levels of occupational structure; rates among whites were inversely associated with occupational structure. Per capita levels of income and numbers of medical-care providers were positively associated with occupational structure.

CONCLUSION: Strategies to improve the resources of disadvantaged communities and the access of black workers to local occupational opportunities may be important for CHD prevention in high risk populations.

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

References (37)

  • DD Ingram et al.

    Regional and urbanization differentials in coronary heart disease mortality in the United States, 1968–85

    J Clin Epidemiol.

    (1989)
  • R Cooper et al.

    The decline in mortality from coronary heart disease, U.S.A., 1968–1975

    J Chronic Dis.

    (1978)
  • M Casper et al.

    Social class and race disparities in premature stroke mortality

    Ann Epidemiol.

    (1997)
  • S Wing et al.

    Geographic variation in the onset of decline of ischemic heart disease mortality in the United States

    Am J Public Health.

    (1986)
  • S Wing et al.

    Geographic and socioeconomic variation in the onset of decline of coronary heart disease mortality in white women

    Am J Public Health.

    (1992)
  • S Wing et al.

    Socioenvironmental characteristics associated with the onset of decline of ischemic heart disease mortality in the United States

    Am J Public Health.

    (1988)
  • KE Ragland et al.

    The onset of decline in ischemic heart disease mortality in the United States

    Am J Epidemiol.

    (1988)
  • Gillum RF. Prevalence of cardiovascular and pulmonary diseases and risk factors by region and urbanization in the...
  • EB Barnett et al.

    Urbanisation and coronary heart disease mortality among African Americans in the US South

    J Epidemiol Commun Health.

    (1996)
  • Wing S, Casper M, Hayes CG, Dargent-Molina P, Riggan W, Tyroler HA. Changing association between community occupational...
  • ED Sclar

    Community economic structure and individual well-being, a look behind the statistics

    Internat J Health Serv.

    (1980)
  • Data Users Services Division. Census of population, 1980: Equal Employment Opportunity Special File Technical...
  • US Department of Health and Human Services. Use of race and ethnicity in public health surveillance. MMWR....
  • World Health Organization. Manual of the International Statistical Classification of Diseases, Injuries and Causes of...
  • C Sempos et al.

    Divergence of the recent trends in coronary mortality for the four major race-sex groups in the United States

    Am J Public Health.

    (1988)
  • US Bureau of Census

    Current Population Reports, Series p-23, No. 115. Coverage of the National Population in the 1980 Census, by Age, Sex, and RacePreliminary Estimates by Demographic Analysis

    (1982)
  • Data Users Services Division Bureau of Census. Census of Population and Housing, 1980: Summary Tape File 3 Technical...
  • Office of Health Professions Analysis and Research. Area Resources File: Bureau of Health Professions, Dept. of Health...
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