On the Importance of Age‐Adjustment Methods in Ecological Studies of Social Determinants of Mortality

Jeffrey D. Milyo · Jennifer M. Mellor

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Abstract

OBJECTIVE: To illustrate the potential sensitivity of ecological associations between mortality and certain socioeconomic factors to different methods of age-adjustment. DATA SOURCES: Secondary analysis employing state-level data from several publicly available sources. Crude and age-adjusted mortality rates for 1990 are obtained from the U.S. Centers for Disease Control. The Gini coefficient for family income and percent of persons below the federal poverty line are from the U.S. Bureau of Labor Statistics. Putnam's (2000) Social Capital Index was downloaded from http://www.bowlingalone.com; the Social Mistrust Index was calculated from responses to the General Social Survey, following the method described in Kawachi et al. (1997). All other covariates are obtained from the U.S. Census Bureau. STUDY DESIGN: We use least squares regression to estimate the effect of several state-level socioeconomic factors on mortality rates. We examine whether these statistical associations are sensitive to the use of alternative methods of accounting for the different age composition of state populations. Following several previous studies, we present results for the case when only mortality rates are age-adjusted. We contrast these results with those obtained from regressions of crude mortality on age variables. PRINCIPAL FINDINGS: Different age-adjustment methods can cause a change in the sign or statistical significance of the association between mortality and various socioeconomic factors. When age variables are included as regressors, we find no significant association between mortality and either income inequality, minority racial concentration, or social capital. CONCLUSIONS: Ecological associations between certain socioeconomic factors and mortality may be extremely sensitive to different age-adjustment methods.

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2000Bowling alone: the collapse and revival of American community 2000Bowling alone 1997Social capital, income inequality, and mortality.2000Social Cohesion, Social Capital, and Health 1996Inequality in income and mortality in the United States: analysis of mortality and potential pathways 1996Income distribution and mortality: cross sectional ecological study of the Robin Hood index in the United States 1997Socioeconomic determinants of health : Health and social cohesion: why care about income inequality?1998Income inequality and mortality in metropolitan areas of the United States.

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