Race, class, and place modify mortality rates for the top 12 causes of death in the United States, 1999-2021

ABSTRACT Objectives To disarticulate the associations of race (whiteness), class (socioeconomic status), and place (county) with risk of cause-specific death in the US. Methods We studied mortality in US counties for 11 causes of death (1999-2019) and COVID-19 (2020-2021). We adjusted for race and age using the American Community Survey and socioeconomic status using the Area Deprivation Index. Bayesian regressions with spatial county effects were estimated for inference. Results County whiteness and socioeconomic status modified death rates; geospatial effects differed by cause of death. Other factors equal, a 20% increase in county whiteness was associated with 5-8% increase in death from three causes and 4-15% reduction in death from others, including COVID-19. Other factors equal, advantaged counties had significantly lower death rates, even when juxtaposed with disadvantaged ones. Geospatial patterns of residual risk varied by cause of death. For example, cancer and heart disease death rates were better explained by age, socioeconomic status, and county whiteness than were COVID-19 and suicide deaths. Conclusions There are important independent contributions from race, class, and geography to risk of death in the US.