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Identifying County-Level All-Cause Mortality Rate Trajectories and Their Spatial Distribution Across the United States

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Figure 1.
Age-adjusted mortality rate trajectories for US counties for 8 groups of counties based on group-based trajectory models, 1999–2016. The outcome measure used to generate rate trajectories was the yearly, age-adjusted, all-cause mortality rate of the county. Solid lines correspond to model-predicted values for rates; dotted lines are confidence intervals for the predicted values.

Year Group 1 Group 2 Group 3 Group 4 Group 5 Group 6 Group 7 Group 8
1999 609.1 (579.8–638.4) 758.6 (751.9–765.4) 818.1 (811.9–824.4) 895.2 (889.5–900.9) 966.0 (959.3–972.7) 1,024.7 (1,017.5–1,031.9) 1,098.9 (1,089.6–1,108.1) 1,266.1 (1,249.8–1,282.3)
2000 590.7 (566.6–614.8) 742.3 (736.74–747.8) 808.7 (804.0–813.5) 887.3 (883.0–891.7) 961.1 (955.6–966.7) 1,025.6 (1,020.0–1,031.2) 1,105.4 (1,098.5–1,112.4) 1,259.2 (1,246.1–1,272.2)
2001 573.3 (552.9–593.7) 726.9 (722.2–731.6) 798.8 (794.5–803.0) 878.2 (874.3–882.1) 954.4 (949.1–959.7) 1,023.6 (1018.5–1028.8) 1,108.09 (1102.1–1114.1) 1,252.8 (1242.1–1263.5)
2002 556.9 (538.8–575.1) 712.4 (708.2–716.6) 788.4 (784.2–792.7) 868.05 (864.1–872.00) 946.2 (940.9–951.5) 1,019.3 (1014.1–1024.6) 1,107.36 (1101.4–1113.3) 1,247.0 (1237.8–1256.3)
2003 541.6 (524.3–558.8) 698.9 (694.9–702.9) 777.9 (773.7–782.2) 857.2 (853.2–861.3) 936.9 (931.6–942.3) 1013.07 (1,007.6–1,018.5) 1,103.83 (1,097.8–1,109.9) 1,241.8 (1,233.1–1,250.5)
2004 527.2 (510.0–544.5) 686.4 (682.4–690.4) 767.5 (763.2–771.8) 846.0 (842.0–850.1) 926.8 (921.6–932.1) 1,005.4 (999.9–1011.0) 1,098.08 (1,092.0–1,104.2) 1,237.2 (1,228.3–1246.0)
2005 513.9 (496.2–531.6) 674.8 (670.7–678.9) 757.2 (753.1–761.4) 834.8 (830.8–838.8) 916.3 (911.2–921.4) 996.8 (991.2–1,002.3) 1,090.69 (1,084.8–1,096.6) 1,23315 (1,223.8–1,242.3)
2006 501.6 (483.4–519.7) 664.1 (659.9–668.4) 747.4 (743.4–751.4) 823.8 (819.8–827.7) 905.7 (900.9–910.6) 987.6 (982.1–993.2) 1,082.23 (1,076.5–1,088.0) 1,229.5 (1,219.8–1,239.2)
2007 490.2 (471.8–508.7) 654.4 (650.05–658.8) 738.2 (734.3–742.1) 813.3 (809.4–817.2) 895.4 (890.7–900.0) 978.4 (972.8–984.0) 1,073.3 (1,067.7–1,078.9) 1,226.5 (1,216.47–1,236.56)
2008 479.9 (461.5–498.4) 645.6 (641.3–650.0) 729.8 (725.9–733.7) 803.7 (799.8–807.6) 885.6 (881.17–890.2) 969.6 (963.9–975.3) 1,064.4 (1,058.8–1,070.1) 1,224.1 (1,213.9–1,234.3)
2009 470.6 (452.5–488.8) 637.8 (633.5–642.2) 722.4 (718.5–726.4) 795.3 (791.3–799.3) 876.8 (872.3–881.4) 961.7 (955.8–967.6) 1,056.2 (1,050.43–1,062.01) 1,222.2 (1,212.0–1,232.5)
2010 462.4 (444.7–480.0) 631.0 (626.7–635.3) 716.2 (712.2–720.3) 788.4 (784.3–792.6) 869.3 (864.7–873.9) 955.2 (949.1–961.3) 1,049.3 (1,043.3–1,055.3) 1,220.9 (1,210.9–1,231.1)
2011 455.1 (437.8–472.3) 625.1 (620.8–629.3) 711.45 (707.3–715.6) 783.3 (779.0–787.6) 863.43 (858.7–868.2) 950.4 (944.2–956.6) 1,044.1 (1,038.0.0–1,050.3) 1,220.1 (1,209.9–1,230.3)
2012 448.8 (431.6–466.0) 620.07 (615.73–624.41) 708.26 (704.09–712.44) 780.30 (775.99–784.61) 859.54 (854.69–864.39) 947.91 (941.73–954.08) 1041.39 (1035.21–1047.57) 1219.93 (1209.44–1230.41)
2013 443.56 (425.44–461.69) 616.1 (611.5–620.7) 706.9 (702.7–711.0) 779.7 (775.4–784.0) 858.0 (853.0–862.9) 948.2 (942.1–954.2) 1,041.6 (1,035.5–1,047.7) 1,220.3 (1,209.0–1,231.5)
2014 439.3 (419.0–459.7) 613.0 (607.8–618.1) 707.5 (703.3–711.7) 781.9 (777.5–786.3) 859.1 (853.9–864.3) 951.6 (945.7–957.5) 1,045.4 (1039.1–1051.7) 1,221.2 (1,208.5–1,233.9)
2015 436.1 (412.0–460.2) 610.9 (604.9–616.9) 710.3 (705.5–715.0) 787.1 (782.3–791.9) 863.2 (857.3–869.1) 958.7 (952.6–964.8) 1,053.31 (1,045.9–1,060.7) 1,222.7 (1,207.7–1,237.77)
2016 433.88 (404.64–463.12) 609.69 (602.53–616.85) 715.44 (709.23–721.65) 795.70 (789.68–801.71) 870.72 (863.32–878.13) 969.93 (962.45–977.41) 1065.92 (1055.95–1075.90) 1224.7 (1206.67–1242.73)

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In Panel A, the Southeast is characterized by counties in trajectory groups with high mortality rates, whereas counties in low mortality trajectory groups tended to be in the Northeast, the upper Midwest, and the West Coast. Clusters of counties with the worst rate trajectory were in Appalachia, the Mississippi Delta, and the Dakotas. In Panel B, clusters of low–low and high–low counties were in the northern, midwestern, and western regions. Clusters of high–high and low–high counties were predominantly in the South.

Figure 2.
Trajectories of age-adjusted all-cause mortality in US counties using group-based trajectory models, 1999–2016. The outcome measure used to generate rate trajectories was the yearly, age-adjusted, all-cause mortality rate of the county. Panel A: Trajectories of all-cause mortality rates for US counties. Panel B: Local clusters of mortality trajectories in US counties detected by using local indicators of spatial association (LISA). The 4 categories of significant spatial clusters (P< .05): 1) high–high clusters representing all counties with high mortality, the worst trajectory group; 2) high–low outliers representing counties in the worst trajectory groups near counties in the most favorable trajectory groups (at-risk counties doing worse than those around them); 3) low–high outliers representing counties in the best trajectory groups near counties in the worst trajectory groups (resilient counties doing better than those around them); and 4) low–low clusters of counties in the most favorable trajectory groups. Source: 1999–2016 Compressed Mortality File, Centers for Disease Control and Prevention (14).

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