Area Deprivation and Inequalities in Health and Health Care Outcomes
Authors: Gopal K. Singh, Ching-Ching Claire Lin
Journal: Annals of Internal Medicine (2019)

Editorials16 July 2019Area Deprivation and Inequalities in Health and Health Care OutcomesGopal K. Singh, PhD, MS, MSc and Ching-Ching Claire Lin, PhD, MHSGopal K. Singh, PhD, MS, MScHealth Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland (G.K.S., C.C.L.) and Ching-Ching Claire Lin, PhD, MHSHealth Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland (G.K.S., C.C.L.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-1510 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Although the United States has made remarkable progress in improving the overall health of its population during the past several decades, substantial health disparities persist among various social groups and geographic areas, and in many instances, these disparities have widened over time (1). Despite the decline in mortality, persistent or increasing inequalities in life expectancy, infant mortality, all-cause mortality, and mortality from several major causes (such as cardiovascular disease, cancer, diabetes, respiratory disease, and HIV/AIDS) have been reported (2–8). To analyze health inequalities over time, many of these studies have used area deprivation indices (ADIs). Without reliable patient-level measures of ...References1. Singh GK, Daus GP, Allender M, et al. Social determinants of health in the United States: addressing major health inequality trends for the nation, 1935-2016. Int J MCH AIDS. 2017;6:139-64. [PMID: 29367890] doi:10.21106/ijma.236 CrossrefMedlineGoogle Scholar2. Singh GK. Area deprivation and widening inequalities in US mortality, 1969-1998. Am J Public Health. 2003;93:1137-43. [PMID: 12835199] CrossrefMedlineGoogle Scholar3. Singh GK, Siahpush M. Increasing inequalities in all-cause and cardiovascular mortality among US adults aged 25-64 years by area socioeconomic status, 1969-1998. Int J Epidemiol. 2002;31:600-13. [PMID: 12055162] CrossrefMedlineGoogle Scholar4. Singh GK, Siahpush M. Widening socioeconomic inequalities in US life expectancy, 1980-2000. Int J Epidemiol. 2006;35:969-79. [PMID: 16684899] CrossrefMedlineGoogle Scholar5. Singh GK, Azuine RE, Siahpush M, et al. All-cause and cause-specific mortality among US youth: socioeconomic and rural-urban disparities and international patterns. J Urban Health. 2013;90:388-405. [PMID: 22772771] doi:10.1007/s11524-012-9744-0 CrossrefMedlineGoogle Scholar6. Singh GK, Kogan MD. Persistent socioeconomic disparities in infant, neonatal, and postneonatal mortality rates in the United States, 1969-2001. Pediatrics. 2007;119:e928-39. [PMID: 17403832] CrossrefMedlineGoogle Scholar7. Singh GK, Siahpush M, Azuine RE, et al. Widening socioeconomic and racial disparities in cardiovascular disease mortality in the United States, 1969-2013. Int J MCH AIDS. 2015;3:106-18. [PMID: 27621991] MedlineGoogle Scholar8. Singh GK, Jemal A. Socioeconomic and racial/ethnic disparities in cancer mortality, incidence, and survival in the United States, 1950-2014: over six decades of changing patterns and widening inequalities. J Environ Public Health. 2017;2017:2819372. [PMID: 28408935] doi:10.1155/2017/2819372 CrossrefMedlineGoogle Scholar9. Jencks SF, Schuster A, Dougherty GB, et al. Safety-net hospitals, neighborhood disadvantage, and readmissions under Maryland's all-payer program. An observational study. Ann Intern Med. 2019;171:91-8. doi:10.7326/M16-2671 LinkGoogle Scholar10. Alpert JS. The role of the environment in health outcomes [Editorial]. Am J Med. 2018;131:1137-8. [PMID: 29959900] doi:10.1016/j.amjmed.2018.06.001 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland (G.K.S., C.C.L.)Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the official policies of the Health Resources and Services Administration or the U.S. Department of Health and Human Services.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1510.Corresponding Author: Gopal K. Singh, PhD, MS, MSc, Health Resources and Services Administration, U.S. Department of Health and Human Services, 5600 Fishers Lane, Room 13N42, Rockville, MD 20857; e-mail, [email protected]gov.Current Author Addresses: Dr. Singh: Health Resources and Services Administration, U.S. Department of Health and Human Services, 5600 Fishers Lane, Room 13N42, Rockville, MD 20857.Dr. Lin: Health Resources and Services Administration, U.S. Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857.This article was published at Annals.org on 2 July 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSafety-Net Hospitals, Neighborhood Disadvantage, and Readmissions Under Maryland's All-Payer Program Stephen F. Jencks , Alyson Schuster , Geoff B. Dougherty , Sule Gerovich , Jane E. Brock , and Amy J.H. Kind Metrics Cited byDoes the place of residence influence your risk of being hypertensive? 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