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

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.