(269) The Two Tales of Healthcare in the United States: The Story of Mississippi and California

Introduction: The overall mortality rates, as well as for leading causes, vary across different states in United States. This study aims to identify different states at the extreme of this spectrum to understand the contributing factors, the gap can be bridged regarding this healthcare disparity and rising mortality.

Methods: We conducted a comprehensive review of age-adjusted death rates per 100,000 population about the ten leading causes of death in US for 1999-2017, utilizing the Centers for Disease Control and Prevention (CDC) database. Following meticulous database review. Mississippi(MS) had the highest age-adjusted death rate per 100,000 population for most diseases, whereas California(CA) was on the lower side.

Results: The results indicate that from 1999-2017, the age-adjusted death rate per 100,000 population for All-causes in Mississippi was 951.3, compared to 618.7 in California. Heart Disease, the leading cause of death in the United States, had the highest age-adjusted death rate in MS vs CA the lowest (231.6 vs 142.9). Similarly, the rates for Cancer varied – MS vs CA (183.1 vs 136.8). Other diseases mortality between two states were: Unintentional Injuries (56.3 vs 33.3). Chronic Lower Respiratory Diseases (58.3 vs 32.2). Stroke (51.1 vs 37.6). Alzheimer’s (49.6 vs 37.1). Diabetes (33.3 vs 22.1). Influenza and Pneumonia (23 vs 14.6). Kidney disease (21.7 vs 8.9), Suicide (15 vs 10.5). We used The Friedman non-parametric test for repeated measures to evaluate the differences between matched samples of overall & each disease mortality between the best-performing state (CA) and worst-performing state (MS). We rounded our data for the purpose of calculation. We used the formula X2r = (12/(nk(k+1)) * (㊥R2) - 3n(k+1). Our p-value was .00091, with the result significant at p < .05. One of the limitations of our study is that the database reported mortality rates till 2017.

Conclusions: CA & MS set out at far ends on the mortality spectrum. This may be due to higher prevalence of chronic diseases in MS. Inaccessibility to healthcare infrastructure, racial and ethnic disparities in quality of care, and poor socioeconomic factors can be other contributing factors. A comprehensive approach and policies for chronic disease prevention and management should help bridge this mortality gap between states.