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Are State Mortality Differences due to Migration From the Rust Belt?

Frank J. Richter, PhD
JAMA. 1991;265(9):1111-1112. doi:10.1001/jama.1991.03460090059026.
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To the Editor.—  Hahn et al1 rank the 50 states by their combined mortality rates from nine chronic diseases. Excess deaths for each state were calculated on the basis of this ranking. The flaw of this study is that it presents age-adjusted death rates in 1986 based on 1980 population. This approach ignores changes in the age structure of states from 1980 through 1986.The early 1980s were a period of great interstate migration, due in part to the 1982 recession. Young people (eg, aged 25 through 29 years) were nearly five times more likely to move to another state than people aged 65 years and older.2 Thus, states with high levels of out-of-state migration in the early 1980s had older populations with higher mortality risks per capita by 1986. The result is a skewed statistical ranking that makes the death rates in "Rust Belt" states seem higher

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