Death by Segregation: Does the Dimension of Racial Segregation Matter?

The county-level geographic mortality differentials have persisted in the past four decades in the United States (US). Though several socioeconomic factors (e.g., inequality) partially explain this phenomenon, the role of race/ethnic segregation, in general, and the different dimensions of segregation, more specifically, has been underexplored. Focusing on all-cause age-sex standardized US county-level mortality (2004-2008), this study has two substantive goals: (1) to understand whether segregation is a determinant of mortality and if yes, how the relationship between segregation and mortality varies by racial/ethnic dyads (e.g., white/black), and (2) to explore whether different dimensions of segregation (i.e., evenness, exposure, concentration, centralization, and clustering) are associated with mortality. A third goal is methodological: to assess whether spatial autocorrelation influences our understanding of the associations between the dimensions of segregation and mortality. Race/ethnic segregation was found to contribute to the geographic mortality disparities. Moreover, the relationship with mortality differed by both race/ethnic group and the dimension of segregation. Specifically, white/black segregation is positively related to mortality, whereas the segregation between whites and non-black minorities is negatively associated with mortality. Among the five dimensions of segregation, evenness and exposure are more strongly related to mortality than other dimensions. Spatial filtering approaches also identified six unique spatial patterns that significantly affect the spatial distribution of mortality. These patterns offer possible insights that help identify omitted variables related to the persistent patterning of mortality in the US.