Heterogenous Effects of Local Government Spending on Mortality Across Racial Groups Among Working-Age Adults in the U.S.

Introduction: Mortality among working-age adults has been rising, but the underlying reasons are not fully known. Given the relationship between higher levels of public spending and better health outcomes, it is possible that differences in public spending may explain some of this trend. This study examined the association between county government spending and overall and race-specific mortality among working-age adults over time. Methods: Hybrid random effects models, which specified separate within- and between-county effects, were used to assess the relationship between per capita county spending and overall and race-specific mortality rates from 1980 to 2019. All models controlled for median age, percentage of the population with at least a bachelor's degree, unemployment rate, and poverty rate. Results: In the overall population, counties with higher k-12 education, library, and police spending were significantly associated with higher mortality rates. Among Black adults, counties with lower corrections spending, lower waste management spending, and higher highway spending had significantly higher Black mortality. Among White adults, counties with lower natural resource spending and higher police spending had higher White mortality. Conclusions: This study showed that differences in public spending may explain the geographic and racial differences in mortality among working-age adults. Local governments should consider public spending as a tool to improve overall population health and address racial health inequalities in their jurisdictions.