The Effect of Urbanization upon the Trend of Adult Mortality in the United States *

Evaluation of the effects of the public health movement in the United States during the past thirty years shows that the results have been attained, for the most part, with respect to the communicable and infectious diseases, and at the younger ages of life. This is particularly evident when the evaluation is concerned with an analysis of mortality rates. The infant mortality rate, for example, has declined substantially from 100 per 1000 live births in 1915 to 47 in 1940 for the U. S. Birth Registration States. The decline in specific death rates for other age groups from 1900 to 1940 has been as follows: 1-4 years, 85 per cent; 5-14 years, 74 per cent; 15-34 years, 64 per cent; 35-64 years, 27 per cent; and 65 years and over, 13 per cent. The percentage reduction in mortality thus progressively decreases with increasing age. It is evident that the possibility of further reducing mortality and morbidity at the older age groups presents a challenging opportunity for the public health and medical professions, especially in view of the fact that further reduction in mortality at the younger ages becomes increasingly difficult. The present study was undertaken with two objectives in mind: (1) to determine the rate of decline in mortality at ages above forty-five for various states for which data are available and (2) to study, if possible, the relation between industrialization and the trend of mortality at the upper ages. The rationale for the second objective will be discussed briefly. Urbanization and industrialization have gone hand in hand. Wu and Winslow5 showed that the coefficient of correlation between percentage rural and the value added to products by manufacturing was -0.67 for counties of the United States in 1920. The correlation between the 1939 male per capita value of products and percentage urban in 1940 was +0.70 for the twenty Death Registration States of 1910;