"Although we are accustomed to seeing varying rates of mortality reduction in states and nations," Kindig and Cheng write, "it is striking and discouraging to find female mortality rates on the rise in 42.8 percent of US counties, despite increasing medical care expenditures and public health efforts."
Kindig and Cheng looked at a number of factors that might give some context for why female morality went up in some counties but down in others. A somewhat surprising finding was that the availability of medical care — measured by the number of primary care providers or percentage of uninsured — didn't really make a difference.
"Female mortality rates were not predicted by any of the medical care factors," they write.
What could predict worsening mortality rates, however, were socioeconomic factors.
"Many people believe that medical care and individual behaviors such as exercise, diet, and smoking are the primary reasons for declines in health," the authors write. "We did find significant associations between mortality rates and some of these factors, such as smoking rates for both sexes. But socioeconomic factors such as the percentage of a county’s population with a college education and the rate of children living in poverty had equally strong or stronger relationships to fluctuations in mortality rates."