Location, location, location! Realtors repeat this mantra to let buyers know that some parts of town have more cache than others, and those properties in the prime zones come with price tags to match.  Top locations usually beat the plebian-priced zones because they look prettier, have bigger yards, have better schools, nicer views, and lower crime rates. But there’s another factor that makes fancier neighborhoods more desirable. Most neighborhoods have distinctive mortality patterns, and high-priced neighborhoods, with a few notable exceptions such as Marin County, CA,¹ Jessica Mullins. “Breast Cancer Rates Drop in Marin.” San Rafael Patch. September 24, 2013. (Accessed 1 Jan 2017.) http://patch.com/california/sanrafael/breast-cancer-rates-drop-in-marin typically have lower overall death rates than poorer regions.

A new report just published in JAMA delineates patterns of death by county throughout the US.² Dwyer, Lindgren, Laura. “US County-Level Trends in Mortality Rates for Major Causes of Death, 1980-2014.” 13 December 2016. JAMA. 30 December 2016.   http://jamanetwork.com/journals/jama/fullarticle/2592499 You can go to an interactive map and click on your county to find out just what’s killing your neighbors, and in what numbers compared to the rest of the US. The study considers how many people die annually, by region, from a variety of disease factors (heart disease, diabetes, liver issues and so on) and also, by calamities such as suicide, drug overdose, and vehicle crashes. The researchers started by looking at 21 causes of death and then extracted the ten factors that kill the most people, grouping some together. It’s interesting to note that among those 10 leading killers, drug abuse, mental disorders, cirrhosis, suicide, and violence have a strong foothold.

The data includes death records on more than 80 million people who died over the course of 34 years, from 1980 to 2014. While cardiovascular disease has been the big number one killer virtually everywhere, there’s surprising variation from one county to the next in terms of how many people die annually from each cause of death. In some places, violent deaths or deaths by suicide are relatively high on the list; in other places, liver disease claims far more victims than in others; in yet other regions, fatal vehicle crashes are far more common than others. The consistent factor is rank order, with cardiovascular disease the most common cause of death in 97 percent of the counties; the variable is how people many actually die of heart disease per 100,000 each year.

In the deep south, for instance, cardiovascular deaths are highest in the nation by a longshot. ³ Howard, Jacqueline. “What’s the most common cause of death in your county?” 26 December 2016. CN. 29 December 2016. http://www.cnn.com/2016/12/13/health/cause-of-death-by-county/Take Franklin Parish, Louisiana, where an average of 545 people per 100,000 die from heart disease each year. Things are much better in nearby Winn Parish, where the cardiovascular death rate is 352 annually. But those rates are still off-the-charts compared to places like Summit County, Colorado, which averages only 79 cardiovascular deaths per year—less than a quarter of the mortality rate in Winn Parish. On the other hand, death by suicide and violence is the fourth leading cause of death in Summit County, and that’s unusual. In Suffolk County, New York, in contrast, it’s number eight.

The good news is that rates of death from heart problems are going down by quite a bit in most places, with an overall 50 percent decline in cardiovascular deaths between 1980 and 2014 nationwide. But in the areas where cardiovascular disease rates are highest—notably the deep South—rates of improvement have lagged. In fact, one trend noticed by the researchers is that disparities are growing between regions. This is probably reflective of the growing economic gap, given that the highest mortality rates overall are, for the most part, concentrated in areas where access to medical care is limited and where a large percentage of the population lives below the poverty line—places along the Mississippi River in the South, in parts of the Great Plains, in Appalachia, and in parts of both North and South Dakota.⁴ Belluz, Julia and Frostenson, Sarah. “These maps show how Americans are dying younger. It’s not just the opioid epidemic.” 13 December 2016. Vox. 30 December 2016. http://www.vox.com/2016/12/13/13926618/mortality-trends-america-causes-death-by-county

While cardiovascular disease appears to be on the decline overall, though, in other categories, the numbers are spiking. For instance, deaths by substance abuse (excluding death caused by cirrhosis) and mental disorders (such as bulimia), were clumped together into one category. In more than 2000 counties, deaths in this category more than tripled during the years of the study, with an overall rise nationwide of 188 percent. Even more shocking, in certain areas of Ohio, Kentucky, and West Virginia, Missouri, Pennsylvania, and Indiana, substance abuse and mental disorder mortality increased tenfold, rising by more than 1000 percent.

The greatest number of substance abuse and mental health deaths, according to this report, were concentrated in eastern Kentucky, southwestern West Virginia, Alaska, and in areas with Native American reservations in North Dakota, South Dakota, and other southwestern states. For instance, McDowell County in West Virginia had an average of 131 substance abuse deaths per 100,000, versus McPherson County in Nebraska, with only 3.5. (McPherson County is also unusual in that cardiovascular disease is the second, rather than first, cause of most deaths.) Interestingly, the Centers for Disease Control also published a large study on drug-related mortality this year. That study excluded the mental health category but also found the highest rates of overdose death in West Virginia, followed by New Hampshire, Kentucky, New Mexico, and Ohio.

Similarly, death by suicide and interpersonal violence were highest in North and South Dakota, as well as in Alaska and parts of the Southwest. While rates of suicide in these regions continued to climb—Alaska saw a 131 percent increase during the study period—suicide rates in New York City plummeted by 72 percent. Could it be that paying the high rents in Manhattan keeps people too busy to think about self-destruction—or perhaps, the ready availability of mental health services that accompany population density make a difference? Nationwide, suicide rates were lowest in the upper Midwest, New England, southwestern Texas and southern California.

The second leading cause of death nationwide, after cardiovascular disease, is cancer, and once again, southern states along the Mississippi have some of the highest rates, as do parts of West Virginia, Kentucky, and Alaska. In Mingo, West Virginia, there are an average of 405 cancer-related deaths per 100,000. Compare that to only 127 deaths in Teton County, Wyoming. The lowest rates were concentrated in western states including Idaho, Wyoming, and Texas. The good news for those of you living in central Colorado, southern Florida, Alaska, parts of New England, and coastal counties in California is that rates in these places are declining sharply.

In third place for mortality is diabetes, a category which the researchers grouped together with urogenital issues, and blood and endocrine diseases. The highest mortality rates in this category were in Louisiana, Arkansas, and Mississippi as well as the Dakotas. A 21 percent increase occurred across nearly all counties nationwide during the years of the study, not surprising given the steady rise in obesity rates and the fact that obesity can lead to diabetes.

Overall, the report shows that urban areas are in better shape than poor rural areas. As one of the research directors, Dr. Christopher Murray of the University of Washington writes, “We know that unequal access and quality of care create health disparities in the US for many causes of death, while other causes are linked to risk factors or policies. The results of this study prompt future research to further identify what drives health disparities in our country.”

Again, you can go to the report for more detail about your own locale and the variations in the nation.