Area Differences in Utilization of Medical Care and Mortality Among U.S. Elderly

This paper examines 313 U.S. areas for differences in medical care utilization and mortality of whites ages 65-84 in 1990. The variables included in the analysis are education, real income, cigarette sales, obesity, air pollution, percent black, and dummy variables for seven regions and five population size categories from MSAs over 500,000 to not in MSA. Utilization, especially inpatient care, is strongly positively related to mortality. Mortality is positively related to cigarette sales, obesity, air pollution and percent black. Utilization (especially outpatient) is significantly higher in MSAs with populations greater than 500,000. Mortality does not vary with population size, with or without controls. Florida is an outlier for both utilization (very high) and mortality (by far the lowest of any region). The puzzles of Floridian exceptionalism and the positive relation between white mortality and percent black are discussed but not resolved.