Allegheny County ranks among the worst urban areas in the country in key measures of mortality, according to data assembled by two of the region’s top health experts.
Among the nation’s 43 most populated counties, Allegheny County slipped from having the 31st age-adjusted mortality rate in 1990 to the 39th in 2019.
While mortality overall has improved; Allegheny County is squarely in the lower ranks in a country already boasting the highest mortality rate among developed nations worldwide, according to the analysis of 30 years of data.
The rankings may seem counterintuitive for a region whose modern reputation is staked upon the success of its higher education institutions and medical facilities, which produce research and care that should theoretically be extending lives, said Dr. Donald Burke, a professor of epidemiology and former dean of the University of Pittsburgh’s Graduate School of Public Health.
“We have outstanding healthcare systems. We have outstanding universities. We’re doing OK economically. We’ve got a political leadership class that cares. We’ve got active philanthropy. How is it with all of these assets that our ranking has been decreasing?” Burke said.
The poor rankings reflect stark racial disparities in the county, where mortality rates for Black residents rank even worse than for the population as a whole.
Burke and Dr. Kenneth Thompson, a practicing psychiatrist who serves as the chief medical officer of the Pennsylvania Psychiatric Leadership Council, released data to PublicSource to raise awareness of the disparities in the county’s mortality rates and call on leaders to address the underlying inequalities driving the low rankings.
For every county, they calculated the number of deaths per 100,000 residents each year from 1990 to 2019, adjusting for the age distribution of each county’s population — a measurement known as age-adjusted mortality. A lower ranking reflects a higher rate of mortality.
How does Allegheny County’s mortality progress stack up?
Although age-adjusted mortality fell in Allegheny County from 1990 to 2019, it fell more slowly than it did in most of the nation’s other largest counties. Slide through the years to track the county’s ranking, in red.
The county’s mortality rate has declined since 1990, reflecting improvements in care for health issues like cardiovascular disease, the leading cause of death nationwide. Nationally, that follows improvements in lifestyle habits, like fewer people smoking cigarettes.
Although Allegheny County’s mortality rate has declined over the past three decades, it has fallen at a significantly slower pace than comparable counties nationwide.
“If we were [ranked] 36 and stayed at 36, then I’d say ‘OK, it’s because of our industrial history and our economic status.’ But we’re getting worse, and I’m pretty sure the cause will not be health care,” Burke said.
According to Burke and Thompson, the main factors stifling improvement in the mortality rate are socioeconomic determinants — the conditions people are born into and live in that shape their health, ability to sustain healthy habits and access to health care. These include factors like education, poverty, employment status and the physical environment.
Mortality “is related to their position in society, in terms of what kind of income, what kind of housing, what kind of educational opportunities they have, and that that drives the overall base of their health,” Thompson said.
For example, mortality rates have increased among individuals who have not attained a high school education, despite the general trend of decreasing mortality over the past century, he added.
Because socioeconomic factors play such a large role in determining people’s health, affluent areas have average lifespans “as long as a group as human beings have ever lived,” Thompson said.
“If you go to Sewickley or Fox Chapel, you’ll see lifespans there that we don’t know how to make better. We actually don’t know how to make people live longer than those lives,” Thompson added.
Burke pointed to another factor, which he called the corporate determinants of health. Corporations encourage people to buy products that lead to health issues like obesity and alcoholism, affecting the mortality rate, he said. For example, deaths related to drug use have increased in the past five years as companies profit from drug sales, he added.
“It drives me nuts that, as a public health practitioner trying to do what I can to blunt the mortality from these causes, there’s somebody else on the other side pushing them just as hard as they can,” Burke said.
Allegheny County has the second-worst mortality rating for Black residents among the nation’s largest counties, according to the report. The mortality rate among Black men in Allegheny County is 1.5 times higher than that of white men, while the mortality rate among Black women is 1.3 times higher than white women.
Allegheny County’s mortality is worse for Black residents
The mortality rate among Black men and women has declined in Allegheny County over the past three decades as care options have improved for issues that disproportionately affect the Black population, like HIV/AIDS. However, following the overall trend, the county’s Black mortality rate has decreased at a slower rate than comparable counties nationwide, which Thompson said he believes shows the persistence of systemic racism.
In recent years, health issues that disproportionately impacted the Black population a few decades ago — like drug-related overdoses — have come to affect all Americans, especially white populations living in poverty in rural areas, Burke said. From 2008 to 2021, 82% of overdose victims in Allegheny County were white. Thompson said overdoses are an even greater issue in the rural areas neighboring Allegheny County, like Fayette County.
Accounting for only white residents, Allegheny County ranks 36th among the 43 counties that Burke and Thompson sampled — still in the lower half, but slightly better than the county’s overall ranking. The county’s white population hovered around this ranking throughout the 30 years studied.
“The white population is not nearly as healthy as we think it is because there’s a big group that’s really not doing well at all,” Thompson said.
Burke and Thompson have not analyzed how different causes of death drive the mortality rate because they are concerned their sample is not large enough to yield accurate, representative results.
Although additional research is needed to fully understand the issue, Burke and Thompson hope the mortality trend will be a call to action for the county’s nonprofit, corporate and governmental leadership.
“I don’t think it is acceptable for a place that prides itself on eds and meds to say that we’re average,” Burke said. “I don’t think that our trajectories and our ranking is likely to change without actively doing something.”
Amelia Winger is a PublicSource editorial intern. She can be reached at amelia@publicsource.org.
This story was fact-checked by Linden Markley.
