BACKGROUND Recent studies of US adult mortality demonstrate a growing disadvantage among southern states. Few studies have examined long-term trends and geographic patterns in US early life (ages 1 to 24) mortality, ages at which key risk factors and causes of death are quite different than among adults. OBJECTIVE This article examines trends and variations in early life mortality rates across US states and census divisions. We assess whether those variations have changed over a 50-year time period and which causes of death contribute to contemporary geographic disparities. METHODS We calculate all-cause and cause-specific death rates using death certificate data from the Multiple Cause of Death files, combining public-use files from 1965–2004 and restricted data with state geographic identifiers from 2005–2014. State population (denominator) data come from US decennial censuses or intercensal estimates. RESULTS Results demonstrate a persistent mortality disadvantage for young people (ages 1 to 24) living in southern states over the last 50 years, particularly those located in the East South Central and West South Central divisions. Motor vehicle accidents and homicide by firearm account for most of the contemporary southern disadvantage in US early life mortality. CONTRIBUTION Our results illustrate that US children and youth living in the southern United States have long suffered from higher levels of mortality than children and youth living in other parts of the country. Our findings also suggest the contemporary southern disadvantage in US early life mortality could potentially be reduced with state-level policies designed to prevent deaths involving motor vehicles and firearms.

中文翻译：

---

1965-2014年，南部地区在美国的早期生命死亡率中持续处于不利地位。

背景技术对美国成年人死亡率的最新研究表明，南部各州之间的劣势日益严重。很少有研究检查美国早期生命（1至24岁）死亡率，关键危险因素和死亡原因的年龄与成年人完全不同的长期趋势和地理模式。目的本文研究了美国各州和人口普查部门的早期生命死亡率的趋势和变化。我们评估了这些变化是否在50年的时间内发生了变化，以及哪些死亡原因导致了当代地理上的差异。方法我们使用多重死亡原因文件中的死亡证明数据，结合1965-2004年的公共用途文件和具有2005-2014年的州地理标识符的受限数据，计算所有原因和特定原因的死亡率。州人口（分母）数据来自美国十年一次的人口普查或两次调查之间的估算。结果结果表明，过去50年来，居住在南部各州的年轻人（1至24岁）的死亡率一直处于不利地位，特别是位于东南部中部和西南部中部的年轻人。机动车辆事故和枪支凶杀是造成美国南部地区早期生命死亡的大部分现代不利因素。贡献我们的结果表明，与居住在美国其他地区的儿童和青年相比，生活在美国南部的美国儿童和青年长期遭受较高的死亡率。