abstract: 'This paper examines the association between US county occupational

  structure, services availability, prevalence of risk factors, and

  coronary mortality rates by sex and race, for 1984 1998. The 3137 US

  counties were classified into five occupational structure categories;

  counties with the lowest percentages of the labor force in managerial,

  professional, and technical occupations were classified in category I

  (5-16\%), counties with the highest percentages were in category V

  (32-59\%). Directly age-adjusted coronary heart disease (CHD) mortality

  rates, for aged 35-64 years, (from vital statistics and Census data),

  per-capita services (County Business Patterns), and the prevalence of

  CHD risk factors (Behavioral Risk Factor Surveillance Surveys data) were

  calculated for each occupational structure category. CHD mortality rates

  and the prevalence of risk factors were inversely monotonically

  associated with occupational structure categories for white men and

  women but not among black men and women. Numbers of producer services

  for banking, business credit, overall business services and

  personnel/employment services were 2-12 times greater in category V

  versus I counties. Consumer services such as fruit/vegetable markets,

  fitness facilities, doctor offices and social services were 1.6-3 times

  greater in category V versus I counties. Residential racial segregation

  scores remained high in most areas despite declines during 1980-1990;

  occupational segregation by race and gender were shown indicating

  continued institutional racism. An ecological model for conceptualizing

  communities and health and the overall influence of state and national

  occupational structure is discussed; intervention strategies such as

  decreased wage disparities and `living wage'' standards and development

  is discussed. (C) 2003 Elsevier Ltd. All rights reserved.'
affiliation: 'Armstrong, DL (Corresponding Author), SUNY Albany, Dept Epidemiol, 1
  Univ Pl, Rensselaer, NY 12144 USA.

  SUNY Albany, Dept Epidemiol, Rensselaer, NY 12144 USA.'
author: Armstrong, DL and Strogatz, D and Wang, R
author-email: dla02@health.state.ny.us
author_list:
- family: Armstrong
  given: DL
- family: Strogatz
  given: D
- family: Wang
  given: R
da: '2023-09-28'
doi: 10.1016/j.socscimed.2003.08.030
files: []
issn: 0277-9536
journal: SOCIAL SCIENCE \& MEDICINE
keywords: coronary heart disease; community health; social class; US counties
keywords-plus: 'ISCHEMIC-HEART-DISEASE; INSTITUTIONAL-RACISM; SOCIAL-CLASS;

  MYOCARDIAL-INFARCTION; SELF-EFFICACY; RISK-FACTORS; NEW-YORK; HEALTH;

  DECLINE; WORKPLACE'
language: English
month: JUN
number: '11'
number-of-cited-references: '64'
pages: 2349-2361
papis_id: c7400df4416895439e8af40b51ecae46
ref: Armstrong2004unitedstates
times-cited: '12'
title: United States coronary mortality trends and community services associated with
  occupational structure, among blacks and whites, 1984-1998
type: Article
unique-id: WOS:000220786100022
usage-count-last-180-days: '0'
usage-count-since-2013: '2'
volume: '58'
web-of-science-categories: 'Public, Environmental \& Occupational Health; Social Sciences,

  Biomedical'
year: '2004'