Measuring health inequality in US: a composite index approach

In this paper, we use the standardized mortality rates for 21 mutual exclusive causes of death to propose a composite index of US county-level health performances in 1980-2014 interval. We aggregate mortality rates by the Stochastic Multi-Criteria Acceptability Analysis (SMAA), in order to avoid any a priori judgement on the importance given to a specific cause of death. The total observed inequality among counties is then decomposed to estimate the variability between and within states by means of the Theil index on SMAA outcomes. On average, there has been a decrease in the Composite Index of mortality from 1980 to 2014, but while the majority of counties had an increase in health conditions, some counties have shown a decrease in health performances in the same interval. This may be the reason of a persistent increase of total inequality among counties, with inequality within states constantly higher than inequality between states, both responsible of the growing inequality levels of health performances in the period analysed.