People who live in areas with lower household incomes are much more likely to die because of their personal and household characteristics and their community surroundings, according to Steven H. Woolf, M.D., M.P.H., director of the VCU Center on Human Needs, professor in the Department of Family Medicine and lead author of the study.

"It's tempting to assume that our findings are based on how much money people make," Woolf said. "But areas with high household incomes also tend to have better schools, a different racial and social mix and healthier community conditions."

In the study to be published in the April issue of the American Journal of Public Health and available online February 18, Woolf and his colleagues analyzed census data and vital statistics from Virginia counties and cities between 1990 and 2006. They demonstrated that one out of four deaths would have been averted if the mortality rates of Virginia's five most affluent counties and cities had existed statewide. In some of the most disadvantaged areas of the state, nearly half of the deaths would have been averted.

"Virginia is an excellent place to explore the connection between health and median household income. There are communities in Northern Virginia with some of the highest incomes in the nation and there are areas of the state, such as the Appalachian Southwest, Southside, the Middle Peninsula and the Eastern Shore, with high poverty and low high school graduation rates," Woolf said.

Regions of the state with deep poverty, large minority populations and lower educational achievement levels had high mortality rates in comparison with high household incomes.

"These findings are especially timely during the current recession. Policymakers typically think of the economy, jobs and education as separate issues from health care reform, but they're deeply connected," Woolf said. "Social care is health policy, probably saving more lives than anything done in health care."

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