How do counties’ industrial structures shape geographic disparities in cardiovascular disease mortality?

Industrial structures refer to the employment opportunities provided by different industries. When employment is concentrated in a single industry, that industry can capitalize power, reshaping political economic logic and, by extension, social life. In this study, we theorize industrial structure as a political determinant of health and investigate the causal pathways linking these configurations to mortalities from cardiovascular disease (CVD). Using county-level data and counterfactual-based causal mediation analysis, we find that CVD mortality rates are significantly higher in counties with heavy dependencies on production and extraction industries, such as manufacturing and mining. While the specific mediating mechanisms vary by industry, we find that an uneven distribution and transformed impact of economic opportunities helps to explain these county-to-county inequalities in premature death. Altogether, these findings suggest industrial structures are an important structural determinant of health and illuminate the causal pathways linking these structures to health outcomes.