Estimating the Effect of County Spending on Life Expectancy Through Structural Equation Modeling

Neha Anand , Johns Hopkins University School of Medicine
Carolina Cardona, Johns Hopkins Bloomberg School of Public Health
Natalia Alfonso, Johns Hopkins Bloomberg School of Public Health
J. P. Leider, Johns Hopkins Bloomberg School of Public Health
Mac MacCullough, Johns Hopkins Bloomberg School of Public Health
Beth Resnick, Johns Hopkins Bloomberg School of Public Health
David Bishai, Johns Hopkins Bloomberg School of Public Health

Several studies have identified the impact of public health and social service sector spending on health outcomes in the US. The following study analyzes county spending across multiple sectors to understand how county spending in 2002 and 2007 impacts county life expectancy at birth (LEB) in 2005 and 2010, respectively. Annual spending data came from the Census of Governments. Through structural equation modeling, we classified counties’ spending into categories of “social,” “infrastructure,” or “law and order” indices to streamline analysis and interpretation. Constraining the effect of the “infrastructure” spending index to 1, a “social” spending index significantly increased LEB and a “law and order” spending index significantly decreased LEB in both the 2002-05 and 2007-10 models. Results were consistent for rural counties, specifically for the 2002-05 model, but not for urban counties. These findings may inform how county governments could redirect spending allocations to benefit the health of their constituents.

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 Presented in Session 216. Health Effects of Social Welfare Policies