Original Article

Sex Differences in the Association between Local Government Spending and Mortality: Evidence from Tennessee

Authors: Courtnee Melton-Fant, PhD, Scott Howard, MD, MSc, Xueyuan Cao, PhD


Objectives: A growing body of research has demonstrated the effect of local government spending on health outcomes; however, the effect of spending on different demographic groups is unclear. We combined national and local data to examine the impact of public spending on mortality rates in Tennessee.

Methods: Within-between random effects models to examine the relation between county-level spending and mortality rates.

Results: We found a significant association between per capita library and kindergarten through grade 12 education spending and mortality outcomes. We also found sex differences in the effects of per capita public health spending and highway spending.

Conclusions: This study provides further evidence that local government spending plays a role in addressing and improving population health and suggests that public spending can have differential effects within a population.

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