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Adam Karpati, MD, MPH, Sandro Galea, MD, MPH, Tamara Awerbuch, PhD and Richard Levins, PhD

At the time of the study, Adam Karpati and Sandro Galea were with the Department of Population and International Health, Harvard School of Public Health, Boston, Mass. Adam Karpati is also with the Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Ga. Sandro Galea is also with the Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York. Tamara Awerbuch and Richard Levins are with the Department of Population and International Health, Harvard School of Public Health.

Correspondence: Requests for reprints should be sent to Adam Karpati, MD, MPH, Bureau of Community HealthWorks, New York City Department of Health, 40 Worth St, Room 1607, New York, NY 10013 (e-mail: aek3{at}cdc.gov).

Objectives. We examined variability in disease rates to gain understanding of the complex interactions between contextual socioeconomic factors and health.

Methods. We compared mortality rates between New York and California counties in the lowest and highest quartiles of socioeconomic status (SES), assessed rate variability between counties for various outcomes, and examined correlations between outcomes’ sensitivity to SES and their variability.

Results. Outcomes with mortality rates that differed most by county SES were among those whose variability across counties was high (e.g., AIDS, homicide, cirrhosis). Lower-SES counties manifested greater variability among outcome measures.

Conclusions. Differences in health outcome variability reflect differences in SES impact on health. Health variability at the ecological level might reflect the impact of stressors on vulnerable populations. (Am J Public Health. 2002;92:1768–1772)

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