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Structural Determinants of Rising Premature Mortality in the US: An examination of the role of the economy, race, and rurality Sara Peters*, Sara Peters, Katherine Curtis, Clayton Adamson, Michael Topping, Anton Babkin,

In this study we use a spatial regime framework to address the fundamental question: How do racial and economic forces intersect to generate spatial inequality in premature mortality among US counties? Prior work on mortality disparities shows that groups experiencing cumulative disadvantage often are more likely to die prematurely and that rural areas suffer a higher mortality penalty. However, structural determinants, such as place-based economic pathways, shaped by historical trajectories of development and structural racism, remain underexplored. Using novel measures of local economic trade, we draw on a spatio-racial stratification framework to investigate how racial opportunity gaps and county-level economic retention jointly shape premature mortality. This research contributes to growing empirical efforts to identify how intersecting structural forces reproduce spatial health disparities.