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American Journal of Public Health logoLink to American Journal of Public Health
. 1998 Jul;88(7):1074–1080. doi: 10.2105/ajph.88.7.1074

Income inequality and mortality in metropolitan areas of the United States.

J W Lynch 1, G A Kaplan 1, E R Pamuk 1, R D Cohen 1, K E Heck 1, J L Balfour 1, I H Yen 1
PMCID: PMC1508263  PMID: 9663157

Abstract

OBJECTIVES: This study examined associations between income inequality and mortality in 282 US metropolitan areas. METHODS: Income inequality measures were calculated from the 1990 US Census. Mortality was calculated from National Center for Health Statistics data and modeled with weighted linear regressions of the log age-adjusted rate. RESULTS: Excess mortality between metropolitan areas with high and low income inequality ranged from 64.7 to 95.8 deaths per 100,000 depending on the inequality measure. In age-specific analyses, income inequality was most evident for infant mortality and for mortality between ages 15 and 64. CONCLUSIONS: Higher income inequality is associated with increased mortality at all per capita income levels. Areas with high income inequality and low average income had excess mortality of 139.8 deaths per 100,000 compared with areas with low inequality and high income. The magnitude of this mortality difference is comparable to the combined loss of life from lung cancer, diabetes, motor vehicle crashes, human immunodeficiency virus (HIV) infection, suicide, and homicide in 1995. Given the mortality burden associated with income inequality, public and private sector initiatives to reduce economic inequalities should be a high priority.

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Selected References

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  1. Anderson R., Dearwater S. R., Olsen T., Aaron D. J., Kriska A. M., LaPorte R. E. The role of socioeconomic status and injury morbidity risk in adolescents. Arch Pediatr Adolesc Med. 1994 Mar;148(3):245–249. doi: 10.1001/archpedi.1994.02170030015003. [DOI] [PubMed] [Google Scholar]
  2. Fiscella K., Franks P. Poverty or income inequality as predictor of mortality: longitudinal cohort study. BMJ. 1997 Jun 14;314(7096):1724–1727. doi: 10.1136/bmj.314.7096.1724. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Iceland J. Urban labor markets and individual transitions out of poverty. Demography. 1997 Aug;34(3):429–441. [PubMed] [Google Scholar]
  4. Kaplan G. A., Keil J. E. Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation. 1993 Oct;88(4 Pt 1):1973–1998. doi: 10.1161/01.cir.88.4.1973. [DOI] [PubMed] [Google Scholar]
  5. Kaplan G. A., Lynch J. W. Whither studies on the socioeconomic foundations of population health? Am J Public Health. 1997 Sep;87(9):1409–1411. doi: 10.2105/ajph.87.9.1409. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Kaplan G. A., Pamuk E. R., Lynch J. W., Cohen R. D., Balfour J. L. Inequality in income and mortality in the United States: analysis of mortality and potential pathways. BMJ. 1996 Apr 20;312(7037):999–1003. doi: 10.1136/bmj.312.7037.999. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Kawachi I., Kennedy B. P., Lochner K., Prothrow-Stith D. Social capital, income inequality, and mortality. Am J Public Health. 1997 Sep;87(9):1491–1498. doi: 10.2105/ajph.87.9.1491. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Kawachi I., Kennedy B. P. The relationship of income inequality to mortality: does the choice of indicator matter? Soc Sci Med. 1997 Oct;45(7):1121–1127. doi: 10.1016/s0277-9536(97)00044-0. [DOI] [PubMed] [Google Scholar]
  9. Kennedy B. P., Kawachi I., Prothrow-Stith D. Income distribution and mortality: cross sectional ecological study of the Robin Hood index in the United States. BMJ. 1996 Apr 20;312(7037):1004–1007. doi: 10.1136/bmj.312.7037.1004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Lynch J. W., Kaplan G. A., Cohen R. D., Tuomilehto J., Salonen J. T. Do cardiovascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction? Am J Epidemiol. 1996 Nov 15;144(10):934–942. doi: 10.1093/oxfordjournals.aje.a008863. [DOI] [PubMed] [Google Scholar]
  11. Lynch J. W., Kaplan G. A., Shema S. J. Cumulative impact of sustained economic hardship on physical, cognitive, psychological, and social functioning. N Engl J Med. 1997 Dec 25;337(26):1889–1895. doi: 10.1056/NEJM199712253372606. [DOI] [PubMed] [Google Scholar]
  12. Mackenbach J. P., Kunst A. E., Cavelaars A. E., Groenhof F., Geurts J. J. Socioeconomic inequalities in morbidity and mortality in western Europe. The EU Working Group on Socioeconomic Inequalities in Health. Lancet. 1997 Jun 7;349(9066):1655–1659. doi: 10.1016/s0140-6736(96)07226-1. [DOI] [PubMed] [Google Scholar]
  13. McCord C., Freeman H. P. Excess mortality in Harlem. N Engl J Med. 1990 Jan 18;322(3):173–177. doi: 10.1056/NEJM199001183220306. [DOI] [PubMed] [Google Scholar]
  14. Sen A. The economics of life and death. Sci Am. 1993 May;268(5):40–47. doi: 10.1038/scientificamerican0593-40. [DOI] [PubMed] [Google Scholar]
  15. Smith G. D., Neaton J. D., Wentworth D., Stamler R., Stamler J. Socioeconomic differentials in mortality risk among men screened for the Multiple Risk Factor Intervention Trial: I. White men. Am J Public Health. 1996 Apr;86(4):486–496. doi: 10.2105/ajph.86.4.486. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Sorlie P. D., Backlund E., Keller J. B. US mortality by economic, demographic, and social characteristics: the National Longitudinal Mortality Study. Am J Public Health. 1995 Jul;85(7):949–956. doi: 10.2105/ajph.85.7.949. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Vågerö D., Erikson R. Socioeconomic inequalities in morbidity and mortality in western Europe. Lancet. 1997 Aug 16;350(9076):516–518. doi: 10.1016/S0140-6736(97)26033-2. [DOI] [PubMed] [Google Scholar]
  18. Wilkinson R. G. Income distribution and life expectancy. BMJ. 1992 Jan 18;304(6820):165–168. doi: 10.1136/bmj.304.6820.165. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Williams J. M., Currie C. E., Wright P., Elton R. A., Beattie T. F. Socioeconomic status and adolescent injuries. Soc Sci Med. 1997 Jun;44(12):1881–1891. doi: 10.1016/s0277-9536(96)00297-3. [DOI] [PubMed] [Google Scholar]
  20. van Doorslaer E., Wagstaff A., Bleichrodt H., Calonge S., Gerdtham U. G., Gerfin M., Geurts J., Gross L., Häkkinen U., Leu R. E. Income-related inequalities in health: some international comparisons. J Health Econ. 1997 Feb;16(1):93–112. doi: 10.1016/s0167-6296(96)00532-2. [DOI] [PubMed] [Google Scholar]

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