Abstract
OBJECTIVE--To examine the relation between health outcomes and the equality with which income is distributed in the United States. DESIGN--The degree of income inequality, defined as the percentage of total household income received by the less well off 50% of households, and changes in income inequality were calculated for the 50 states in 1980 and 1990. These measures were then examined in relation to all cause mortality adjusted for age for each state, age specific deaths, changes in mortalities, and other health outcomes and potential pathways for 1980, 1990, and 1989-91. MAIN OUTCOME MEASURE--Age adjusted mortality from all causes. RESULTS--There was a significant correlation (r = -0.62 [corrected], P < 0.001) between the percentage of total household income received by the less well off 50% in each state and all cause mortality, unaffected by adjustment for state median incomes. Income inequality was also significantly associated with age specific mortalities and rates of low birth weight, homicide, violent crime, work disability, expenditures on medical care and police protection, smoking, and sedentary activity. Rates of unemployment, imprisonment, recipients of income assistance and food stamps, lack of medical insurance, and educational outcomes were also worse as income inequality increased. Income inequality was also associated with mortality trends, and there was a suggestion of an impact of inequality trends on mortality trends. CONCLUSION--Variations between states in the inequality of the distribution of income are significantly associated with variations between states in a large number of health outcomes and social indicators and with mortality trends. These differences parallel relative investments in human and social capital. Economic policies that influence income and wealth inequality may have an important impact on the health of countries.
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Selected References
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- Castleman B. I., Navarro V. International mobility of hazardous products, industries, and wastes. Annu Rev Public Health. 1987;8:1–19. doi: 10.1146/annurev.pu.08.050187.000245. [DOI] [PubMed] [Google Scholar]
- Judge K. Income distribution and life expectancy: a critical appraisal. BMJ. 1995 Nov 11;311(7015):1282–1287. doi: 10.1136/bmj.311.7015.1282. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kaplan G. A. Where do shared pathways lead? Some reflections on a research agenda. Psychosom Med. 1995 May-Jun;57(3):208–212. doi: 10.1097/00006842-199505000-00002. [DOI] [PubMed] [Google Scholar]
- Perry H. M., Jr, Gillespie K. N., Romeis J. C., Smith M. M., Virgo K. S., Carmody S. E., Sambhi M. P. Effects of 'stroke-belt' residence, screening blood pressure and personal history risk factors on all-cause mortality among hypertensive veterans. J Hypertens. 1994 Mar;12(3):315–321. [PubMed] [Google Scholar]
- Schwartz S. The fallacy of the ecological fallacy: the potential misuse of a concept and the consequences. Am J Public Health. 1994 May;84(5):819–824. doi: 10.2105/ajph.84.5.819. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stallones R. A. The rise and fall of ischemic heart disease. Sci Am. 1980 Nov;243(5):53–59. doi: 10.1038/scientificamerican1180-53. [DOI] [PubMed] [Google Scholar]
- Susser M. The logic in ecological: I. The logic of analysis. Am J Public Health. 1994 May;84(5):825–829. doi: 10.2105/ajph.84.5.825. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Syme S. L., Berkman L. F. Social class, susceptibility and sickness. Am J Epidemiol. 1976 Jul;104(1):1–8. doi: 10.1093/oxfordjournals.aje.a112268. [DOI] [PubMed] [Google Scholar]
- 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]