Not Just Smoking and High-Tech Medicine: Socioeconomic Inequities in U.S. Mortality Rates, Overall and by Race/Ethnicity, 1960-2006 (original) (raw)
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International Journal of Epidemiology, 2002
In the US, as well as in many other industrialized countries, geographical variations in health and mortality have long been associated with socio-economic conditions or characteristics of areas. Using linked census and vital statistics data from metropolitan Chicago for the 1930-1960 time period and for the US in 1960, Kitagawa and Hauser showed that census tracts or metropolitan areas with higher levels of social and economic disadvantage had substantially higher mortality rates than less disadvantaged areas. 1 A recent ecological study of census tracts for the city of Chicago utilizing the 1990 census data and 1989-1991 death records showed substantial positive effects of area socio-economic disadvantage on infant and working-age mortality. 2 A recent large scale prospective study of residents in 18 US cities showed a substantial gradient in all-cause mortality rates for white and black men by median family income of Background This study examined the extent to which areal socio-economic gradients in allcause and cardiovascular disease (CVD) mortality among US men and women aged 25-64 years increased between 1969 and 1998.
The Widening Gap in Death Rates among Income Groups in the United States from 1967 to 1986
International Journal of Health Services, 2000
Death rates in the United States have fallen since the 1960s, but improvements have not been shared equally by all groups. This study investigates the change in inequality in mortality by income level from 1967 to 1986. Comparable death rates are constructed for 1967 and 1986 using National Mortality Followback Surveys as numerators and National Health Interview Surveys as denominators. Direct age-adjusted death rates are calculated for income levels for the U.S. noninstitutionalized civilian population 35 to 64 years old. A summary measure of inequality in mortality adjusts for differences in the size and definition of income groups in the two years. In both 1967 and 1986, mortality decreased with each rise in income level. Measured in relative terms, this inverse relationship was greater in 1986 then in 1967 for men and women, blacks and whites. Between 1967 and 1986, death rates for those with maximal income declined between two and three times more rapidly than did rates for the...
SocioEconomic Status and Life Expectancy in the United States, 1970“1990
2009
The relationship between socio-economic status (SES) and life expectancy for 1970 and 1990 is examined in eight states randomly selected from each of eight of the nine census divisions in the United States. High SES populations in seven of the eight states gained additional life expectancy over low SES populations between 1970 and 1990. In the remaining state, the gap between high and low SES populations found in 1970 narrowed by 1990, but did not disappear. The findings have implications for the study of social inequality and its relationship to health outcomes. They also suggest that the United States is unlikely to meet one of two key national health policy goals, the elimination of health disparities by 2010.
Widening of Socioeconomic Inequalities in U.S. Death Rates, 1993–2001
PLoS ONE, 2008
Background: Socioeconomic inequalities in death rates from all causes combined widened from 1960 until 1990 in the U.S., largely because cardiovascular death rates decreased more slowly in lower than in higher socioeconomic groups. However, no studies have examined trends in inequalities using recent US national data. Methodology/Principal Findings: We calculated annual age-standardized death rates from 1993-2001 for 25-64 year old non-Hispanic whites and blacks by level of education for all causes and for the seven most common causes of death using death certificate information from 43 states and Washington, D.C. Regression analysis was used to estimate annual percent change. The inequalities in all cause death rates between Americans with less than high school education and college graduates increased rapidly from 1993 to 2001 due to both significant decreases in mortality from all causes, heart disease, cancer, stroke, and other conditions in the most educated and lack of change or increases among the least educated. For white women, the all cause death rate increased significantly by 3.2 percent per year in the least educated and by 0.7 percent per year in high school graduates. The rate ratio (RR) comparing the least versus most educated increased from 2.9 (95% CI, 2.8-3.1) in 1993 to 4.4 (4.1-4.6) in 2001 among white men, from 2.1 (1.8-2.5) to 3.4 (2.9-3-9) in black men, and from 2.6 (2.4-2.7) to 3.8 (3.6-4.0) in white women. Conclusion: Socioeconomic inequalities in mortality are increasing rapidly due to continued progress by educated white and black men and white women, and stable or worsening trends among the least educated.
The Relationship Between Primary Care, Income Inequality, and Mortality in US States, 1980-1995
The Journal of the American Board of Family Medicine, 2003
This study tests the robustness of the relationships between primary care, income inequality, and population health by (1) assessing the relationship during 4 time periods-1980, 1985, 1990 and 1995; (2) examining the independent effect of components of the primary care physician supply; (3) using 2 different measures of income inequality (Robin Hood index and Gini coefficient); and (4) testing the robustness of the association by using 5-year time-lagged independent variables. Data Sources/Study Setting: Data are derived from the Compressed Mortality Files, the US Department of Commerce and the Census Bureau, the National Center for Health Statistics, the Centers for Disease Control and Prevention, and the American Medical Association Physician Master File. The unit of analysis was the 50 US states over a 15-year period. Study Design: Ecological, cross-sectional design for 4 selected years (1980, 1985, 1990, 1995), and incorporating 5-year time-lagged independent variables. The main outcome measure is agestandardized, all-cause mortality per 100,000 population in all 50 US states in all 4 time periods. Data Collection/Extraction Methods: The study used secondary data from publicly available data sets. The CDC WONDER/PC software was used to obtain mortality data and directly standardize them for age to the 1980 US population. Data used to calculate the income inequality measure came from the US census population and housing summary tapes for the years 1980 to 1995. Counts of the number of households that fell into each income interval along with the total aggregate income and the median household income were obtained for each state. The Gini coefficient for each state was calculated using software developed for this purpose. Results: In weighted multivariate regressions, both contemporaneous and time-lagged income inequality measures (Gini coefficient, Robin Hood Index) were significantly associated with all-cause mortality (P < .05 for both measures for all time periods). Contemporaneous and time-lagged primary care physician-to-population ratios were significantly associated with lower all-cause mortality (P < .05 for all 4 time periods), whereas specialty care measures were associated with higher mortality (P < .05 for all time periods, except 1990, where P < .1). Among primary care subspecialties, only family medicine was consistently associated with lower mortality (P < .01 for all time periods). Conclusions: Enhancing primary care, particularly family medicine, even in states with high levels of income inequality, could lead to lower all-cause mortality in those states. (J Am Board Fam Pract 2003; 16:412-22.) During the past decade, there has been an ongoing debate over the role of income inequality as a determinant of population health. 1-4 The debate continues , with evidence both supporting and refuting what has become known as the "relative income hypothesis"-the proposition that the greater the gap in income between the rich and poor in a given area, the worse the health status for the population of that area. Although international and crosscountry studies of the relative income hypothesis have resulted in conflicting conclusions, 5,6 there is considerable evidence that, at least within the United States, income inequality is associated with poorer population health. 7-9 There also has been increasing evidence of a link between primary care and improved health status.
This study updates earlier findings regarding changes in the relationship between socio-economic status (SES) and life expectancy (at birth) between 1970 and 1990. In a sample randomly drawn from each of eight of the nine census divisions of the United States, the earlier study found that High SES populations in seven of the eight states gained additional life expectancy over Low SES populations between 1970 and 1990. In the remaining state, the gap between High and Low SES populations found in 1970 narrowed by 1990, but did not disappear. Thus, High SES populations had higher average life expectancy than Low SES populations both in 1970 and in 1990. In the process of conducting this research, it became apparent that the life expectancy gains observed between 1970 and 1990 for both low and High SES populations did not continue from 1990 to 2010. This finding was neither wholly unexpected nor an active focus of the research. However, because the finding fits within the debate on the limits to human longevity, it seemed worthwhile to report it. Thus, the current study offers two major findings. First, the average life expectancy gap between high and Low SES populations found in 1990 has persisted to 2010; second, average life expectancy gains are far less for the Low SES population between 1990 and 2010 than was found for 1970 to 1990; and third, average life expectancy gains for the High SES populations effectively came to a halt between 1990 and 2010. These results have implications for the relationship between social inequality and health outcomes. They also confirm that the United States did not meet one of two key national health policy goals: the elimination of health disparities by 2010.
Income dynamics and adult mortality in the United States, 1972 through 1989
American Journal of Public Health, 1997
Widening socioeconomic differentials in mortality in recent decades in several European countries raise a third concern about population health.2 22 It it- ;-appears that not all social groups are benefiting from overall declining death rates, although three recent studies using US data have produced equivocal results.2325 To the extent that population health is related to the level of inequality within a particular society,26'27 increasing income disparities in the United States28'29 may forecast worsening health for the nation.
Demographic Research, 2004
We examined the concordance of income inequality trends with 30-year US regional trends in cause-specific mortality and 100-year trends in heart disease and infant mortality. The evidence suggests that any effects of income inequality on population health trends cannot be reduced to simple processes that operate across all contexts and in all time periods. If income inequality does indeed drive