Article

Income inequality and socioeconomic gradients in mortality.

Division of Epidemiology and Public Health, University of Nottingham Medical School, Nottingham NG7 2UH, UK.
American Journal of Public Health (impact factor: 3.93). 05/2008; 98(4):699-704. DOI:10.2105/AJPH.2007.109637
Source: PubMed

ABSTRACT We investigated whether the processes underlying the association between income inequality and population health are related to those responsible for the socioeconomic gradient in health and whether health disparities are smaller when income differences are narrower.
We used multilevel models in a regression analysis of 10 age- and cause-specific US county mortality rates on county median household incomes and on state income inequality. We assessed whether mortality rates more closely related to county income were also more closely related to state income inequality. We also compared mortality gradients in more- and less-equal states.
Mortality rates more strongly associated with county income were more strongly associated with state income inequality: across all mortality rates, r= -0.81; P=.004. The effect of state income inequality on the socioeconomic gradient in health varied by cause of death, but greater equality usually benefited both wealthier and poorer counties.
Although mortality rates with steep socioeconomic gradients were more sensitive to income distribution than were rates with flatter gradients, narrower income differences benefit people in both wealthy and poor areas and may, paradoxically, do little to reduce health disparities.

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Keywords

county income
 
county median household incomes
 
flatter gradients
 
greater equality
 
health disparities
 
health varied
 
income differences
 
income distribution
 
income inequality
 
less-equal states
 
mortality gradients
 
multilevel models
 
narrower income differences benefit people
 
poor areas
 
poorer counties
 
population health
 
processes
 
socioeconomic gradient
 
state income inequality
 
steep socioeconomic gradients
 

Richard G Wilkinson