Income distribution and mortality: cross sectional ecological study of the Robin Hood index in the United States.
OBJECTIVE
To determine the effect of income inequality as measured by the Robin Hood index and the Gini coefficient on all cause and cause specific mortality in the United States.


METHODS
Cross sectional ecological study.


METHODS
Households in the United States.


METHODS
Disease specific mortality, income, household size, poverty, and smoking rates for each state.


RESULTS
The Robin Hood index was positively correlated with total mortality adjusted for age (r = 0.54; P < 0.05). This association remained after adjustment for poverty (P < 0.007), where each percentage increase in the index was associated with' an increase in the total mortality of 21.68 deaths per 100,000. Effects of the index were also found for infant mortality (P = 0.013); coronary heart disease (P = 0.004); malignant neoplasms (P = 0.023); and homicide (P < 0.001). Strong associations were also found between the index and causes of death amenable to medical intervention. The Gini coefficient showed very little correlation with any of the causes of death.


CONCLUSIONS
Variations between states in the inequality of income were associated with increased mortality from several causes. The size of the gap between the wealthy and less well off--as distinct from the absolute standard of living enjoyed by the poor--seems to matter in its own right. The findings suggest that policies that deal with the growing inequities in income distribution may have an important impact on the health of the population.
Kennedy
B P
BP
Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA.
Kawachi
I
I
Prothrow-Stith
D
D
D000328:Adult; D000368:Aged; D002423:Cause of Death; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D006305:Health Status Indicators; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008875:Middle Aged; D009026:Mortality; D011203:Poverty / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012907:Smoking; D014481:United States / Q000453:epidemiology