Inequality in income and mortality in the United States: analysis of mortality and potential pathways.
OBJECTIVE
To examine the relation between health outcomes and the equality with which income is distributed in the United States.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Kaplan
G A
GA
Human Population Laboratory, California Department of Health Services, Berkeley 94704, USA.
Pamuk
E R
ER
Lynch
J W
JW
Cohen
R D
RD
Balfour
J L
JL
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005843:Geography; D006305:Health Status Indicators; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D009026:Mortality; D011203:Poverty; D011632:Public Assistance; D012923:Social Class; D012940:Social Problems; D014481:United States / Q000453:epidemiology