Individual income, income inequality, health, and mortality: what are the relationships?
OBJECTIVE
To examine the pathways between income inequality, self-rated health, and mortality in the United States.


METHODS
The first National Health and Nutrition Examination Survey and Epidemiologic Follow-up Study.


METHODS
This was a longitudinal, multilevel study.


METHODS
Baseline data were collected on county income inequality, individual income, age, sex, self-rated health, level of depressive symptoms, and severity of biomedical morbidity from physical examination. Follow-up data included self-rated health assessed in 1982 through 1984 and mortality through 1987.


RESULTS
After adjustment for age and sex, income inequality had a modest independent effect on the level of depressive symptoms, and on baseline and follow-up self-rated health, but no independent effect on biomedical morbidity or subsequent mortality. Individual income had a larger effect on severity of biomedical morbidity, level of depressive symptoms, baseline and follow-up self-rated health, and mortality.


CONCLUSIONS
Income inequality appears to have a small effect on self-rated health but not mortality; the effect is mediated in part by psychological, but not biomedical pathways. Individual income has a much larger effect on all of the health pathways.
Fiscella
K
K
Primary Care Institute, Highland Hospital, Rochester, NY, USA.
Franks
P
P
D000328:Adult; D000368:Aged; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008875:Middle Aged; D015233:Models, Statistical; D009026:Mortality; D012044:Regression Analysis; D012494:Sampling Studies; D012923:Social Class; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology