title: Not just smoking and high-tech medicine: socioeconomic inequities in U.S. mortality rates, overall and by race/ethnicity, 1960-2006.
abstract: Recent research on the post-1980 widening of U.S. socioeconomic inequalities in mortality has emphasized the contribution of smoking and high-tech medicine, with some studies treating the growing inequalities as effectively inevitable. No studies, however, have analyzed long-term trends in U.S. mortality rates and inequities unrelated to smoking or due to lack of basic medical care, even as a handful have shown that U.S. socioeconomic inequalities in overall mortality shrank between the mid-1960s and 1980. The authors accordingly analyzed U.S. mortality data for 1960-2006, stratified by county income quintile and race/ethnicity, for mortality unrelated to smoking and preventable by 1960s' standards of medical care. Key findings are that relative and absolute socioeconomic inequalities in U.S. mortality unrelated to smoking and preventable by 1960s' medical care standards shrank between the 1960s and 1980 and then increased and stagnated, with absolute rates on a par with several leading causes of death, and with the burden greatest for U.S. populations of color. None of these findings can be attributed to trends in smoking-related deaths and access to high-tech medicine, and they also demonstrate that socioeconomic inequities in mortality can shrink and need not inevitably rise.
authors.affiliation: Department of Society, Human Development and Health Harvard School of Public Health, Boston, MA 02115, USA. nkrieger@hsph.harvard.edu
authors.forename: Nancy
authors.initials: N
authors.lastname: Krieger
authors.forename: Jarvis T
authors.initials: JT
authors.lastname: Chen
authors.forename: Anna
authors.initials: A
authors.lastname: Kosheleva
authors.forename: Pamela D
authors.initials: PD
authors.lastname: Waterman
mesh_terms: D000328:Adult; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data*; D012907:Smoking / Q000208:ethnology / Q000401:mortality*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology / Q000208:ethnology