title: Income inequality, life expectancy and cause-specific mortality in 43 European countries, 1987-2008: a fixed effects study.
abstract: Whether income inequality is related to population health is still open to debate. We aimed to critically assess the relationship between income inequality and mortality in 43 European countries using comparable data between 1987 and 2008, controlling for time-invariant and time-variant country-level confounding factors. Annual data on income inequality, expressed as Gini index based on net household income, were extracted from the Standardizing the World Income Inequality Database. Data on life expectancy at birth and age-standardized mortality by cause of death were obtained from the Human Lifetable Database and the World Health Organization European Health for All Database. Data on infant mortality were obtained from the United Nations World Population Prospects Database. The relationships between income inequality and mortality indicators were studied using country fixed effects models, adjusted for time trends and country characteristics. Significant associations between income inequality and many mortality indicators were found in pooled cross-sectional regressions, indicating higher mortality in countries with larger income inequalities. Once the country fixed effects were added, all associations between income inequality and mortality indicators became insignificant, except for mortality from external causes and homicide among men, and cancers among women. The significant results for homicide and cancers disappeared after further adjustment for indicators of democracy, education, transition to national independence, armed conflicts, and economic freedom. Cross-sectional associations between income inequality and mortality seem to reflect the confounding effects of other country characteristics. In a European context, national levels of income inequality do not have an independent effect on mortality.
authors.affiliation: Department of Public Health, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. y.hu@erasmusmc.nl.
authors.forename: Yannan
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Public Health, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: van Lenthe
authors.affiliation: Department of Public Health, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004812:Epidemiologic Methods; D005060:Europe / Q000453:epidemiology; D005260:Female; D006304:Health Status; D054624:Health Status Disparities; D006708:Homicide / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000401:mortality; D012923:Social Class; D055815:Young Adult
keywords: Causes of death; Europe; Fixed effects models; Income inequality; Life expectancy; Mortality