title: The associations between US state and local social spending, income inequality, and individual all-cause and cause-specific mortality: The National Longitudinal Mortality Study.
abstract: OBJECTIVE
  To investigate government state and local spending on public goods and income inequality as predictors of the risks of dying.
  
  
  METHODS
  Data on 431,637 adults aged 30-74 and 375,354 adults aged 20-44 in the 48 contiguous US states were used from the National Longitudinal Mortality Study to estimate the impacts of state and local spending and income inequality on individual risks of all-cause and cause-specific mortality for leading causes of death in younger and middle-aged adults and older adults. To reduce bias, models incorporated state fixed effects and instrumental variables.
  
  
  RESULTS
  Each additional $250 per capita per year spent on welfare predicted a 3-percentage point (-0.031, 95% CI: -0.059, -0.0027) lower probability of dying from any cause. Each additional $250 per capita spent on welfare and education predicted 1.6-percentage point (-0.016, 95% CI: -0.031, -0.0011) and 0.8-percentage point (-0.008, 95% CI: -0.0156, -0.00024) lower probabilities of dying from coronary heart disease (CHD), respectively. No associations were found for colon cancer or chronic obstructive pulmonary disease; for diabetes, external injury, and suicide, estimates were inverse but modest in magnitude. A 0.1 higher Gini coefficient (higher income inequality) predicted 1-percentage point (0.010, 95% CI: 0.0026, 0.0180) and 0.2-percentage point (0.002, 95% CI: 0.001, 0.002) higher probabilities of dying from CHD and suicide, respectively.
  
  
  CONCLUSIONS
  Empirical linkages were identified between state-level spending on welfare and education and lower individual risks of dying, particularly from CHD and all causes combined. State-level income inequality predicted higher risks of dying from CHD and suicide.
authors.affiliation: Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, United States; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, United States; EHESP School of Public Health, Sorbonne Paris Cité, Paris Descartes University, Paris, France. Electronic address: dkim@neu.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D003327:Coronary Disease / Q000191:economics / Q000401:mortality; D005260:Female; D006801:Humans; D007182:Income; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012923:Social Class; D012946:Social Welfare / Q000191:economics*; D012959:Socioeconomic Factors; D013219:State Government; D013405:Suicide / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: Income inequality; Social determinants of health; Social spending