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Education, income inequality, and mortality: a multiple regression analysis. Of the small minority of studies which find no association, most can be explained by income inequality being measured at an inappropriate scale, the inclusion of mediating variables as controls, the use of subjective rather than objective measures of health, or follow up periods which are too short. For example, the average annual salary in America in inflation-adjusted 1998 dollars increased from $32,522 in 1970 to $35,864 in 1999, that is, a modest 10 percent increase over three decades. Commentary on “Is exposure to income inequality a public health concern?”. (Letter). It may be noted that proportion Black is a state-level variable, as distinct from the individual-level clustering (within states) of Blacks, even though the two are in some ways related. (22) studied 546,888 subjects, and Subramanian et al. In other words, economic polarization leads to political polarization, as reflected by state variations in the generosity of benefits to the poor (38, 39). Subsequently, introducing the individual demographic variables associated with age, sex, and marital status does not attenuate the state income inequality effect (odds ratio (OR) = 1.51), but additionally accounting for individual race reduces the state income inequality effect (OR = 1.42). Second, studies conducted outside the United States have generally failed to find an association between income inequality and health (31–35). Liang KY, Zeger SL, Qaqish B. Multivariate regression analyses for categorical data. Health status may have a reciprocal relationship with income inequality. Meanwhile, in the marginal model, the β coefficient represents the population change in the individual response probability of poor health across all states for different levels of state income inequality and, as such, averages the effect across all states. We must emphasize that any discussion of inequality and health, in general, cannot be divorced from the fundamental question of “inequality of what?” (9, 75). State-level income inequality and individual mortality risk: a prospective multilevel study. Laird N, Ware JH. More recent studies, not included in those review … The macroeconomic determinants of health. There is a very large literature examining income inequality in relation to health. Including individual educational attainment attenuates the state income inequality effect somewhat (OR = 1.34), but nonetheless it remains statistically significant. 2. Kawachi I, Kennedy BP. Lagged effects of income inequality on individual and population health. (Letter). The standard errors associated with the state income inequality point estimates from the marginal and two-level logistic models, meanwhile, are identical (standard error, 1.08). and Milyo, J. Blakely TA, Kawachi I. Income inequality also causes obesity however; we mostly blame individuals for being obese. Here are some research findings that show how the increasing income inequality in Britain and the US has impacted people’s health, as also written in The Zeitgeist Movement Defined: 1. Other studies suggest that income inequality is particularly detrimental to the health of poor or near-poor individuals (19, 22). From the Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA. Both measures were derived from the 1989–1990 US Census (52, 53). However, given the minor changes in the data sample and model specification in those studies, we calibrated new models. Using typical regression notations, we can specify the individual-level relation between income and health as follows: yi = β*(xi) + ei, (1). for counties and tracts not reported), 279,066 adults nested within 50 US states, Behavioral Risk Factor Surveillance System (1990), Hypertension, smoking, sedentarism, body mass index, National Maternal and Infant Health Survey (1991), National Health Interview Survey–National Death Index-linked study (1987–1995), 309,135 adults aged 25–74 years from US states and metropolitan areas (no. Mellor JM, Milyo J. Reexamining the evidence of an ecological association between income inequality and health. The causal processes may extend to violence and other problems with social gradients. While American society is getting more, and not less, segregated (68) and getting more unequal (39), there is, however, little systematic empirical research that has explored the connections between the two and their influence on health. While marginal models are robust (42) when our interest is only in estimating the “fixed” (average) effect of an exposure (e.g., income inequality), there may be problems of inefficiency (43). * All variance estimates were significant at less than the 0.0001 level. (19) studied 205,245 subjects, Lochner et al. London, United Kingdom: Ashgate Press, 2004. Smeeding TM. Finally, issues related to modeling strategies and subsequent interpretation of the coefficients require careful consideration. INCOME INEQUALITY AND HEALTH: CURRENT DEBATES, INCOME INEQUALITY AND HEALTH: AN AGENDA FOR FUTURE RESEARCH, Receive exclusive offers and updates from Oxford Academic, The Global Burden of Unintentional Injuries and an Agenda for Progress. Other null US studies carried out at levels of aggregation below the level of the state were similarly based on small sample sizes. And as the gap between rich and poor yawns, so does the gap in their health, according to … A British study examining depression among people in their 20s found that it was twice as common in 1970 than it was in 1958. Daly MC, Duncan GJ, Kaplan GA, et al. U.S. income inequality in a cross-national perspective: why are we so different? Wagstaff A, van Doorslaer E. Income inequality and health: what does the literature tell us? Social capital: a guide to its measurement. Multilevel analysis of self-rated health in the U.S. Subramanian SV, Blakely T, Kawachi I. Various long term studies have established that this relationship is largely causal - higher income leads to better health. Earlier ecologic studies, summarized elsewhere (6, 7), suggested an association between income inequality and poor health status. Narrowing the gap will improve the health and wellbeing of populations. Random-effects models for longitudinal data. Correspondence to Dr. S. V. Subramanian, Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA 02115-6096 (e-mail: Search for other works by this author on: Policing practices and HIV Risk Among People Who Inject Drugs – a Systematic Literature Review, The Evolving Overdose Epidemic: Synthetic Opioids And Rising Stimulant-Related Harms, Assessment of Co-Occurring Substance Use During Opiate Treatment Programs in the United States, Prevalence and Correlates of Providing and Receiving Assistance With the Transition to Injection Drug Use, Drug Use Disorders and Violence: Associations With Individual Drug Categories, About the Johns Hopkins Bloomberg School of Public Health, INCOME INEQUALITY AND HEALTH: THEORETICAL CONSIDERATIONS, THE MULTILEVEL NATURE OF THE INCOME INEQUALITY HYPOTHESIS. While these studies may have lacked statistical power, we also hasten to add that the lack of an association between income inequality and health at levels below the US states may be attributable to a true absence of an association (a finding corroborated in studies that were adequately powered, for instance, at the metropolitan area level (16)). Since the most common statistic that is used to measure income inequality is the Gini coefficient, we also outline a brief description of this measure. On the horizontal axis (abscissa), the population (in this case, households) is sorted and ranked according to income, from the lowest decile group to the top decile group. for municipalities not reported), 8,720 adults nested within 207 UK constituencies nested within 22 regions, Two cohort studies in Copenhagen, Denmark (1964–1992, 1976–1994), 25,728 adults from parishes within Copenhagen city (no. Larsen K, Petersen JH, Budtz-Jorgensen E, et al. 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