The Association Between Income and Life Expectancy in the United States, 2001-2014.
The Association Between Income and Life Expectancy in the United States, 2001-2014.
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DOI：
10.1001/jama.2016.4226
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发表时间：
2016-04-26
期刊：
影响因子：
--
通讯作者：
Cutler D
中科院分区：
文献类型：
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作者：
Chetty R;Stepner M;Abraham S;Lin S;Scuderi B;Turner N;Bergeron A;Cutler D
收入与死亡率之间的关系已经确立，但人们对这一关系的了解仍然很少。测量收入和预期寿命之间的关联的水平，时间趋势和地理变异性，并确定与这种关联的小区域变化相关的因素。美国人口的收入数据来自1999年至2014年期间的14亿个去识别税务记录。死亡率数据来自社会保障管理局的死亡记录。这些数据被用来估计种族和民族调整后的预期寿命在40岁的家庭收入百分位数，性别和地理区域，并评估与预期寿命的差异相关的因素。收入与预期寿命的关系;按收入组别分列的预期寿命趋势;按收入组别分列的预期寿命水平和趋势的地理差异;与各地区预期寿命差异有关的因素。样本包括1408287218人年的观察结果（分析个体的平均年龄为53.0岁;工作个体的家庭收入中位数为61175美元/年[平均值为97725美元/年]）。在40至76岁的人口中，男性死亡人数为4 114 380人（死亡率为每10万人596.3人），女性死亡人数为2 694 808人（死亡率为每10万人375.1人）。分析得出了四个结果。首先，在整个收入分配中，收入越高，寿命越长。最富有的1%和最贫穷的1%之间的预期寿命差距差距，男性为14.6岁（95% CI，14.4至14.8岁），女性为10.1岁（95% CI，9.9至10.3岁）。第二，预期寿命的不平等随着时间的推移而加剧。2001年至2014年，收入分配最高5%的男性预期寿命增加了2.34岁，女性增加了2.91岁，但收入分配最低5%的男性预期寿命仅增加了0.32岁，女性预期寿命仅增加了0.04岁（两性差异P <0.001）。第三，各地区的预期寿命差异很大。对于收入最低的四分之一的个人，预期寿命最高和最低地区之间的差异约为4.5年。2001年至2014年期间，各地区的预期寿命从增加4年多到减少2年多不等。第四，最低收入四分位数人群预期寿命的地理差异与吸烟等健康行为显著相关（r =-0.69，P <0.001），但与医疗服务的获得、物理环境因素、收入不平等或劳动力市场条件没有显著相关性。低收入人群的预期寿命与当地移民比例（r = 0.72，P <0.001）、大学毕业生比例（r = 0.42，P <0.001）和地方政府支出（r = 0.57，P <0.001）呈正相关。在美国，2001年至2014年期间，较高的收入与较长的寿命相关，不同收入群体的预期寿命差异增加。然而，预期寿命与收入之间的关联在不同地区有很大差异;不同收入群体之间的寿命差异在一些地区缩小，在另一些地区扩大。预期寿命的差异与健康行为和当地特征有关。
The relationship between income and mortality is well established but remains poorly understood. To measure the level, temporal trend, and geographic variability in the association between income and life expectancy, and identify factors related to small area variation in this association. Income data for the US population were obtained from 1.4 billion de-identified tax records between 1999 and 2014. Mortality data were obtained from Social Security Administration death records. These data were used to estimate race- and ethnicity-adjusted life expectancy at 40 years of age by household income percentile, sex, and geographic area, and to evaluate factors associated with differences in life expectancy. Relationship between income and life expectancy; trends in life expectancy by income group; geographic variation in life expectancy levels and trends by income group; and factors associated with differences in life expectancy across areas. The sample consisted of 1 408 287 218 person-year observations (mean age at which individuals were analyzed, 53.0 years; median household earnings among working individuals, $61 175 per year [mean, $97 725 per year]). Among those aged 40 to 76 years, there were 4 114 380 deaths among men (mortality rate, 596.3 per 100 000) and 2 694 808 deaths among women (mortality rate, 375.1 per 100 000). The analysis yielded four results. First, higher income was associated with greater longevity throughout the income distribution. The gap in life expectancy between the richest 1% and poorest 1% of individuals was 14.6 years (95% CI, 14.4 to 14.8 years) for men and 10.1 years (95% CI, 9.9 to 10.3 years) for women. Second, inequality in life expectancy increased over time. Between 2001 and 2014, life expectancy increased by 2.34 years for men and 2.91 years for women in the top 5% of the income distribution, but increased by only 0.32 years for men and 0.04 years for women in the bottom 5% (P < .001 for the difference for both sexes). Third, life expectancy varied substantially across local areas. For individuals in the bottom income quartile, life expectancy differed by approximately 4.5 years between areas with the highest and lowest longevity. Changes in life expectancy between 2001 and 2014 ranged from gains of more than 4 years to losses of more than 2 years across areas. Fourth, geographic differences in life expectancy for individuals in the lowest income quartile were significantly correlated with health behaviors such as smoking (r = −0.69, P < .001), but were not significantly correlated with access to medical care, physical environmental factors, income inequality, or labor market conditions. Life expectancy for low income individuals was positively correlated with the local area fraction of immigrants (r = 0.72, P < .001), fraction of college graduates (r = 0.42, P < .001), and local government expenditures (r = 0.57, P < .001). In the United States between 2001 and 2014, higher income was associated with greater longevity, and differences in life expectancy across income groups increased. However, the association between life expectancy and income varied substantially across areas; differences in longevity across income groups decreased in some areas and increased in others. The differences in life expectancy were correlated with health behaviors and local area characteristics.