Inequality in income and mortality in the United States: analysis of mortality and potential pathways
Inequality in income and mortality in the United States: analysis of mortality and potential pathways
复制标题
DOI：
10.1136/bmj.312.7037.999
复制
发表时间：
1996-04
期刊：
影响因子：
--
通讯作者：
G. Kaplan;E. Pamuk;J. Lynch;R. Cohen;J. Balfour
中科院分区：
文献类型：
--
作者：
G. Kaplan;E. Pamuk;J. Lynch;R. Cohen;J. Balfour
摘要目的：研究美国健康结果与收入分配平等之间的关系。设计图：收入不平等的程度，定义为不太富裕的50%的家庭获得的家庭总收入的百分比，以及1980年和1990年50个州的收入不平等变化。这些措施，然后检查有关的全因死亡率调整年龄为每个国家，年龄特定的死亡，死亡率的变化，以及其他健康结果和潜在的途径，1980年，1990年和1989-91年。主要结局指标：年龄校正的全因死亡率。结果如下：每个州50%的不太富裕的家庭收入占家庭总收入的百分比与全因死亡率之间存在显著相关性（r=0.62，P<0.001），不受州收入中位数调整的影响。收入不平等还与特定年龄的死亡率和低出生体重率、凶杀、暴力犯罪、工作残疾、医疗保健和警察保护支出、吸烟和久坐活动密切相关。随着收入不平等的加剧，失业率、监禁率、收入援助和食品券领取者、缺乏医疗保险和教育成果也更差。收入不平等也与死亡率趋势有关，有人认为不平等趋势对死亡率趋势有影响。结论：各州之间收入分配不平等的差异与各州之间大量健康结果和社会指标的差异以及死亡率趋势密切相关。这些差异与人力资本和社会资本的相对投资相对应。影响收入和财富不平等的经济政策可能对国家的健康产生重要影响。关键信息有显著的相关性（r=0.62）收入不平等占家庭总收入的50%的家庭收入与美国各州死亡率的变化之间的关系收入不平等也与死亡率的变化显著相关，1980年至1999年期间下降幅度较小。在收入不平等程度较高的州，收入不平等与大量其他健康结果以及与人力和社会资本投资有关的措施有关。对人口健康产生有害影响
Abstract Objective: To examine the relation between health outcomes and the equality with which income is distributed in the United States. Design: The degree of income inequality, defined as the percentage of total household income received by the less well off 50% of households, and changes in income inequality were calculated for the 50 states in 1980 and 1990. These measures were then examined in relation to all cause mortality adjusted for age for each state, age specific deaths, changes in mortalities, and other health outcomes and potential pathways for 1980, 1990, and 1989-91. Main outcome measure: Age adjusted mortality from all causes. Results: There was a significant correlation (r=0.62, P<0.001) between the percentage of total household income received by the less well off 50% in each state and all cause mortality, unaffected by adjustment for state median incomes. Income inequality was also significantly associated with age specific mortalities and rates of low birth weight, homicide, violent crime, work disability, expenditures on medical care and police protection, smoking, and sedentary activity. Rates of unemployment, imprisonment, recipients of income assistance and food stamps, lack of medical insurance, and educational outcomes were also worse as income inequality increased. Income inequality was also associated with mortality trends, and there was a suggestion of an impact of inequality trends on mortality trends. Conclusions: Variations between states in the inequality of the distribution of income are significantly associated with variations between states in a large number of health outcomes and social indicators and with mortality trends. These differences parallel relative investments in human and social capital. Economic policies that influence income and wealth inequality may have an important impact on the health of countries. Key messages There was a significant correlation (r=0.62) between the proportion of total household income received by the less well off 50% of households and variation between states in death rates for the United States Income inequality was also significantly related to changes in mortality with smaller declines between 1980-90 in those states with greater income inequality Income inequality was associated with a large number of other health outcomes and with measures related to investments in human and social capital Economic policies that increase income inequality may also have a deleterious effect on population health