The Shape of Income and Mortality

描述(由申请人提供)：在过去的二十年里，研究社会经济地位(SEP)和各种健康结果之间的关系的出版物数量呈指数增长，研究了社会经济地位(SEP)和各种健康结果之间的关系。例如，根据MEDLINE的搜索，自1990年以来出现了700多篇关于收入和死亡率之间关系的文章，不包括只将收入作为调整变量的分析。对于大多数结果，已经发现了分级的反向关联，SEP越高，这些结果的风险越低。虽然最近的一些注意力已经转向估计反向选择(健康状况不佳导致低收入)对这些观察到的关联的贡献，但还有其他关键问题需要解决，这些问题的答案也将对关于收入对健康的因果影响的论点产生一些影响。我们建议检验收入增加对死亡风险的好处是否主要体现在较低的收入上，如果收入的保护作用随着收入的增加而减少--在这种“梯度”中是否存在重要的非线性，并计算死亡在收入分配的不同部分的相对集中度。此外，我们还将通过考虑税收和转移支付对收入和死亡率之间的关联的不同贡献以及它们对死亡率集中度的影响来补充文献，这是以前没有进行过的分析。利用三项代表美国人口的大型纵向研究，这项拟议的研究将估计所有原因和常见原因造成的收入和死亡风险之间的联系，其中死亡负担最大的是收入分配，并分析税收和转移项目改变这种联系的程度。此外，它还将协调在加拿大、丹麦、芬兰、挪威和瑞典进行相同分析的一批经验丰富的研究人员的努力，以便在更广泛的背景下审查收入和死亡率风险之间的关联的性质，并探索税收和转移政策在收入与死亡率之间的关联中的作用。通过召集在对社会福利政策的承诺方面存在分歧的国家进行相同分析的调查人员，我们希望为关于这种政策的健康益处的讨论提供信息。公共卫生相关性：拟议的探索性研究通过仔细估计收入和死亡率之间这种关系的确切形式，收入相关死亡率的负担落在人口中，以及税收和转移项目是否对人口死亡率产生影响，有助于我们理解死亡率中的社会经济不平等。此外，通过协调其他五个国家(加拿大、丹麦、芬兰、挪威、瑞典)的一组相同的分析，我们希望对更多再分配税收和转移政策对人口死亡负担分布的可能影响有所了解。

DESCRIPTION (provided by applicant): Over the last two decades there has been an exponential increase in the number of publications that have examined the association between socioeconomic position (SEP) and a wide variety of health outcomes examined the association between socioeconomic position (SEP) and a wide variety of health outcomes. For example, according to a MEDLINE search, well over 700 articles on the association between income and mortality have appeared since 1990, not including analyses that only included income as an adjustment variable. For most outcomes, a graded inverse association has been found, with higher SEP associated with lower risk of these outcomes. While some recent attention has turned to estimating the contribution of reverse selection (poor health leading to low income) to these observed associations, there are additional critical issues that are necessary to resolve, the answers to which will also have some bearing upon the argument over the causal effect of income on health. We propose to examine whether or not the benefits of increasing income on risk of death are primarily felt at lower incomes, if the protective effects of income decrease with increasing income- whether there are important non-linearities in this "gradient," and calculate the relative concentration of deaths in different parts of the income distribution. In addition we will add to the literature by considering the differential contribution of taxes and transfers to the association between income and mortality and their impact on the concentration of mortality, analyses not previously done. Using three large longitudinal studies, representative of the US population, the proposed study will estimate the shape of the association between income and risk of death from all causes and common causes, where the greatest burden of mortality falls in the income distribution, and analyze the extent to which tax and transfer programs alter the shape of this association. In addition, it will coordinate efforts of an experienced set of researchers conducting identical analyses in Canada, Denmark, Finland, Norway, and Sweden in order to examine in a broader context the nature of the association between income and mortality risk, and to explore the role of tax and transfer policies in the income-mortality association. By bringing together investigators conducting identical analyses in countries that differ with regard to their commitment to social welfare policies we hope to inform the discussion of the health benefits of such policies. PUBLIC HEALTH RELEVANCE: The proposed exploratory study contributes to our understanding of socioeconomic inequalities in mortality by carefully estimating the exact shape of this relationship between income and mortality, where the burden of income-related mortality falls in the population, and whether or not tax and transfer programs have an impact on mortality in the population. In addition, by coordinating a set of identical analyses in five other countries (Canada, Denmark, Finland, Norway, Sweden) we hope to gain some insight into the possible impact of more redistributive tax and transfer policies on the distribution of the mortality burden in the population.