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The relationship of income inequality to mortality: Does the choice of indicator matter?


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  • Kawachi, Ichiro
  • Kennedy, Bruce P.
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    Ecologic studies in the U.S. and elsewhere in the world have demonstrated that income inequality is strongly related to mortality and life expectancy: the greater the dispersion of income within a given society, the lower the life expectancy. However, these empirical studies have been criticized on the grounds that the choice of indicator may have influenced positive findings. Using a cross-sectional, ecologic design, we tested the relationships of six different income inequality indicators to total mortality rates in the 50 U.S. states. The following summary measures of income distribution were examined: the Gini coefficient; the decile ratio; the proportions of total income earned by the bottom 50%, 60%, and 70% of households; the Robin Hood Index; the Atkinson Index; and Theil's entropy measure. All were highly correlated with each other (Pearson r >= 0.94), and all were strongly associated with mortality (Pearson r ranging from 0.50 to 0.66), even after adjustment for median income and poverty. Thus, the choice of income distribution measure does not appear to alter the conclusion that income inequality is linked to higher mortality. Furthermore, adjustment for taxes and transfers, as well as household size (using equivalence scales), made no difference to the income inequality/mortality association. From a policy perspective, the alternative income distribution measures perform differently under varying types of income transfers, so that theoretical considerations should guide the selection of an indicator to assess the impact of social and economic policies that address income inequality.

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    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 45 (1997)
    Issue (Month): 7 (October)
    Pages: 1121-1127

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    Handle: RePEc:eee:socmed:v:45:y:1997:i:7:p:1121-1127

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    Keywords: income inequality mortality poverty;


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    Cited by:
    1. Angus Deaton, 2003. "Health, Inequality, and Economic Development," Journal of Economic Literature, American Economic Association, vol. 41(1), pages 113-158, March.
    2. Jennifer M. Mellor & Jeffrey Milyo, 1999. "Re-Examining the Evidence of an Ecological Association between Income Inequality and Health," Discussion Papers Series, Department of Economics, Tufts University 9922, Department of Economics, Tufts University.
    3. Mary C. Daly & Daniel J. Wilson, 2013. "Inequality and mortality: new evidence from U.S. county panel data," Working Paper Series 2013-13, Federal Reserve Bank of San Francisco.
    4. Rostila, Mikael & Kölegård, Maria L. & Fritzell, Johan, 2012. "Income inequality and self-rated health in Stockholm, Sweden: A test of the ‘income inequality hypothesis’ on two levels of aggregation," Social Science & Medicine, Elsevier, vol. 74(7), pages 1091-1098.
    5. Hongbin Li & Yi Zhu, 2004. "Income, Income Inequality, and Health: Evidence from China," Discussion Papers 00006, Chinese University of Hong Kong, Department of Economics.
    6. Peter Lindert, 2003. "Why The Welfare State Looks Like a Free Lunch," Working Papers 27, University of California, Davis, Department of Economics.
    7. Zheng, Hui, 2012. "Do people die from income inequality of a decade ago?," Social Science & Medicine, Elsevier, vol. 75(1), pages 36-45.
    8. Ken Judge & Iain Paterson, 2001. "Poverty, Income Inequality and Health," Treasury Working Paper Series 01/29, New Zealand Treasury.
    9. Aida, Jun & Kondo, Katsunori & Kondo, Naoki & Watt, Richard G. & Sheiham, Aubrey & Tsakos, Georgios, 2011. "Income inequality, social capital and self-rated health and dental status in older Japanese," Social Science & Medicine, Elsevier, vol. 73(10), pages 1561-1568.
    10. Parish, Susan L. & Rose, Roderick A. & Dababnah, Sarah & Yoo, Joan & Cassiman, Shawn A., 2012. "State-level income inequality and family burden of US families raising children with special health care needs," Social Science & Medicine, Elsevier, vol. 74(3), pages 399-407.
    11. Yang, Tse-Chuan & Chen, Vivian Yi-Ju & Shoff, Carla & Matthews, Stephen A., 2012. "Using quantile regression to examine the effects of inequality across the mortality distribution in the U.S. counties," Social Science & Medicine, Elsevier, vol. 74(12), pages 1900-1910.
    12. d'Hombres, Beatrice & Rocco, Lorenzo & Suhrcke, Marc & McKee, Martin, 2006. "Does social capital determine health? Evidence from eight transition countries," MPRA Paper 1862, University Library of Munich, Germany.


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