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Using quantile regression to examine the effects of inequality across the mortality distribution in the U.S. counties

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  • Yang, Tse-Chuan
  • Chen, Vivian Yi-Ju
  • Shoff, Carla
  • Matthews, Stephen A.
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    Abstract

    The U.S. has experienced a resurgence of income inequality in the past decades. The evidence regarding the mortality implications of this phenomenon has been mixed. This study employs a rarely used method in mortality research, quantile regression (QR), to provide insight into the ongoing debate of whether income inequality is a determinant of mortality and to investigate the varying relationship between inequality and mortality throughout the mortality distribution. Analyzing a U.S. dataset where the five-year (1998–2002) average mortality rates were combined with other county-level covariates, we found that the association between inequality and mortality was not constant throughout the mortality distribution and the impact of inequality on mortality steadily increased until the 80th percentile. When accounting for all potential confounders, inequality was significantly and positively related to mortality; however, this inequality–mortality relationship did not hold across the mortality distribution. A series of Wald tests confirmed this varying inequality–mortality relationship, especially between the lower and upper tails. The large variation in the estimated coefficients of the Gini index suggested that inequality had the greatest influence on those counties with a mortality rate of roughly 9.95 deaths per 1000 population (80th percentile) compared to any other counties. Furthermore, our results suggest that the traditional analytic methods that focus on mean or median value of the dependent variable can be, at most, applied to a narrow 20 percent of observations. This study demonstrates the value of QR. Our findings provide some insight as to why the existing evidence for the inequality–mortality relationship is mixed and suggest that analytical issues may play a role in clarifying whether inequality is a robust determinant of population health.

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    Bibliographic Info

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

    Volume (Year): 74 (2012)
    Issue (Month): 12 ()
    Pages: 1900-1910

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    Handle: RePEc:eee:socmed:v:74:y:2012:i:12:p:1900-1910

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    Keywords: Quantile regression; Income inequality; Mortality; County; USA;

    References

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    1. Edward L. Glaeser & David Laibson & Bruce Sacerdote, 2000. "The Economic Approach to Social Capital," NBER Working Papers 7728, National Bureau of Economic Research, Inc.
    2. Ronald Cossman & Jeralynn Cossman & Arthur Cosby & Rebel Reavis, 2008. "Reconsidering the Rural–Urban Continuum in Rural Health Research: A Test of Stable Relationships Using Mortality as a Health Measure," Population Research and Policy Review, Springer, Springer, vol. 27(4), pages 459-476, August.
    3. Angus Deaton, 2002. "Health, inequality, and economic development," Working Papers 209, Princeton University, Woodrow Wilson School of Public and International Affairs, Research Program in Development Studies..
    4. Wilkinson, Richard G & Pickett, Kate E., 2006. "Income inequality and population health: A review and explanation of the evidence," Social Science & Medicine, Elsevier, Elsevier, vol. 62(7), pages 1768-1784, April.
    5. Laporte, Audrey, 2002. "A note on the use of a single inequality index in testing the effect of income distribution on mortality," Social Science & Medicine, Elsevier, Elsevier, vol. 55(9), pages 1561-1570, November.
    6. Kawachi, Ichiro & Kennedy, Bruce P., 1997. "The relationship of income inequality to mortality: Does the choice of indicator matter?," Social Science & Medicine, Elsevier, Elsevier, vol. 45(7), pages 1121-1127, October.
    7. Jennifer Mellor & Jeffrey Milyo, 1998. "Income Inequality and Health Status in the United States: Evidence From the Current Population Survey," Discussion Papers Series, Department of Economics, Tufts University, Department of Economics, Tufts University 9815, Department of Economics, Tufts University.
    8. Rupasingha, Anil & Goetz, Stephan J. & Freshwater, David, 2006. "The production of social capital in US counties," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, Elsevier, vol. 35(1), pages 83-101, February.
    9. Koenker, Roger W & Bassett, Gilbert, Jr, 1978. "Regression Quantiles," Econometrica, Econometric Society, Econometric Society, vol. 46(1), pages 33-50, January.
    10. Angus Deaton & Darren Lubotsky, 2002. "Mortality, inequality and race in American cities and states," Working Papers 204, Princeton University, Woodrow Wilson School of Public and International Affairs, Research Program in Development Studies..
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    Cited by:
    1. Owen O'Donnell & Eddy Van Doorslaer & Tom Van Ourti, 2013. "Health and Inequality," Tinbergen Institute Discussion Papers 13-170/V, Tinbergen Institute.

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