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Mortality Inequality: The Good News from a County-Level Approach

Listed author(s):
  • Janet Currie
  • Hannes Schwandt

In this essay, we ask whether the distributions of life expectancy and mortality have become generally more unequal, as many seem to believe, and we report some good news. Focusing on groups of counties ranked by their poverty rates, we show that gains in life expectancy at birth have actually been relatively equally distributed between rich and poor areas. Analysts who have concluded that inequality in life expectancy is increasing have generally focused on life expectancy at age 40 to 50. This observation suggests that it is important to examine trends in mortality for younger and older ages separately. Turning to an analysis of age-specific mortality rates, we show that among adults age 50 and over, mortality has declined more quickly in richer areas than in poorer ones, resulting in increased inequality in mortality. This finding is consistent with previous research on the subject. However, among children, mortality has been falling more quickly in poorer areas with the result that inequality in mortality has fallen substantially over time. We also show that there have been stunning declines in mortality rates for African Americans between 1990 and 2010, especially for black men. Finally we offer some hypotheses about causes for the results we see, including a discussion of differential smoking patterns by age and socioeconomic status.

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Article provided by American Economic Association in its journal Journal of Economic Perspectives.

Volume (Year): 30 (2016)
Issue (Month): 2 (Spring)
Pages: 29-52

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Handle: RePEc:aea:jecper:v:30:y:2016:i:2:p:29-52
Note: DOI: 10.1257/jep.30.2.29
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References listed on IDEAS
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  1. James P. Smith, 2007. "The Impact of Socioeconomic Status on Health over the Life-Course," Journal of Human Resources, University of Wisconsin Press, vol. 42(4).
  2. Goldring, Thomas & Lange, Fabian & Richards-Shubik, Seth, 2016. "Testing for changes in the SES-mortality gradient when the distribution of education changes too," Journal of Health Economics, Elsevier, vol. 46(C), pages 120-130.
  3. Angus Deaton, 2003. "Health, Inequality, and Economic Development," Journal of Economic Literature, American Economic Association, vol. 41(1), pages 113-158, March.
  4. Angus S. Deaton & Christina Paxson, 2001. "Mortality, Education, Income, and Inequality among American Cohorts," NBER Chapters,in: Themes in the Economics of Aging, pages 129-170 National Bureau of Economic Research, Inc.
  5. repec:pri:rpdevs:case_and_paxson_whitehall_jan_2011 is not listed on IDEAS
  6. Anne Case & Angua Deaton, 2015. "Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century," Working Papers 15078.full.pdf, Princeton University, Woodrow Wilson School of Public and International Affairs, Research Program in Development Studies..
  7. Janet Currie & Maya Rossin‐Slater, 2015. "Early‐Life Origins of Life‐Cycle Well‐Being: Research and Policy Implications," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 34(1), pages 208-242, 01.
  8. Elo, Irma T. & Preston, Samuel H., 1996. "Educational differentials in mortality: United States, 1979-1985," Social Science & Medicine, Elsevier, vol. 42(1), pages 47-57, January.
  9. Almond, Douglas & Currie, Janet, 2011. "Human Capital Development before Age Five," Handbook of Labor Economics, Elsevier.
  10. Anne Case & Christina Paxson, 2011. "The Long Reach of Childhood Health and Circumstance: Evidence from the Whitehall II Study," Economic Journal, Royal Economic Society, vol. 121(554), pages 183-204, 08.
  11. repec:pri:cheawb:case_and_paxson_whitehall_jan_2011 is not listed on IDEAS
  12. Cutler, David M. & Lange, Fabian & Meara, Ellen & Richards-Shubik, Seth & Ruhm, Christopher J., 2011. "Rising educational gradients in mortality: The role of behavioral risk factors," Journal of Health Economics, Elsevier, vol. 30(6), pages 1174-1187.
  13. Jens Ludwig & Douglas L. Miller, 2007. "Does Head Start Improve Children's Life Chances? Evidence from a Regression Discontinuity Design," The Quarterly Journal of Economics, Oxford University Press, vol. 122(1), pages 159-208.
  14. Jennifer M. Mellor & Jeffrey Milyo, 2002. "Income Inequality and Health Status in the United States: Evidence from the Current Population Survey," Journal of Human Resources, University of Wisconsin Press, vol. 37(3), pages 510-539.
  15. repec:pri:cheawb:case_and_paxson_whitehall_jan_2011.pdf is not listed on IDEAS
  16. David W. Brown & Amanda E. Kowalski & Ithai Z. Lurie, 2015. "Medicaid as an Investment in Children: What is the Long-Term Impact on Tax Receipts?," NBER Working Papers 20835, National Bureau of Economic Research, Inc.
  17. Damien de Walque, 2010. "Education, Information and Smoking Decisions: Evidence from Smoking Histories in the United States, 1940–2000," Journal of Human Resources, University of Wisconsin Press, vol. 45(3).
  18. Janet Currie & Mark Stabile, 2003. "Socioeconomic Status and Child Health: Why Is the Relationship Stronger for Older Children?," American Economic Review, American Economic Association, vol. 93(5), pages 1813-1823, December.
  19. Dora L. Costa & Matthew E. Kahn, 2015. "Declining Mortality Inequality within Cities during the Health Transition," American Economic Review, American Economic Association, vol. 105(5), pages 564-569, May.
  20. John Bound & Arline Geronimus & Javier Rodriguez & Timothy Waidmann, 2014. "The Implications of Differential Trends in Mortality for Social Security Policy," Working Papers wp314, University of Michigan, Michigan Retirement Research Center.
  21. James P. Smith, 1999. "Healthy Bodies and Thick Wallets: The Dual Relation between Health and Economic Status," Journal of Economic Perspectives, American Economic Association, vol. 13(2), pages 145-166, Spring.
  22. Andrew Fenelon & Samuel Preston, 2012. "Estimating Smoking-Attributable Mortality in the United States," Demography, Springer;Population Association of America (PAA), vol. 49(3), pages 797-818, August.
  23. Currie, Janet & Decker, Sandra & Lin, Wanchuan, 2008. "Has public health insurance for older children reduced disparities in access to care and health outcomes?," Journal of Health Economics, Elsevier, vol. 27(6), pages 1567-1581, December.
  24. Barry P. Bosworth & Kathleen Burke, 2014. "Differential Mortality and Retirement Benefits in the Health and Retirement Study," Working Papers, Center for Retirement Research at Boston College wp2014-4, Center for Retirement Research.
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