Mortality, Inequality and Race in American Cities and States

A number of studies have found that mortality rates are positively correlated with income inequality across the cities and states of the US. We argue that this correlation is confounded by the effects of racial composition. Across states and MSAs, the fraction of the population that is black is positively correlated with average white incomes, and negatively correlated with average black incomes. Between-group income inequality is therefore higher where the fraction black is higher, as is income inequality in general. Conditional on the fraction black, neither city nor state mortality rates are correlated with income inequality. Mortality rates are higher where the fraction black is higher, not only because of the mechanical effect of higher black mortality rates and lower black incomes, but because white mortality rates are higher in places where the fraction black is higher. This result is present within census regions, and for all age groups and both sexes (except for boys aged 1 9). It is robust to conditioning on income, education, and (in the MSA results) on state fixed effects, and cannot plausibly be attributed to variations in the local provision of health care.