Death rates in the United States have fallen since the 1960s, but improvements have not been shared equally by all groups. This study investigates the change in inequality in mortality by income level from 1967 to 1986. Comparable death rates are constructed for 1967 and 1986 using National Mortality Followback Surveys as numerators and National Health Interview Surveys as denominators. Direct age-adjusted death rates are calculated for income levels for the U.S. noninstitutionalized civilian population 35 to 64 years old. A summary measure of inequality in mortality adjusts for differences in the size and definition of income groups in the two years. In both 1967 and 1986, mortality decreased with each rise in income level. Measured in relative terms, this inverse relationship was greater in 1986 then in 1967 for men and women, blacks and whites. Between 1967 and 1986, death rates for those with maximal income declined between two and three times more rapidly than did rates for the middle and low income groups. The greatest increase in relative inequality was seen among white males.
Get full access to this article
View all access options for this article.
References
1.
SusserM.WatsonW., and HopperK.Sociology in Medicine, Ed. 3. Oxford University Press, New York, 1985.
2.
TownsendP.DavidsonN., and WhiteheadM. (eds). Inequalities in Health: The Black Report and The Health Divide. Penguin Books, London, 1988.
3.
MaCintyreS., The Black Report and beyond: What are the issues?Soc. Sci. Med.44(6): 723–745, 1997.
4.
KunstA. E.GeurtsJ. J., and van den BergJ., International variation in socioeconomic inequalities in self reported health. J. Epidemiol. Community Health49(2): 117–123, 1995.
5.
HoyertD. L.SinghG. K., and RosenbergH., Sources of data on socioeconomic differential mortality in the United States. J. Official Stat. 11(3): 233–260, 1995.
6.
StockwellE. G., Socioeconomic status and mortality in the United States. Public Health Rep. 76(12): 1081–1086, 1961.
7.
LernerM., and StutzR. N., Have we narrowed the gaps between the poor and the nonpoor? Part II. Narrowing the gaps, 1959–1961 to 1969–1971: Mortality. Med. Care.15(8): 620–635, 1977.
8.
YeracarisC. A., and KimJ. H., Socioeconomic differentials in selected causes of death. Am. J. Public Health68(4): 342–351, 1978.
9.
KitagawaE., and HauserP. M.Differential Mortality in the United States: A Study of Socioeconomic Epidemiology. Harvard University Press, Cambridge, Mass.1973.
10.
EloI. T., and PrestonS. H., Educational differentials in mortality: United States, 1979–1985. Soc. Sci. Med.42(1): 47–57, 1996.
11.
FeldmanJ. J., National trends in educational differences in mortality. Am. J. Epidemiol.129(5): 919–933, 1989.
12.
PappasG., The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N. Engl. J. Med.329: 103–109, 1993.
DuleepH. O., Has the US mortality differential by socioeconomic status increased over time? (letter). Am. J. Public Health88(7): 1125, 1998.
15.
National Center for Health Statistics.1996–1968 National Mortality Followback Survey 1966–68. Tape Documentation Package, PS80–117146. National Technical Information Center, U.S. Department of Commerce, Springfield, Va., 1968.
16.
National Center for Health Statistics.National Mortality Followback Survey, 1986. Public Use Data Tape and Documentation. U.S. Public Health Service, Hyattsville, Md., 1988.
17.
MasseyJ. T.Design and estimation for the National Health Interview Survey, 1985–1994. Vital and Health Statistics, Ser. 2, No. 110. National Center for Health Statistics, U.S. Department of Health and Human Services, 1989.
18.
National Center for Health Statistics. Current estimates from the Health Interview Survey: United States—1967. Vital Statistics, Ser. 10, No. 52. Department of Health, Education and Welfare, 1969.
19.
SchalickL. M.Social Class and Mortality: Time Trend Analysis of Social Class Mortality Differences in the United States, 1950 to 1986. Doctoral dissertation, Johns Hopkins University, 1998.
20.
WeinkamJ. J.RosenbaumW. L., and SterlingT. D., Computation of relative risk based on simultaneous surveys: An alternative to cohort and case-control studies. Am. J. Epidemiol.136(6): 102–103, 1992.
21.
WagstaffA.PaciP., and van DoorslaerE., On the measurement of inequalities in health. Soc. Sci. Med.33(5): 545–557, 1991.
22.
MaCkenbachJ. P.StronksK., and KunstA. E., The contribution of medical care to inequalities in health: Differences between socio-economic groups in decline of mortality from conditions amenable to medical intervention. Soc. Sci. Med.29(3): 369–376, 1989.
23.
National Center for Health Statistics. Comparability of age on death certificate and matching census record. Vital and Health Statistics, Ser. 2, No. 29. U.S. Government Printing Office, Washington, D. C., 1968.
24.
National Center for Health Statistics. Comparability of marital status, race, nativity, and country of origin on death certificate and matching census. Vital and Health Statistics, Ser. 2, No. 34. U.S. Government Printing Office, Washington, D.C., 1969.
25.
AdlerN. E., Socioeconomic status and health: The challenge of the gradient. Am. Psychologist.49(1): 15–24, 1994.
26.
PhillipsK.The Politics of Rich and Poor: Wealth and the American Electorate in the Reagan Aftermath. Harper Perennial, New York, 1990.
27.
LevyF.Incomes and income inequality. In State of the Union, edited by FarleyR.. Russell Sage Foundation, New York, 1995.
28.
WilkinsonR. G., The epidemiological transition: From material scarcity to social disadvantage?Daedalus123(4): 61–77, 1994.
29.
WilkinsonR. G., Income distribution and life expectancy. BMJ304: 165–168, 1992.
KennedyB. P.KawachiI., and Prothrow-StithD., Income distribution and mortality: Cross sectional ecological study of the Robin Hood index in the United States. BMJ312: 1004–1007, 1996.
32.
KaplanG. A., Inequality in income and mortality in the United States: Analysis of mortality and potential pathways. BMJ312: 999–1003, 1996.
33.
StamlerJ., The marked decline in coronary heart disease mortality rates in the United States, 1968–1981: Summary of findings and possible explanations. Cardiology72: 11–22, 1986.
34.
National Center for Health Statistics.Health, United States, 1995, Table 64. U.S. Public Health Service, Hyattsville, Md., 1996.
35.
SinghG. K., and YuS. M., Infant mortality in the United States: Trends, differentials, and projections 1950 through 2010. Am. J. Public Health85: 957–964, 1995.
36.
ShoendorfK. C., Mortality among infants of black as compared with white college-educated parents. N. Engl. J. Med.326: 1522–1526, 1992.
