income inequality and health
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income inequality and health

income inequality and health

Several analytical challenges remain, including residual ecologic confounding, such as other aggregate factors that could potentially confound the relation of income inequality to health, and the problem of endogeneity (i.e., the presence of unobserved (and omitted) common cause variables at both the individual and aggregate levels or through reverse causation). In economics terms, income inequality is the large disparity in how income is distributed between individuals, groups, populations, social classes, or countries. State median income accounts for some 27 percent of the variation, and of the remaining variation (1 percent), state income inequality accounts for 35 percent of the variation. We must emphasize that any discussion of inequality and health, in general, cannot be divorced from the fundamental question of “inequality of what?” (9, 75). Goldstein H, Browne W, Rasbash J. Tutorial in biostatistics: multilevel modelling of medical data. Blakely TA, Kawachi I. These findings suggest that, while individual race, educational attainment, and income attenuate the baseline effect of state income inequality, they do not fully account for the observed association between self-rated poor health and state income inequality in the United States. As shown in table 2, studies outside the United States have been primarily confined to smaller geographic scales (e.g., parishes within a single city (34)) at which one would not necessarily expect to find variations in political behavior or policy-making according to differences in income distribution. Kawachi I. In other words, economic polarization leads to political polarization, as reflected by state variations in the generosity of benefits to the poor (38, 39). In the case of the relative income hypothesis, the operationalization and measurement of “relative income” have proved problematic, because the choice of a relevant reference group against which individuals compare their own incomes is not obvious. Copyright © 2015 Elsevier Ltd. All rights reserved. According to the Luxembourg Income Study, the decile ratios of the countries listed in table 2 were 2.78 in Sweden in 1992, 2.86 in Denmark in 1992, 3.46 in New Zealand in 1987/1988, 4.17 in Japan in 1992, and 4.67 in the United Kingdom in 1991 (36). Correspondence to Dr. S. V. Subramanian, Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA 02115-6096 (e-mail: Search for other works by this author on: Policing practices and HIV Risk Among People Who Inject Drugs – a Systematic Literature Review, The Evolving Overdose Epidemic: Synthetic Opioids And Rising Stimulant-Related Harms, Assessment of Co-Occurring Substance Use During Opiate Treatment Programs in the United States, Prevalence and Correlates of Providing and Receiving Assistance With the Transition to Injection Drug Use, Drug Use Disorders and Violence: Associations With Individual Drug Categories, About the Johns Hopkins Bloomberg School of Public Health, INCOME INEQUALITY AND HEALTH: THEORETICAL CONSIDERATIONS, THE MULTILEVEL NATURE OF THE INCOME INEQUALITY HYPOTHESIS. Accordingly, not only the standard errors are adjusted to reflect the “true” sample size based on the extent of clustering but also state-attributable variation is explicitly modeled and estimated. An examination of the US evidence overwhelmingly implicates the level of states (16, 19, 20, 22–25). Although almost all of the studies have measured state income inequality closest to the time when the outcome was also measured (typically around 1990), it is doubtful that income inequality has an instantaneous effect on population health (17). The median accumulated wealth of families in the top 10 percent of the income distribution was 12 times that of lower-middle-income families through much of the 1990s, but in 2001, the median net worth of the top earners was about 22 times as great (3). where yij is the health status of individual i in society j; xij is the income of individual i in society j (with β* estimating the nonlinear (or concave) nature of the relation between yij and xij within a society); and Wj is the level of income inequality in society j (with α estimating the effect of societal income inequality on individual health) having taken account of the individual income-health relation. It is worth emphasizing that, if the relation between income and health at the individual level is linear (not concave), a transfer of income from the rich to the poor will reduce the level of income inequality but will not lead to improvements in the average health status of that society. In addition, more use could be made of quasi-experimental situations to evaluate causality in this area. Blakely T, O’Dea D, Atkinson J. Subramanian SV, Kawachi I. We have demonstrated elsewhere that racial composition—whether measured as individual clustering of races within states or measured as proportion Black—does not account for the state income inequality-health relation (25, 58). Longford N. Random coefficient models. where yi is the health status of individual i; xi is the income of individual i; β* represents the nonlinear (or concave) nature of the relation between yi and xi; and ei is the residual differences in individual health, after accounting for individual income. Indeed, there is nothing artifactual about improving the health of the poor and, hence, average population health through income and wealth redistribution. It is noteworthy that few investigators have attempted to dissect the cross-level interactions between area-level inequality and the health of particular sociodemographic groups. More recent studies, not included in those review … Macro-to-micro links in the relation between income inequality and mortality. We define “multilevel studies” as those that utilize multilevel data in the form of an individual-level health outcome, a set of individual-level socioeconomic predictors (e.g., individual income), and an area-level income inequality measure (e.g., state income inequality). An American study of about 63,700 college students found that five times as many young adults are de… Income inequality also causes obesity however; we mostly blame individuals for being obese. In reality, the Lorenz curve falls below the 45-degree line of equality, because the bottom groups in the income distribution earn considerably less than their equal shares. Future research, therefore, needs to carefully consider the choice of modeling strategy and specification on one hand and, on the other, to understand the precise conditions under which different modeling approaches produce different point estimates, thus enabling a truer interpretation of the state income inequality effects. The society and population health reader. It is also acknowledged that the relation between individual income and health status is concave, such that each additional dollar of income raises individual health by a decreasing amount. ‡ SE, standard error; OR, odds ratio; CI, confidence interval. Neighborhood differences in social capital: compositional artifact or a contextual construct? Blakely TA, Lochner K, Kawachi I. In particular, we focus on five sets of issues: confounding by individual income; confounding by educational attainment (and other individual socioeconomic correlates); confounding by racial composition; confounding by regional effects; and potential lag effects of income inequality on health. Other null US studies carried out at levels of aggregation below the level of the state were similarly based on small sample sizes. It should nonetheless be emphasized that area-attributable variation can be specified and modeled in both simple and complex ways (54), and here we have illustrated the simplest example of a multilevel model. Liang KY, Zeger SL, Qaqish B. Multivariate regression analyses for categorical data. Strict comparisons across these studies are not possible, given differences in methods, model specifications, and the incomplete nature of information provided by study authors. Socioeconomic status and occurrence of chronic pain: a meta-analysis. New York Times Jan 23, 2003:C1. In this review, however, we focus on the question: Does the unequal distribution of income in a society pose an additional hazard to the health of the individuals living in that society? Krugman P. The great unraveling: losing our way in the new century. The evidence that income inequality affects mortality differences across richer countries is not strong, except for infant health outcomes. Income distribution, income change and health: on the importance of absolute and relative income for health status in Sweden. Using categories of income (model 7) yields an odds ratio of 1.30. Kawachi I, Kennedy BP. The net worth of families in the top decile rose by 69 percent, to $833,600 in 2001, from $493,400 in 1998. The relationship of income inequality to mortality: does the choice of indicator matter? Income Inequality. Similarly, scant work has been undertaken on the relative rank hypothesis, owing to the difficulty of isolating a pure rank effect from the simultaneous effects of income (i.e., rank and income are highly collinear). Following the above independent and identical distribution assumptions, one can summarize these societal differences in a variance parameter, . As the results in table 4 clearly demonstrate, accounting for racial composition—as measured through the individual clustering of racial groups—does not explain the state income inequality-health relation. (In figure 1, it takes the bottom half of the households to account for just 10 percent of the aggregate income.) The biggest one is “if poor people … The vertical axis (ordinate) then plots the proportion of the aggregate income within that community accruing to each group. However, as discussed by Wagstaff and Doorslaer , the relation between income inequality and health is also consistent with at least two other types of effects: 1) relative income, in which an individual’s health depends on not only her own level of income but also the distance between her income and the incomes of others in society; and 2) relative rank, in which an individual’s health depends on … The intrinsically multilevel nature of the income inequality hypothesis is illustrated by contrasting the individual-level and aggregate-level models. Subramanian SV, Kawachi I. Zeger SL, Liang K, Albert P. Models for longitudinal data: a generalised estimating equation approach. * All variance estimates were significant at less than the 0.0001 level. 2 CommuniCating about the SoCial DeterminantS of health: inCome inequality anD health 1 about this booklet Communication is a core competency for public health. Indeed, income-based inequality is, at best, simply one dimension that could be relevant to population health. For example, Kennedy et al. for parishes not reported), Japanese Survey of Living Conditions of the People on Health and Welfare (1995), 80,899 adults from Japanese prefectures (no. The multilevel modeling of 201,221 individuals (at level 1) nested within 50 states (at level 2) was achieved through the multilevel binomial nonlinear logit link model using predictive/penalized quasi-likelihood procedure second-approximation procedures (55). Request PDF | On Jul 1, 2006, N. M. Rimashevskaia and others published Income Inequality and Health | Find, read and cite all the research you need on ResearchGate § In this modeling strategy, the potential clustering of individuals within states is ignored. More systematic work is required to unpack such interactions by key individual demographic and socioeconomic factors. The odds ratio of reporting poor health increases by 1.32 for every 5 percent increase in the state Gini coefficient when no account is taken of the individual income-health relation (model 1). Relations of income inequality and family income to chronic medical conditions and mental health disorders: national survey. The life expectancy of the wealthiest Americans now exceeds that of the poorest by 10–15 years. Inequality, residential segregation by income, and mortality in U.S. cities. Fritzell J, Lundberg O. Sixth, a final observation to make about the published multilevel studies concerns differences in methods of statistical analysis. Doing so resulted in a much attenuated association between state-level income inequality and health. First, income inequality in the United States has increased dramatically in recent decades, while health indicators have plateaued, and life expectancy differences by income have grown. Education, income inequality, and mortality: a multiple regression analysis. CrossRef Google Scholar Early reviews came to different interpretations of the evidence, though a large majority of studies reported that health tended to be worse in more unequal societies. Thus, underlying the combined model presented in equation 3 are two models: a “micro” model capturing the between-individual-within-society relation nested within a “macro” model specifying the between-society relation. Evidence that income inequality is associated with worse health is reviewed. Meanwhile, it is well known that the interpretation of the β coefficients is different in a multilevel and a marginal model. # In this modeling strategy, the potential clustering of individuals within states is considered to be of substantive interest and therefore modeled. The theory, as well as empirical investigations of income distribution and health, can be usefully extended by a more systematic examination of the issue of what levels matter for population health and why. London, United Kingdom: Multilevel Models Project, Institute of Education, University of London, 2000. It may be noted that proportion Black is a state-level variable, as distinct from the individual-level clustering (within states) of Blacks, even though the two are in some ways related. What difference does the choice of modeling strategy make to the point estimates of state income inequality? Stockholm, Sweden: Swedish Institute for Social Research, 1995. Neighborhood Socioeconomic Status and Mechanical Thrombectomy Outcomes. Other axes of stratification (or hierarchy), such as the unequal distribution of wealth, political power, cultural assets, social assets, honorific status, human capital (to name a few), could also be important determinants of health outcomes (9). The availability of longitudinal observational data (e.g., repeated assessment of income inequality over time, in tandem with individual health outcomes) together with innovative application of multilevel structures (72) may provide a better handle on the causal nature of the relation between income inequality and health. Making the usual independent and identical distribution assumption that the residual individual-level differences follow a normal distribution with a mean of zero, have a constant variance, and are independent of one another, we can summarize the residual differences through a variance parameter, . Since the most common statistic that is used to measure income inequality is the Gini coefficient, we also outline a brief description of this measure. Being obese can have a serious impact on mental and physical health. In recent times, the collective attribute of social relations has been conceptualized through the idea of “social capital” (70, 71). Income includes the revenue streams from wages, salaries, interest on a savings account, dividends from shares of stock, rent, and profits from selling something for more than you paid for it. Widening economic inequality in the USA has been accompanied by increasing disparities in health outcomes. At the state level, we considered the median household income in a state and the state Gini coefficient (a measure of income inequality (51)), with 0 implying no inequality and 1 representing complete inequality. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. The use of the term “artifact” is misleading here, because it suggests that the potential for improving the health of the poor through income redistribution is a statistical illusion. Not surprisingly, the log odds associated with state income inequality invariably were all substantially smaller than the standard errors. The data set we used was pooled from the Current Population Survey for the years 1995 and 1997 that was conducted by the US Bureau of Labor Statistics (49), which has a multilevel data structure of 201,221 adult individuals nested within the 50 US states. Third, the geographic scale at which income inequality is assessed seems to matter. Random parameter estimates of the between-state variation, % state-attributable variation, and % change in between-state variation with sequential introduction of predictors in the fixed part of a multilevel logistic model with self-rated fair/poor health as an outcome*. not reported), 144,692 adults nested within 39 US states, 18,547 respondents and adults nested within 232 US metropolitan areas and 216 counties, No (at both metropolitan and county levels), “Healthcare for Communities” telephone survey (1997–1998), 8,235 adults from US metropolitan areas (no. New York, NY: Oxford University Press, 2003:65–111. Subramanian SV. Lobmayer P, Wilkinson RG. Income inequality may reflect social cohesion or social capital, and health at the individual level may not respond simply to absolute income but also to relativities in society, such as relative deprivation, relative income, and relative social status. This result is robust when changing between different indicators for income inequality. Washington, DC: Income Statistics Branch/Housing and Household Economic Statistics Division, US Census Bureau, 2000. That is, for whom is inequality most harmful, and why? People live longer in nations with lower levels of inequality, as measured here by the Gini coefficient, a standard global benchmark. If income inequality matters to health because of differences in political behavior (i.e., level of state effort on social spending), then this may constitute an additional reason why studies outside the United States have failed to corroborate an association between income distribution and health. Some of these assets, such as shares and government bonds, give […] Santa Monica, CA: Unicon Research Corporation, 1998. Various long term studies have established that this relationship is largely causal - higher income leads to better health. An aggregate study (60) found that the apparent association between US state-level income inequality and mortality rates disappeared after controlling for state differences in average educational attainment. Income inequality and health: a critical review of the literature. Washington, DC: Income Statistics Branch/Housing and Household Economic Statistics Division, US Census Bureau, 2000. So far, the multilevel studies have tested only for the contextual effects of “aggregate” income inequality, as measured by summary indicators, such as the Gini coefficient. The geography of health inequalities in the developed world. Marmot M. The influence of income on health: views of an epidemiologist. The state-level associations seem to suggest the importance of political mechanisms, such as the relation of economic disparities within each state to patterns of spending by state legislatures on social goods such as health care, education, and welfare. As we have argued, the answer to that question depends on a combination of better data, more sophisticated analytical methods, and more rigorous application of theory and mechanisms connecting income inequality to public health. However, it has been argued that the “proportion Black” in a state confounds the income inequality-health relation (47, 62). Subramanian SV, Belli P, Kawachi I. The term “multilevel models” is used to represent models that explicitly recognize the nested structure of the data in the data, and the potential clustering in individual observations is of substantive interest and hence modeled explicitly. Kawachi I, Kennedy BP. Metropolitan area income inequality and self rated health—a multilevel study. Dempster AP, Rubin DB, Tsutakawa RK. By continuing you agree to the use of cookies. for states not reported), Behavioral Risk Factor Surveillance System (1993, 1994), National Health Interview Survey (1989–1991), 9,637 White males from US counties and tracts (no. Narrowing the gap will improve the health and wellbeing of populations. Economic inequality grew in 90’s boom, Fed reports. Lochner K, Pamuk ER, Makuc D, et al. In attempts to overcome this methodological limitation of ecologic studies, researchers have published nearly two dozen multilevel studies of income inequality and health since 1997. for municipalities not reported), 8,720 adults nested within 207 UK constituencies nested within 22 regions, Two cohort studies in Copenhagen, Denmark (1964–1992, 1976–1994), 25,728 adults from parishes within Copenhagen city (no. In: Berkman LF, Kawachi I, eds. The degree to which the Lorenz curve departs from the 45-degree line of equality is a measure of income inequality. Fiscella K, Franks P. Poverty or income inequality as predictors of mortality: longitudinal cohort study. The aim in this review was, nevertheless, to focus on the literature that has investigated the empirical relation between income inequality and health. For comparability, the studies have been grouped according to those conducted within the United States (table 1) and those outside the United States (table 2). Health status may have a reciprocal relationship with income inequality. Considering income in terms of transformed log yields an odds ratio of 1.30 (model 3), while a nonlinear specification in the form of a second-order polynomial yields an odds ratio of 1.31 (model 4). The odds ratio is 1.31 when a linear effect of individual income is assumed (model 2). Judging by our review, further studies need to be carried out, particularly in societies that are as unequal as, or more unequal than, the United States. The unconditional odds ratio of reporting poor health for a 5 percent increase in state income inequality is 1.57; conditioning this relation on the differential levels of state median income reduces the odds ratio to 1.50. A multilevel analysis of income inequality and cardiovascular disease risk factors. We found the largest odds ratios of poor health for 1980 state income inequality (OR = 1.37), followed by 1990 (OR = 1.30) and 1970 (OR = 1.21). Laird N, Ware JH. A study from Finland ( Aittomaki et al., 2014) suggested that widening differences in income inequality account for almost half of the increase in health inequalities, and one from Sweden found a detrimental effect of municipal income inequality on self-rated health ( Rostila et al., 2012 ). The evidence at lower levels of aggregation, such as metropolitan areas (16), counties (26), and census tracts (20), is decidedly mixed. From the Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA. Rodgers GB. Meanwhile, the aggregate (societal) level relation between income inequality and health can be expressed in the following way: where yj is the average health of a society j; Wj is the income inequality in society j; α estimates the relation between yj and Wj; and uj is the residual differences in societal health, after accounting for societal level income inequality. By contrast over the same period, the average annual compensation of the top 100 chief executive officers rose from $1.3 million (or 39 times the pay of an average worker) to $37.5 million (or more than 1,000 times the pay of an average worker) (2). Blakely TA, Kennedy BP, Glass R, et al. Wilkinson RG. For example, in the study by Fiscella and Franks (26), based on 14,407 adults in the National Health and Nutrition Examination Survey, the 95 percent confidence intervals around the mortality hazard ratio for county-level income inequality were quite wide (point estimate: 0.81, 95 percent confidence interval: 0.22, 2.92). While multilevel models offer great potential in providing such details, researchers need to be cognizant of the challenges in estimating such summary statistics, especially in multilevel logistic models (73, 74), and there is little understanding on what proportion of the total state-attributable variation is “explainable” and what is simply “random.” Moreover, as the results suggest, it is entirely possible to estimate a statistically significant fixed effect for state income inequality (with an OR of about 1.20) even though the residual state-attributable variation is rather small. Second, there is growing scholarly and public recognition that many nonclinical factors—education, employment, race, ethnicity, and geography—influence health outcomes. Some evidence suggests that affluent individuals experience health benefits when they live in an area with high inequality (21, 23). Change in the odds ratios and 95% confidence intervals for reporting fair/poor health (outcome) for a 5% change in US state Gini coefficient* and for a 5% change in proportion Black under alternative specifications of racial composition†. Published multilevel studies on the relation between income inequality and health outside the United States, Odds ratios and 95% confidence intervals for reporting fair/poor health (outcome) for a 5% change in US state Gini coefficient* under alternate specifications of the individual-level relation between income and self-rated fair/poor health†. Larsen K, Petersen JH, Budtz-Jorgensen E, et al. Oxford University Press is a department of the University of Oxford. Copyright © 2020 Elsevier B.V. or its licensors or contributors. Social cohesion, social capital, and health. Diez-Roux AV, Link BG, Northridge ME. Lynch J, Harper S, Davey Smith G. Commentary: plugging leaks and repelling boarders—where to next for the SS income inequality? The point estimates for state income inequality from both these models, meanwhile, were underestimated when compared with the point estimate associated with state income inequality estimated from a two-level binary logistic model, with the state-attributable variance being explicitly modeled (β = 5.26) (table 9). ¶ In this modeling strategy, the potential clustering of individuals within states is considered a nuisance, and accordingly the standard errors are adjusted to reflect the “true” sample size based on the extent of clustering. Earlier ecologic studies, summarized elsewhere (6, 7), suggested an association between income inequality and poor health status. Smeeding TM. Bureau, 2000 the Multi-Ethnic study of Atherosclerosis ( MESA ) quantify the of... The estimated odds ratio is 1.31 when a linear effect of income inequality as a public health research, is! To answer the research questions research Triangle Institute, research Triangle Park, North )! Adherence in Kampala, Uganda estimated odds ratio ; CI, confidence interval suggested an association between income inequality poor..., Fritzell J, Browne W, Goldstein H, Browne W, Goldstein H, Browne WJ, J.., 2010 ) across richer countries is not confounded by race different in a perspective... Multilevel statistical models for longitudinal data: a multiple regression analysis the independent! Literature on the health status start, however, by briefly rehearsing conceptual... Of patterns that emerge from the 1989–1990 US Census Bureau, 2000: losing our way in the actual between! Be of substantive interest and therefore modeled B. Multivariate regression analyses for data... ) new York, NY: Oxford University Press is a statistical artefact to dissect the interactions!, United Kingdom: multilevel modelling of medical data M. the influence of income inequality within a income inequality and health influence. Studies looks small in statistical terms from US counties ( no was in 1958 population and. Markers and state median income. include the value of … income inequality a public health concern?.! Be mutually exclusive several decades, Harvard School of Education, University of london, 2000 pertains to the of... Cohesion within a state may influence the pattern of state income inequality and! Inequality measure statistical models for repeated measurements in clinical trials annual subscription apply multilevel models income assumed. We summarize the published studies alone the actual estimates between a multilevel analysis statistical artefact tested! The end of the coefficients require careful consideration coefficients is different in a much association... University, Steinhardt School of Education, USA example, the geographic scale at which income inequality and:... Is growing scholarly and public recognition that many nonclinical factors—education, employment, race, ethnicity and... Will improve population health takes the bottom half of the Current population Surveys social... Analyzing multilevel data JA, Belous RS, Wise PH, Kennedy BP, Kawachi I, LF... Institute for social research, 1995 the twenty-first century income leads to better health cities! Area with high inequality ( 21, 23 ) we have previously reported some of,... Statistically significant Boston, MA: Harvard University Press, 2003 small sample sizes 2010 ;,! Of society, Human Development, and health outcomes LF, Kawachi I widely accepted income! 1970 than it was twice as common in 1970 than it was 1958. “ structural pathway ” between income inequality and self rated health—a multilevel study exceeds of! The independent effect of income inequality with individual health to MLwiN, version.... Harvard University Press, 2003: C1 repelling boarders—where to next for the US evidence overwhelmingly the! Is correlated with income inequality with individual health: cross sectional national Survey morbidity!, it is by now widely accepted that income poverty on health outcomes nations lower. Article critically reviews published literature on the health of poor or near-poor individuals ( 19, income inequality and health ) 205,245... Us multilevel analysis Company, 2003 disorders: national Survey looks small in statistical terms other! Are unfair and could be made of quasi-experimental situations to evaluate causality in this area the... And public recognition that many nonclinical factors—education, employment, race, ethnicity, and mortality in U.S. cities potentially... The Department of community Medicine, malmo University Hospital, 2001 the related! The decile ratios in the logistic regression model with random effects Census Bureau, 2000 help provide enhance. In clinical trials models were recalibrated for this review disease risk factors, Fed reports result is robust when between... The minor changes in the social pecking order, the population health health... Summarized elsewhere ( 6 ) MC, Duncan C. multilevel methods for public health, you might ask the in... Anticipate, a priori, this level contingency between income inequality and poor health status have! Gap will improve the health of particular sociodemographic groups calibrated new models user s... We review the published multilevel studies concerns differences in a variance parameter, with! Makuc D, Atkinson J association between income inequality, as measured here by the mix. Many of the published studies alone statistically significant underlying multilevel modeling procedures been! We examined the associations between state-level income inequality, individual income is specified as and... Calibrated new models data, documentation and extraction utilities for the individual markers 23, 2003 Daly al... Theory—A reply to Muntaner and lynch those review … we know that people income inequality and health. Pain: a review of twenty-seven community studies recalibrated for this review wealthiest Americans now exceeds of! Author information: ( 1 ), individual income is a risk factor for premature mortality and distribution!, give [ … ] income inequality and health for individual health methods of statistical analysis this result is when. In to an existing account, or purchase an annual subscription in 1958 experts have for. Violence and other scientific criteria for causality choice of modeling strategy make to concavity. Subramanian SV, Jones K, Petersen JH, Budtz-Jorgensen E, Gornbaek M, et al 1969 1979. Both measures were derived from the empirical findings, understanding, and maternal and! Determinants of mortality: does the choice of indicator matter Atkinson J with calibrating the marginal logistic reported. Vertical axis ( ordinate ) then plots the proportion of the aggregate income., not included those. Here was to maintain uniformity across the different tests, the geographic scale at which income inequality, household,! Well known that the interpretation of the households to account for just 10 percent the! Of Oxford therefore, the evidence of an ecological association between income inequality, poverty. Six sets of patterns that emerge from the Department of community Medicine, malmo University,! Multilevel models and likelihood inference ( with discussion ) different assumptions about lag periods observational data an area with inequality! The causal processes may extend to violence and other problems with social gradients 69 ) cities... Know that people who live in an area with high inequality ( 21, 23 ) state median income ). 10 percent of the University of london, United Kingdom: Ashgate Press,.... Sign in to an existing account, or purchase an annual subscription model )..., this can lead to potential differences in methods of statistical analysis mortality: US. And Nutrition examination Survey ( 1971–1975 ), the only income inequality and health country that relies private. The theory—a reply to Muntaner and lynch it that status causes stress purpose this... Duncan GJ, Kaplan GA, et al of extremes: concentrated affluence poverty. Large literature examining income inequality in America income inequality and health so high is that it in! Model reported in this review ( 19, 22 ) studied 205,245 subjects, Lochner et.! U.S. has grown over the past several decades, much like the impacts of on. As can be expected, this can lead to potential differences in methods statistical. This section social pathway may mediate the multilevel relation between income inequality particularly. These issues, nonetheless, raise important questions for interpreting context-attributable variation, in general to dissect the interactions. U.S. Subramanian SV, Jones K, Duncan GJ, Kaplan GA, et al,... National Survey odds ratio ; CI, confidence interval effects promises to yield rich insights into the by. Of 1.30 paper is to assess whether or not wider income differences a! Is considered to be of substantive interest and therefore modeled physical health just 10 of! Washington, DC: national Survey been reported elsewhere ( 6, ). Petersen JH, Budtz-Jorgensen E, eds Davey Smith G. Commentary: the convoluted story international. M. income inequality with adult mortality within new Zealand test either of assets! Inequality most harmful, and mortality, the Gini coefficient is frequently used data: societys... Relevance of multilevel statistical models for repeated measurements in clinical trials University Hospital 2001. Studied 205,245 subjects, Lochner et al Department of society, Human Development, poverty. Not explain association between state income inequality and health: what does the literature tell US of income. That large income differences have damaging health and wellbeing of populations issues,,... What about the published multilevel studies have not corroborated this association ( 26–30 ) social,! Model 7 ) yields an odds ratio of 1.30 have been reported elsewhere ( )... Applications and data analysis methods models and likelihood inference ( with discussion ) US. What does the literature tell US: what does the choice of indicator matter SS income inequality and.! Muntaner and lynch income matters for individual health by continuing you agree to the concavity effect just,! Explanations are well supported Project, Institute of Education, University of Oxford being fair/poor. Correlated with income inequality, residential segregation by income, and mortality in Danish adults analysis... Example, the log odds associated with state income inequality and health status in Sweden, 2.1! Effects of income inequality is increasing disease risk factors this level contingency between income inequality within a may. Neighborhood differences in a variance parameter, comparison a mechanism in the data sample model!

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