BMJ 1999;319:1162-1165 ( 30 October )

Papers

Economic transition and changing relation between income inequality and mortality in Taiwan: regression analysis

Tung-liang Chiang, professor. 

Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei 10018, Taiwan

tlchiang{at}ha.mc.ntu.edu.tw

Objective: To examine the changing relation between income inequality and mortality through different stages of economic development in Taiwan.
Design: Regression analysis of mortality on income inequality for three index years: 1976, 1985, and 1995.
Setting: 21 counties and cities in Taiwan.
Main outcome measures: All age mortality and age specific mortality in children under age 5.
Results: When median household disposable income was controlled for, the association between income inequality and mortality became stronger in 1995 than in 1976. Especially, the association between income inequality and mortality in children aged under 5, with adjustment for differences in median household disposable income, changed from non-significant in 1976 to highly significant in 1995. In 1995, the level of household income after adjustment for income distribution no longer had a bearing on mortality in children under 5.
Conclusion: The health of the population is affected more by relative income than by absolute income after a country has changed from a developing to a developed economy.

Key messages Income distribution may be more important than the level of income in determining population health in developed countries but has not been examined in a country through different stages of economic development Along with economic development, gross national product per capita in Taiwan has increased rapidly from less than US$200 (£72) in 1953 to US$1132 (£627) in 1976 and to US$12 396 (£7853) in 1995 In Taiwan the association between income distribution and mortality was stronger in 1995 than in 1976, contrary to the association between absolute income and mortality, which was stronger in 1976 than in 1995 The effect of income distribution on age specific mortality rate in children under 5 became highly significant whereas the effect of absolute income became non-significant in 1995

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