BMJ 2000;321:1311-1315 ( 25 November )

Papers

State income inequality, household income, and maternal mental and physical health: cross sectional national survey

Robert S Kahn, assistant professor, ^a Paul H Wise, associate professor, ^b Bruce P Kennedy, deputy director, ^c Ichiro Kawachi, associate professor. ^d

^a Division of General and Community Pediatrics, Children's Hospital Medical Center, CH-1, 3333 Burnet Avenue, Cincinnati, OH 45229, USA, ^b Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA 02118, USA, ^c Division of Public Health Practice, Harvard School of Public Health, Boston, MA 02115, ^d Department of Health and Social Behavior, Harvard School of Public Health, Boston

Correspondence to: R Kahn kahnr0{at}chmcc.org

Objective: To examine the association of state income inequality and individual household income with the mental and physical health of women with young children.
Design: Cross sectional study. Individual level data (outcomes, income, and other sociodemographic covariates) from a 1991 follow up survey of a birth cohort established in 1988. State level income inequality calculated from the income distribution of each state from 1990 US census.
Setting: United States, 1991.
Participants: Nationally representative stratified random sample of 8060 women who gave birth in 1988 and were successfully contacted (89%) in 1991.
Main outcome measures: Depressive symptoms (Center for Epidemiologic Studies depression score >15) and self rated health
Results: 19% of women reported depressive symptoms, and 7.5% reported fair or poor health. Compared with women in the highest fifth of distribution of household income, women in the lowest fifth were more likely to report depressive symptoms (33% v 9%, P<0.001) and fair or poor health (15% v 2%, P<0.001). Compared with low income women in states with low income inequality, low income women in states with high income inequality had a higher risk of depressive symptoms (odds ratio 1.6, 95% confidence interval 1.0 to 2.6) and fair or poor health (1.8, 0.9 to 3.5).
Conclusions: High income inequality confers an increased risk of poor mental and physical health, particularly among the poorest women. Both income inequality and household income are important for health in this population.

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Rapid Responses:

Read all Rapid Responses

Error in Table 1

Paul Duberstein
bmj.com, 27 Nov 2000 [Full text]

Re: Error in Table 1

Robert S Kahn
bmj.com, 29 Nov 2000 [Full text]

Relationship between area income inequality and individual health may still be statistical artefact

Matt Sutton
bmj.com, 6 Dec 2000 [Full text]

Re: statistical artefact

Robert Kahn, et al.
bmj.com, 12 Dec 2000 [Full text]