Education, income inequality, and mortality: a multiple regression analysis

doi:10.1136/bmj.324.7328.23

BMJ 2002;324:23 ( 5 January )

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Education, income inequality, and mortality: a multiple regression analysis

Andreas Muller, professor.

Department of Health Services Administration, University of Arkansas at Little Rock, 207 Ross Hall, 2801 South University Ave, Little Rock, AR 72204, USA

axmuller{at}ualr.edu

Objective: To test whether the relation between incomeinequality and mortality found in US states is because of differentlevels of formaleducation.
Design: Cross sectional, multiple regressionanalysis.
Setting: All US states and the District of Columbia(n=51).
Data sources: US census statistics and vital statisticsfor the years 1989 and1990.
Main outcome measure: Multiple regression analysis with age adjustedmortality from all causes as the dependent variable and 3 independentvariables $---$ the Gini coefficient, per capita income, and percentageof people aged $>=$ 18 years without a high schooldiploma.
Results: The income inequality effect disappeared whenpercentage of people without a high school diploma was added tothe regression models. The fit of the regression significantlyimproved when education was added to themodel.
Conclusions: Lack of high school education accounts forthe income inequality effect and is a powerful predictor of mortalityvariation among USstates.

What is already known on this topic
Aggregate studies have shown a positive relation between income inequality and mortality and three possible explanations have been suggested (relative deprivation, absolute deprivation, and aggregation artefact)

Income inequality may reflect the effects of other socioeconomic variables that are also related to mortality

What this study adds
Multiple regression analysis of the 50 US states and District of Columbia for 1989-90 indicates that the relation between income inequality and age adjusted mortality is due to differences in high school educational attainment: education absorbs the income inequality effect and is a more powerful predictor of variation in mortality among US states

Lack of high school education seems to affect mortality by economic resource deprivation, risk of occupational injury, and learnt risk behaviour. It may also measure the lifetime, cumulative effect of adverse socioeconomic conditions

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Rapid Responses:

Read all Rapid Responses

Is education inequality important?: Neil R Parker
bmj.com, 4 Jan 2002 [Full text]
Another Possible Explanation of Dr. Muller's Findings: James M. Howard
bmj.com, 15 Jan 2002 [Full text]
Dr. Muller�s response to electronic comments: Andreas Muller
bmj.com, 17 Feb 2002 [Full text]
INDIVIDUAL-LEVEL EDUCATION DOES NOT EXPLAIN THE ASSOCIATION OF STATE-LEVEL INCOME INEQUALITY WITH HE: Tony A Blakely, et al.
bmj.com, 13 Mar 2002 [Full text]
WHY IS EDUCATION LESS IMPORTANT AT THE INDIVIDUAL LEVEL OF ANALYSIS THAN AT THE STATE LEVEL?: Andreas Muller
bmj.com, 7 Apr 2002 [Full text]