BMJ 2000;321:1532 ( 16 December )

Letters

Income inequality and mortality in Canada and the United States

    Third explanation is plausible
    Low mortality in Canadian cities may be driven by low mortality in immigrants
    Authors' reply

Third explanation is plausible

The first 150 words of the full text of this article appear below.

EDITORRoss et al report that income inequality in the state or province and metropolitan area is associated with mortality in the United States but not in Canada.¹ They offer two explanations for this discrepancy. Firstly, this association is observed only at levels of inequality present in the United States, not the lower levels observed in Canada. Secondly, the actual association of income inequality with mortality is modified by the social and political characteristics specific to a place.

There is, however, another possible explanation: confounding of the association of income inequality with health at the state level (or metropolitan area level) in the United States. This is not the same as confounding at the individual level by, for example, personal income, which varies between states.² State level confounding may occur when characteristics of the states are correlated with income inequality, remain associated with mortality within strata of states by . . . [Full text of this article]

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