Education does not explain association between income inequality and health

doi:10.1136/bmj.324.7349.1336/a

BMJ 2002;324:1336 ( 1 June )

Letters

Education does not explain association between income inequality and health

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

EDITOR $---$ Muller has shown in an ecological study that lack of high school education accounts for the association of income inequalitywith mortality at state level in the United States.¹ The implicitinference is that education at the level of the individual isresponsible for the association with inequality ofincome.

But ecological studies are weak study designs to assess the independent associations of ecological (income inequality) andindividual level (education) variables with an individual leveloutcome (health status). In particular, aggregate data are proneto problems of collinearity, rendering it difficult to tease apartindependent effects. Multilevel study designs overcome this limitationby including data at both individual and ecological levels. ² ³

We have previously reported results for the association of income inequality at state level with self rated health using datafrom the current population survey data. ⁴ ⁵ We have not previouslyreported the effect of controlling for education . . . [Full text of this article]

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