Observed association between income inequality and mortality is not a statistical artefact

There is considerable debate regarding the importance of income inequality as a cause of higher mortality. About a year ago in the BMJ, Gravelle suggested that any observed relations could be merely statistical artefacts. The analysis by Wolfson and colleagues (p 953), using data from the United States, suggests that this is wrong. It is true that some of the relation between income inequality and mortality for population groups can be ascribed to the fact that at the individual level, lower income predisposes to higher mortality. The significant association among US states between income inequality and mortality, however, cannot be primarily explained as a statistical artefact. This result reinforces the need to consider a broad range of factors, including the social milieu, as fundamental determinants of health.

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Relation between income inequality and mortality: empirical demonstration • Diminishing returns to aggregate level studies • Two pathways, but how much do they diverge?

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BMJ 1999 319: 953-957. [Abstract] [Full Text] [PDF]