Intended for healthcare professionals

Papers

Income distribution and mortality: cross sectional ecological study of the Robin Hood index in the United States

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7037.1004 (Published 20 April 1996) Cite this as: BMJ 1996;312:1004

This article has a correction. Please see:

  1. Bruce P Kennedy, instructora,
  2. Ichiro Kawachi, assistant professorb,
  3. Deborah Prothrow-Stith, professora
  1. a Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA
  2. b Department of Health and Social Behavior, Harvard School of Public Health, Boston
  1. Correspondence to: Dr Kennedy.
  • Accepted 24 January 1996

Abstract

Objective: To determine the effect of income inequality as measured by the Robin Hood index and the Gini coefficient on all cause and cause specific mortality in the United States.

Design: Cross sectional ecological study.

Setting: Households in the United States.

Main outcome measures: Disease specific mortality, income, household size, poverty, and smoking rates for each state.

Results: The Robin Hood index was positively correlated with total mortality adjusted for age (r=0.54; P<0.05). This association remained after adjustment for poverty (P<0.007), where each percentage increase in the index was associated with an increase in the total mortality of 21.68 deaths per 100000. Effects of the index were also found for infant mortality (P=0.013); coronary heart disease (P=0.004); malignant neoplasms (P=0.023); and homicide (P<0.001). Strong associations were also found between the index and causes of death amenable to medical intervention. The Gini coefficient showed very little correlation with any of the causes of death.

Conclusion: Variations between states in the inequality of income were associated with increased mortality from several causes. The size of the gap between the wealthy and less well off—as distinct from the absolute standard of living enjoyed by the poor—seems to matter in its own right. The findings suggest that policies that deal with the growing inequities in income distribution may have an important impact on the health of the population.

Key messages

  • The size of the gap between the wealthy and less well off—as distinct from the absolute standard of living enjoyed by the poor—seems to be related to mortality

  • Policies that deal with the growing inequities in income distribution may have a considerable impact on the health of the population

Footnotes

  • Funding No special funding.

  • Conflict of interest None.

  • Accepted 24 January 1996
View Full Text