Intended for healthcare professionals


State income inequality, household income, and maternal mental and physical health: cross sectional national survey

BMJ 2000; 321 doi: (Published 25 November 2000) Cite this as: BMJ 2000;321:1311
  1. Robert S Kahn, assistant professora (kahnr0{at},
  2. Paul H Wise, associate professorb,
  3. Bruce P Kennedy, deputy directorc,
  4. Ichiro Kawachi, associate professord
  1. a Division of General and Community Pediatrics, Children's Hospital Medical Center, CH-1, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
  2. b Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA 02118, USA,
  3. c Division of Public Health Practice, Harvard School of Public Health, Boston, MA 02115,
  4. d Department of Health and Social Behavior, Harvard School of Public Health, Boston
  1. Correspondence to: R Kahn
  • Accepted 11 September 2000


Objective: To examine the association of state income inequality and individual household income with the mental and physical health of women with young children.

Design: Cross sectional study. Individual level data (outcomes, income, and other sociodemographic covariates) from a 1991 follow up survey of a birth cohort established in 1988. State level income inequality calculated from the income distribution of each state from 1990 US census.

Setting: United States, 1991.

Participants: Nationally representative stratified random sample of 8060 women who gave birth in 1988 and were successfully contacted (89%) in 1991.

Main outcome measures: Depressive symptoms (Center for Epidemiologic Studies depression score >15) and self rated health

Results: 19% of women reported depressive symptoms, and 7.5% reported fair or poor health. Compared with women in the highest fifth of distribution of household income, women in the lowest fifth were more likely to report depressive symptoms (33% v 9%, P<0.001) and fair or poor health (15% v 2%, P<0.001). Compared with low income women in states with low income inequality, low income women in states with high income inequality had a higher risk of depressive symptoms (odds ratio 1.6, 95% confidence interval 1.0 to 2.6) and fair or poor health (1.8, 0.9 to 3.5).

Conclusions: High income inequality confers an increased risk of poor mental and physical health, particularly among the poorest women. Both income inequality and household income are important for health in this population.


  • Funding Ichiro Kawachi and Bruce P Kennedy are recipients of the RWJF Investigator Awards in Health Policy Research. Ichiro Kawachi is a core member of the MacArthur Foundation Network on Socioeconomic Status and Health.

  • Competing interests None declared.

  • Embedded Image An extra table on state income disparity can be found on the BMJ's website

  • Accepted 11 September 2000
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