Distinguishing the Race-Specific Effects of Income Inequality and Mortality in U.S. Metropolitan Areas

Abstract

In the United States, the association between income inequality and mortality has been fairly consistent. However, few studies have explicitly examined the impact of race. Studies that have either stratified outcomes by race or conducted analyses within race-specific groups suggest that the income inequality/mortality relation may differ for blacks and whites. The factors explaining the association may also differ for the two groups. Multivariate ordinary least squares regression analysis was used to examine associations between study variables. We used three measures of income inequality to examine the association between income inequality and age-adjusted all-cause mortality among blacks and whites separately. We also examined the role of racial residential segregation and concentrated poverty in explaining associations among groups. Metropolitan areas were included if they had a population of at least 100,000 and were at least 10 percent black. There was a positive income inequality/mortality association among blacks and an inverse association among whites. Racial residential segregation completely attenuated the income inequality/mortality relationship for blacks, but was not significant among whites. Concentrated poverty was a significant predictor of mortality rates in both groups but did not confound associations. The implications of these findings and directions for future research are discussed.

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References

Antonovsky

Social class, life expectancy, and overall mortality. Milbank Q. 45: 31–73, 1967.

Krieger

Williams

D. R.

, and Moss

N. E.

Measuring social class in US public health research: Concepts, methodologies, and guidelines. Ann. Rev. Public Health 18: 341–378, 1997. doi: 10.1146/annurev.publhealth.18.1.341.

Backlund

Income inequality and mortality: A multilevel prospective study of 521,248 individuals in 50 US states. Int. J. Epidemiol. 36: 590–596, 2007. doi: 10.1093/ije/dym012.

Kaplan

G. A.

Inequality in income and mortality in the United States: Analysis of mortality and potential pathways. BMJ 312: 999–1003, 1996. doi: 10.1136/bmj.312.7037.999.

Kawachi

, and Kennedy

B. P.

The relationship of income inequality to mortality: Does the choice of indicator matter?

Soc. Sci. Med. 45: 1121–1127, 1997. doi: https://dx-doi-org.web.bisu.edu.cn/10.1016/S0277-9536(97)00044-0.

Lobmayer

, and Wilkinson

R. G.

Inequality, residential segregation by income, and mortality in US cities. J. Epidemiol. Community Health 56: 183–187, 2002. doi: 10.1136/jech.56.3.183.

Lochner

State-level income inequality and individual mortality risk: A prospective, multilevel study. Am. J. Public Health 91: 385–391, 2001. doi: 10.2105/AJPH.91.3.385.

Lopez

Income inequality and self-rated health in US metropolitan areas: A multilevel analysis. Soc. Sci. Med. 59: 2409–2419, 2004. https://dx-doi-org.web.bisu.edu.cn/10.1016/j.socscimed.2004.03.033.

Lynch

, and Kaplan

Understanding how inequality in the distribution of income affects health. J. Health Psychol. 2: 297–314, 1997. doi: 10.1177/135910539700200303.

10.

Lynch

J. W.

Income inequality and mortality in metropolitan areas of the United States. Am. J. Public Health 88: 1074–1080, 1998. doi: 10.2105/AJPH.88.7.1074.

11.

Lynch

J. W.

Income inequality and mortality: Importance to health of individual income, psychosocial environment, or material conditions. BMJ 320: 1200–1204, 2000. doi: 10.1136/bmj.320.7243.1200.

12.

Wilkinson

R. G.

Income distribution and life expectancy. BMJ 304: 165–168, 1992. doi: 10.1136/bmj.304.6820.165.

13.

Wilkinson

R. G.

Unhealthy Societies: The Afflictions of Inequality. Routledge, London, 1996.

14.

Wilkinson

R. G.

Socioeconomic determinants of health. Health inequalities: Relative or absolute material standards?

BMJ 314: 591–595, 1997. doi: 10.1136/bmj.314.7080.591.

15.

Blakely

Lochner

, and Kawachi

Metropolitan area income inequality and self-rated health—A multi-level study. Soc. Sci. Med. 54: 65–77, 2002. doi: https://dx-doi-org.web.bisu.edu.cn/101016/S0277-9536(01)00007-7.

16.

Wilkinson

R. G.

, and Pickett

K. E.

Income inequality and population health: A review and explanation of the evidence. Soc. Sci. Med. 62: 1768–1784, 2006. doi: https://dx-doi-org.web.bisu.edu.cn/10.1016/j.socscimed.2005.08.036.

17.

Cooper

R. S.

Relationship between premature mortality and socioeconomic factors in black and white populations of US metropolitan areas. Public Health Rep. 116: 464–473, 2001.

18.

Deaton

, and Lubotsky

Mortality, inequality and race in American cities and states. Soc. Sci. Med. 56: 1139–1153, 2003. doi: https://dx-doi-org.web.bisu.edu.cn/10.1016/S0277-9536(02)00115-6.

19.

LeClere

F. B.

, and Soobader

M. J.

The effect of income inequality on the health of selected US demographic groups. Am. J. Public Health 90: 1892–1897, 2000. doi: 10.2105/AJPH.90.12.1892.

20.

McLaughlin

D. K.

, and Stokes

C. S.

Income inequality and mortality in US counties: Does minority racial concentration matter?

Am. J. Public Health 92: 99–104, 2002. doi: 10.2105/AJPH.92.1.99.

21.

Jargowsky

P. A.

Take the money and run: Economic segregation in US metropolitan areas. Am. Sociol. Rev. 61: 984–998, 1996. doi: http://www.jstor.org/stable/2096304.

22.

Nuru-Jeter

, and LaVeist

T. A.

Racial segregation, income inequality, and mortality in US metropolitan areas. J. Urban Health 88: 270–282, 2001. doi: 10.1007/s11524-010-9524-7.

23.

Ash

, and Robinson

D. E.

Inequality, race, and mortality in U.S. cities: A political and econometric review of Deaton and Lubotsky (56:6, 1139–1153, 2003). Soc. Sci. Med. 68: 1909–1913, 2009. doi: https://dx-doi-org.web.bisu.edu.cn/10.1016/j.socscimed.2009.02.038.

24.

Mellor

J. M.

, and Milyo

Reexamining the evidence of an ecological association between income inequality and health. J. Health Polit. Pol. Law. 26: 487–522, 2001. doi: 10.1215/03616878-26-3-487.

25.

Ram

Income inequality, poverty, and population health: Evidence from recent data for the United States. Soc. Sci. Med. 61: 2568–2576, 2005. doi: https://dx-doi-org.web.bisu.edu.cn/10.1016/j.socscimed.2005.04.038.

26.

Ronzio

C. R.

Urban premature mortality in the U.S. between 1980 and 1990: Changing roles of income inequality and social spending. J. Public Health Policy 24: 386–400, 2003. doi: http://www.jstor.org/stable/3343384.

27.

Subramanian

S. V.

, and Kawachi

The association between state income inequality and worse health is not confounded by race. Int. J. Epidemiol. 32: 1022–1028, 2003. doi: 10.1093/ije/dyg245.

28.

Miller

, and Paxon

Relative income, race, and mortality. J. Health Econ. 25: 979–1003, 2006. doi: https://dx-doi-org.web.bisu.edu.cn/10.1016.j.healeco.2006.02.003.

29.

Kennedy

B. P.

Kawachi

, and Prothrow-Stith

Income distribution and mortality: Cross-sectional ecological study of the Robin Hood index in the United States. BMJ 312: 1004–1007, 1996. doi: 10.1136/bmj.312.7037.1004.

30.

Shi

Primary care, race, and mortality in US states. Soc. Sci. Med. 61: 65–75, 2005. doi: https://dx-doi-org.web.bisu.edu.cn/10.1016/j.socscimed.2004.11.056.

31.

Wilson

The Truly Disadvantaged. University of Chicago Press, Chicago, 1987.

32.

Massey

D. S.

, and Denton

N. A.

American Apartheid: Segregation and the Making of the Underclass. Harvard University Press, Boston, 1993.

33.

Massey

D. S.

, and Denton

N. A.

Hypersegregation in U.S. metropolitan areas: Black and Hispanic segregation along five dimensions. Demography 26: 373–391, 1989. doi: 10.2307/2061599.

34.

Wilkes

, and Iceland

Hypersegregation in the twenty-first century. Demography 41: 23–36, 2004. doi: 10.1353/dem.2004.0009.

35.

Charles

C. Z.

The dynamics of racial residential segregation. Ann. Rev. Sociol. 29: 167–207, 2003. doi: http://www.jstor.org/stable/30036965.

36.

Massey

D. S.

, and Denton

N. A.

Spatial assimilation as a socioeconomic outcome. Am. Sociol. Rev. 50: 94–106, 1985. doi: http://www.jstor.org/stable/2095343.

37.

Fischer

M. J.

The relative importance of income and race in determining residential outcomes in U.S. urban areas, 1970–2000. Urban Affairs Rev. 38, 2003. doi: 10.1177/1078087403038005003.

38.

Clark

W. A. V.

Residential preferences and neighborhood racial segregation: A test of the Schelling segregation model. Demography 28: 1–19, 1991. doi: 10.2307/2061333.

39.

Emerson

M. O.

Chai

K. J.

, and Yancey

Does race matter in residential segregation? Exploring the preferences of White Americans. Amer. Sociol. Rev. 66: 922–935, 2001. doi: http://www.jstor.org/stable/3088879.

40.

McPherson

Smith-Lovin

, and Cook

J. M.

Birds of a feather: Homophily in social networks. Ann. Rev. Sociol. 27: 415–444, 2001. doi: http://www.jstor.org/stable/2678628.

41.

Rogers

E. M.

, and Bhowmik

D. K.

Homophily-Heterophily: Relational concepts for communications research. Public Opin. Q. 34: 523–538, 1970. doi: 10.1086/267838.

42.

Krysan

, and Farley

The residential preferences of Blacks: Do they explain persistent segregation?

Soc. Forc. 80: 937–980, 2002. doi: 10.1353/sof.2002.0011.

43.

U.S. Census Bureau. Geographic Area Description: Metropolitan Area Cartographic Boundary Files, 2005.

44.

LaVeist

T. A.

Segregation, poverty, and empowerment: Health consequences for African Americans. Milbank Q. 71: 41–64, 1993. doi: http://www.jstor.org/stable/3350274.

45.

Ross

N. A.

Relation between income inequality and mortality in Canada and in the United States: Cross-sectional assessment using census data and vital statistics. BMJ 320: 898–902, 2000. doi: 10.1136/bmj.320.7239.898.

46.

Massey

D. S.

, and Denton

N. A.

The dimensions of residential segregation. Soc. Forc. 67: 281–315, 1988. doi: 10.1093/sf/67.2.281.

47.

Stata. Intercooled Stata v. 9.0. College Station, TX, 2007.

48.

Franks

Gold

M. R.

, and Fiscella

Sociodemographics, self-rated health, and mortality in the US. Soc. Sci. Med. 56: 2505–2514, 2003. doi: https://dx-doi-org.web.bisu.edu.cn/10.1016/S0277-9536(02)00281-2.

49.

Satcher

What if we were equal? A comparison of the Black-White mortality gap in 1960 and 2000. Health Aff. 24: 459–464, 2005. doi: 10.1377/hlthaff.24.2.459.

50.

Tabachnik

B. G.

, and Fidell

L. S.

Using Multivariate Statistics. Allyn and Bacon, Boston, 2001.

51.

Lynch

J. W.

Income inequality and mortality: Importance to health of individual income, psychosocial environment, or material conditions. BMJ 320: 1200–1203, 2000. doi: 10.1136/bmj.320.7243.1200.

52.

McEwen

B. S.

Protective and damaging effects of stress mediators. New Engl. J. Med. 338: 171–179, 1998.

53.

Taylor

S. E.

, and Repetti

R. L.

Health psychology: What is an unhealthy environment and how does it get under the skin?

Ann. Rev. Psychol. 48: 411–447, 1997.

54.

Yen

I. H.

Racial discrimination and alcohol-related behavior in urban transit operators: Findings from the San Francisco Muni Health and Safety Study. Public Health Rep. 114: 448–458, 1999.

55.

Markowitz

F. E.

Extending social disorganization theory: Modeling the relationships between cohesion, disorder, and fear. Criminol. 39: 293–319, 2006. doi: 10.1111/j.1745-9125.2001.tb00924.x.

56.

Williams

D. R.

, and Collins

Racial residential segregation: A fundamental cause of racial disparities in health. Public Health Rep. 116: 404–416, 2001.

57.

Jackson

S. A.

The relation of residential segregation to all-cause mortality: A study in black and white. Am. J. Public Health 90: 615–617, 2000. doi: 10.2105/AJPH.90.4.615.

58.

Massey

D. S.

, and Eggers

M. L.

The ecology of inequality: Minorities and the concentration of poverty, 1970–1980. Amer. J. Sociol. 95: 1153–1188, 1990. doi: http://www.jstor.org/stable/2780513.

59.

Massey

D. S.

, and Fischer

M. J.

How segregation concentrates poverty. Ethnic Racial Stud. 23: 670–691, 2000. doi: 10.1080/01419870050033676.

60.

Osypuk

T. L.

Quantifying separate and unequal: Racial and ethnic distributions of neighborhood poverty in metropolitan America. Urban Aff. Rev. 45: 25–65, 2009. doi: 10.1177/1078087408331119.

61.

Mora

, and Ruiz-Castillo

An evaluation of an entropy based index of segregation. Unpublished working paper. Universidad Carlos III de Madrid, 2003.

62.

Wong

D. W. S.

Measuring multi-ethnic spatial segregation. Urban Geogr. 19: 77–87, 1998.