International Journal of Epidemiology 2003;32:1022-1028
© International Epidemiological Association 2003
Income Inequality and Health |
The association between state income inequality and worse health is not confounded by race
Department of Health and Social Behavior, Harvard School of Public Health, 677 Huntington Avenue, KRESGE BLDG 7th Floor, Boston, MA 02115–6096, USA. E-mail: svsubram{at}hsph.harvard.edu
Background The relationship between income inequality and health across US states has been challenged recently on grounds that this relationship may be confounded by the effect of racial composition, measured as the proportion of the state’s population who are black.
Methods Using multilevel statistical models, we examined the association between state income inequality and poor self-rated health. The analysis was based on the pooled 1995 and 1997 Current Population Surveys, comprising 201 221 adults nested within 50 US states.
Results Controlling for the individual effects of age, sex, race, marital status, education, income, health insurance coverage, and employment status, we found a significant effect of state income inequality on poor self-rated health. For every 0.05-increase in the Gini coefficient, the odds ratio (OR) of reporting poor health increased by 1.39 (95% CI: 1.26, 1.51). Additionally controlling for the proportion of the state population who are black did not explain away the effect of income inequality (OR = 1.30; 95% CI: 1.15, 1.45). While being black at the individual level was associated with poorer self-rated health, no significant relationship was found between poor self-rated health and the proportion of black residents in a state.
Conclusion Our finding demonstrates that neither race, at the individual level, nor racial composition, as measured at the state level, explain away the previously reported association between income inequality and poorer health status in the US.
Keywords Income inequality, self-rated health, race, multilevel analysis, US
Accepted 22 May 2003
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