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

^a Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA, ^b Department of Health and Social Behavior, Harvard School of Public Health, Boston

Correspondence to: Dr Kennedy.

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.

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• Woodward, A., Kawachi, I. (2000). Why reduce health inequalities?. J. Epidemiol. Community Health 54: 923-929 [Abstract] [Full text]  
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• STARFIELD, B., PAGANINI, J. M. (2000). Is equity a scientific issue?. J. Epidemiol. Community Health 54: 324-325 [Full text]  
• Lynch, J. W, Smith, G. D., Kaplan, G. A, House, J. S (2000). Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions. BMJ 320: 1200-1204 [Full text]  
• Geyer, S., Peter, R. (2000). Income, occupational position, qualification and health inequalities---competing risks? (Comparing indicators of social status). J. Epidemiol. Community Health 54: 299-305 [Abstract] [Full text]  
• Reijneveld, S. A, Verheij, R. A, de Bakker, D. H (2000). The impact of area deprivation on differences in health: does the choice of the geographical classification matter?. J. Epidemiol. Community Health 54: 306-313 [Abstract] [Full text]  
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• DiLiberti, J. H. (2000). The Relationship Between Social Stratification and All-Cause Mortality Among Children in the United States: 1968-1992. Pediatrics 105: e2-e2 [Abstract] [Full text]  
• Williamson, D. L., Reutter, L. (1999). Defining and measuring poverty: implications for the health of Canadians. HEALTH PROMOT INT 14: 355-364 [Abstract] [Full text]  
• Percy, A. K. (1999). Eliminating institutional child abuse: A road too well traveled. Neurology 53: 1617-1617 [Full text]  
• Chiang, T.-l. (1999). Economic transition and changing relation between income inequality and mortality in Taiwan: regression analysis. BMJ 319: 1162-1165 [Abstract] [Full text]  
• Wolfson, M., Kaplan, G., Lynch, J., Ross, N., Backlund, E., Gravelle, H., Wilkinson, R. G (1999). Relation between income inequality and mortality: empirical demonstration • Diminishing returns to aggregate level studies • Two pathways, but how much do they diverge?. BMJ 319: 953-957 [Abstract] [Full text]  
• Malmstrom, M., Sundquist, J., Johansson, S.-E., Johansson, L. M. (1999). The influence of social deprivation as measured by the CNI on psychiatric admissions. Scand J Public Health 27: 189-195 [Abstract]  
• Hayes, M. (1999). 'Man, disease and environmental associations': from medical geography to health inequalities. Prog Hum Geogr 23: 289-296  
• Gornel, D. L., Gray, D. P., Steele, R., Sweeney, K., Rosamond, W. D., Chambless, L. E., Folsom, A. R., Levy, D., Thom, T. J. (1999). Rates of Death from Coronary Heart Disease. NEJM 340: 730-732 [Full text]  
• Kennedy, B. P, Kawachi, I., Glass, R., Prothrow-Stith, D. (1998). Income distribution, socioeconomic status, and self rated health in the United States: multilevel analysis. BMJ 317: 917-921 [Abstract] [Full text]  
• Rosengren, A., Orth-Gomer, K., Wilhelmsen, L. (1998). Socioeconomic differences in health indices, social networks and mortality among Swedish men. A study of men born in 1933. Scand J Public Health 26: 272-280 [Abstract]  
• Starfield, B. (1998). Quality-of-Care Research: Internal Elegance and External Relevance. JAMA 280: 1006-1008 [Full text]  
• Walberg, P., McKee, M., Shkolnikov, V., Chenet, L., Leon, D. A (1998). Economic change, crime, and mortality crisis in Russia: regional analysis. BMJ 317: 312-318 [Abstract] [Full text]  
• Massing, M. W., Rywik, S. L., Jasinski, B., Manolio, T. A., Williams, O. D., Tyroler, H. A. (1998). Opposing National Stroke Mortality Trends in Poland and for African Americans and Whites in the United States, 1968 to 1994. Stroke 29: 1366-1372 [Abstract] [Full text]  
• Greenberg, R. (1998). The Painful Reality of Hunger. Arch Pediatr Adolesc Med 152: 423-424 [Full text]  
• Regidor, E., Navarro, P., Dominguez, V., Rodriguez, C. (1997). Inequalities in income and long term disability in Spain: analysis of recent hypotheses using cross sectional study based on individual data. BMJ 315: 1130-1135 [Abstract] [Full text]  
• Lynch, J. W., Kaplan, G. A. (1997). Understanding How Inequality in the Distribution of Income Affects Health. J Health Psychol 2: 297-314 [Abstract]  
• MacIntyre, S., Hunt, K. (1997). Socio-economic Position, Gender and Health: How Do They Interact?. J Health Psychol 2: 315-334 [Abstract]  
• Fiscella, K., Franks, P. (1997). Poverty or income inequality as predictor of mortality: longitudinal cohort study. BMJ 314: 1724-1724 [Abstract] [Full text]  
• Wilkinson, R. G (1997). Commentary: Income inequality summarises the health burden of individual relative deprivation. BMJ 314: 1727-1727 [Full text]  
• Wilson, M., Daly, M. (1997). Life expectancy, economic inequality, homicide, and reproductive timing in Chicago neighbourhoods. BMJ 314: 1271-1271 [Abstract] [Full text]  
• Pearn, J. (1997). Recent advances in paediatrics: II–childhood and adolescence. BMJ 314: 1099-1099 [Full text]  
• Kawachi, I., Kennedy, B. P (1997). Socioeconomic determinants of health : Health and social cohesion: why care about income inequality?. BMJ 314: 1037-1037 [Abstract] [Full text]  
• Wilkinson, R. G (1997). Socioeconomic determinants of health: Health inequalities: relative or absolute material standards?. BMJ 314: 591-591 [Full text]  
• Judge, K. (1996). Income and mortality in the United States. BMJ 313: 1206c-1207 [Full text]  
• Purdy, S. (1996). Welfare reform in the United States. BMJ 313: 1028-1029 [Full text]  
• Smith, G. D. (1996). Income inequality and mortality: why are they related?. BMJ 312: 987-988 [Full text]