Economic Opportunity, Health Behaviors, and Mortality in the United States

Abstract

Objectives We assessed whether economic opportunity was independently associated with health behaviors and outcomes in the United States. Methods Using newly available, cross-sectional, county-level data from the Equality of Opportunity Project Database and vital statistics, we estimated associations between all-cause mortality rates (averaged over 2000–2012) and economic opportunity, adjusting for socioeconomic, demographic, and health system covariates. Our measure of economic opportunity was the county-average rank in the national income distribution attained by individuals born to families in the bottom income quartile. Secondary outcomes included rates of age- and race-specific mortality, smoking, obesity, hypertension, and diabetes. Results An increase in economic opportunity from the lowest to the highest quintile was associated with a 16.7% decrease in mortality. The magnitudes of association were largest for working-age adults and African Americans. Greater economic opportunity was also associated with health behaviors and risk factors. Conclusions Economic opportunity is a robust, independent predictor of health. Future work should investigate underlying causal links and mechanisms.

Economic Mobility and the Mortality Crisis Among US Middle-aged Whites

“…Our findings are consistent with recent work showing an inverse relationship between lack of economic opportunity and a range of negative health behaviors and health outcomes [7]. While the aggregate, observational study design precludes causal inference, our findings motivate further inquiry into whether and how future expectations and changes in living standards may create despair and compromise health.…”

Association Between Automotive Assembly Plant Closures and Opioid Overdose Mortality in the United States

“…47,48 Declining economic opportunity is one hypothesized mechanism associated with these longer-term trends. 15,16,21,49 Given our study context, this argument is most relevant for worsening population health trends in the midwestern and southern United States, regions that have experienced some of the largest increases in opioid overdose mortality 50,51 and in which the automotive industry has long been economically and culturally significant. In addition, our focus on an acute, sustained decline in economic opportunity may help reconcile prior disparate findings about the importance of the economic factors associated with the opioid overdose crisis, which are based primarily on standard measures of economic status (eg, unemployment and per capita income).…”

“…[17][18][19][20] This lack of consensus may reflect the fact that standard economic measures do not adequately capture the fundamental and sustained decline in economic opportunity or the adverse socioeconomic and cultural climate that follows. 16, [21][22][23][24] Consistent with this hypothesis, studies based on other economic measures (eg, changes in employment opportunities owing to changes in international trade policy) have estimated strong associations with drug overdose mortality. [23][24][25] To reconcile the mixed findings in the literature, we conducted a study to estimate the association between automotive assembly plant closures and opioid overdose mortality among working-age adults.…”

Income Mobility, Income Inequality and Mortality in the U.S.

“…This research landscape is changing and in a series of very recent papers, a group of researchers began exploring the association between a place's income mobility and health behaviors, self-reported health and mortality. (Venkataramani et al 2015(Venkataramani et al , 2016Palloni et al 2016).…”