Are manual workers at higher risk of death than non-manual employees when living in Swedish municipalities with higher income inequality?

Henriksson, Göran; Allebeck, Peter; Weitoft, Gunilla Ringbäck; Thelle, Dag S.

doi:10.1093/eurpub/ckl119

Cited by 14 publications

(10 citation statements)

References 18 publications

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“…An analysis of Swedish individuals aged 40–64 years evaluating occupation as a modifier found that income inequality was associated with a higher risk of mortality for unskilled manual workers only 15. A US study examining individual income and ethnicity as modifiers found effects on mortality were largest in poor white people 9.…”

Section: Discussionmentioning

confidence: 99%

Mitigating effect of immigration on the relation between income inequality and mortality: a prospective study of 2 million Canadians

Auger

Hamel²,

Martinez³

et al. 2011

J Epidemiol Community Health

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Section: Discussionmentioning

confidence: 99%

Mitigating effect of immigration on the relation between income inequality and mortality: a prospective study of 2 million Canadians

Auger

Hamel²,

Martinez³

et al. 2011

J Epidemiol Community Health

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“…There is earlier evidence from other Nordic countries that is in accordance with this hypothesis. Dahl et al (2006) have reported that the effects of economic inequality on mortality are particularly marked among socio‐economically disadvantaged groups in Norway, 13 and the findings by Henriksson et al (2007), through the use of the Swedish census, point out that there could be a differential impact from income inequality on mortality, dependent on individuals’ social position. Overall, our results do not change much when we estimate the models separately for those individuals who have at most 10 years of education.…”

Section: Resultsmentioning

confidence: 99%

Economic inequality and population health: looking beyond aggregate indicators

Böckerman

Johansson

Helakorpi

et al. 2009

Sociology Health & Illness

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This paper studies the sensitivity of various health indicators to income inequality as measured by regional Gini coefficients, using individual microdata from Finland over the period [1993][1994][1995][1996][1997][1998][1999][2000][2001][2002][2003][2004][2005]. There is no overall association between income and health at the regional level. We discovered that, among men, there are no significant associations between income inequality and several measures of health status. Among women or among both sexes combined, there are some indications of associations in the predicted direction between income inequality and physical health, disability retirement, sick leave, and consumption of medicines, but none are robust to different model specifications. Only among the population aged less than 30 there is some indication that mental health is associated with inequality. Our findings confirm that income inequality in small populations (not large enough to measure the overall class pyramid of the society) is often immaterial for health outcomes.

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“…analyses included 2,916,576 individuals in 38 studies considering SRH and 14 studies with 10,727,470 million individuals considering mortality 141,[167][168][169][170][171][172][173][174][175][176][177][178][179] (study characteristics in Appendices 15 and 16, respectively). An additional seven reports considering SRH [180][181][182][183][184][185][186] and eight considering mortality, [187][188][189][190][191][192][193][194] including one natural experimental study, 191 were included in one or more of the subgroup or sensitivity analyses.…”

Section: Evidence Against Bh Viewpointmentioning

confidence: 99%

“…191 Despite its favorable study design, estimates from the natural experimental study were excluded from the main analysis, as it used a subset of the Swedish census that overlaps, but is smaller than, another report included in the primary meta-analysis. 171 Of the studies considering SRH, most used the Gini coefficient to measure income inequality except for two that used the Theil index 129,130 and one that used median share. 141 All but six (15.8%) were cross-sectional.…”

Section: Evidence Against Bh Viewpointmentioning

confidence: 99%

Causal Assessment of Income Inequality on Self‐Rated Health and All‐Cause Mortality: A Systematic Review and Meta‐Analysis

SHIMONOVICH,

CAMPBELL,

THOMSON

et al. 2024

Milbank Quarterly

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Policy Points Income is thought to impact a broad range of health outcomes. However, whether income inequality (how unequal the distribution of income is in a population) has an additional impact on health is extensively debated. Studies that use multilevel data, which have recently increased in popularity, are necessary to separate the contextual effects of income inequality on health from the effects of individual income on health. Our systematic review found only small associations between income inequality and poor self‐rated health and all‐cause mortality. The available evidence does not suggest causality, although it remains methodologically flawed and limited, with very few studies using natural experimental approaches or examining income inequality at the national level. ContextWhether income inequality has a direct effect on health or is only associated because of the effect of individual income has long been debated. We aimed to understand the association between income inequality and self‐rated health (SRH) and all‐cause mortality (mortality) and assess if these relationships are likely to be causal.MethodsWe searched Medline, ISI Web of Science, Embase, and EconLit (PROSPERO: CRD42021252791) for studies considering income inequality and SRH or mortality using multilevel data and adjusting for individual‐level socioeconomic position. We calculated pooled odds ratios (ORs) for poor SRH and relative risk ratios (RRs) for mortality from random‐effects meta‐analyses. We critically appraised included studies using the Risk of Bias in Nonrandomized Studies – of Interventions tool. We assessed certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework and causality using Bradford Hill (BH) viewpoints.FindingsThe primary meta‐analyses included 2,916,576 participants in 38 cross‐sectional studies assessing SRH and 10,727,470 participants in 14 cohort studies of mortality. Per 0.05‐unit increase in the Gini coefficient, a measure of income inequality, the ORs and RRs (95% confidence intervals) for SRH and mortality were 1.06 (1.03‐1.08) and 1.02 (1.00‐1.04), respectively. A total of 63.2% of SRH and 50.0% of mortality studies were at serious risk of bias (RoB), resulting in very low and low certainty ratings, respectively. For SRH and mortality, we did not identify relevant evidence to assess the specificity or, for SRH only, the experiment BH viewpoints; evidence for strength of association and dose–response gradient was inconclusive because of the high RoB; we found evidence in support of temporality and plausibility.ConclusionsIncreased income inequality is only marginally associated with SRH and mortality, but the current evidence base is too methodologically limited to support a causal relationship. To address the gaps we identified, future research should focus on income inequality measured at the national level and addressing confounding with natural experiment approaches.

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Are manual workers at higher risk of death than non-manual employees when living in Swedish municipalities with higher income inequality?

Abstract: The findings suggest that there could be a differential impact from income inequality on risk of death, dependent on individuals' social position.

Cited by 14 publications

References 18 publications

Mitigating effect of immigration on the relation between income inequality and mortality: a prospective study of 2 million Canadians

Mitigating effect of immigration on the relation between income inequality and mortality: a prospective study of 2 million Canadians

Economic inequality and population health: looking beyond aggregate indicators

Causal Assessment of Income Inequality on Self‐Rated Health and All‐Cause Mortality: A Systematic Review and Meta‐Analysis

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