Income inequality and population health: a political-economic research agenda

Dunn, James R.; Park, Gum‐Ryeong; Brydon, Robbie; Wolfson, Michael; Veall, Michael R.; Rolheiser, Lyndsey; Siddiqi, Arjumand; Ross, Nancy A.

doi:10.1136/jech-2022-219252

Cited by 2 publications

(2 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although income inequality and social mobility have been separately associated with population health, no studies have investigated the joint association of income inequality and social mobility with deaths of despair, to our knowledge. Recent literature has proposed focusing on the interactions between income inequality, social mobility, and population health as an important research agenda . The literature has also suggested that linking income inequality to cause-specific mortality instead of all-cause mortality, particularly avoidable and preventable mortality, could provide significant implications for policy responses .…”

Section: Introductionmentioning

confidence: 99%

“…Recent literature has proposed focusing on the interactions between income inequality, social mobility, and population health as an important research agenda. 37 The literature has also suggested that linking income inequality to cause-specific mortality instead of all-cause mortality, particularly avoidable and preventable mortality, could provide significant implications for policy responses. 37 We thus addressed this knowledge gap by examining the interaction between county-level income inequality and social mobility with deaths of despair (suicide, drug overdose, and alcoholic liver disease) among working-age Black, Hispanic, and White populations.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

County-Level Income Inequality, Social Mobility, and Deaths of Despair in the US, 2000-2019

Kuo

Kawachi

2023

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceIncreasing mortality from suicide, drug overdose, and alcohol-related liver disease (collectively referred to as deaths of despair) is a critical public health crisis. Income inequality and social mobility have been separately associated with all-cause mortality; however, no studies have examined their interaction with these preventable deaths.ObjectiveTo assess the interaction between income inequality and social mobility with deaths of despair among working-age Hispanic, non-Hispanic Black, and non-Hispanic White populations.Design, Setting, and ParticipantsThis cross-sectional study analyzed data from the Centers for Disease Control and Prevention WONDER (Wide-Ranging Online Data for Epidemiologic Research) database on county-level deaths of despair from 2000 to 2019 across racial and ethnic groups. Statistical analysis was performed from January 8 to May 20, 2023.ExposuresThe primary exposure of interest was county-level income inequality, measured by the Gini coefficient. Another exposure was race- and ethnicity-specific absolute social mobility. Tertiles for the Gini coefficient and social mobility were created to evaluate the dose-response association.Main Outcomes and MeasuresThe main outcomes were adjusted risk ratios (RRs) of deaths from suicide, drug overdose, and alcoholic liver disease. The interaction between income inequality and social mobility was formally tested on both the additive and multiplicative scales.ResultsThe sample included 788 counties for Hispanic populations, 1050 counties for non-Hispanic Black populations, and 2942 counties for non-Hispanic White populations. Over the study period, 152 350, 149 589, and 1 250 156 deaths of despair were recorded for working-age Hispanic, non-Hispanic Black, and non-Hispanic White populations, respectively. Compared with the reference group (counties with low income inequality and high social mobility), counties with greater income inequality (high inequality: RR, 1.26 [95% CI, 1.24-1.29] for Hispanic populations; RR, 1.18 [95% CI, 1.15-1.20] for non-Hispanic Black populations; and RR, 1.22 [95% CI, 1.21-1.23] for non-Hispanic White populations) or less social mobility (low mobility: RR, 1.79 [95% CI, 1.76-1.82] for Hispanic populations; RR, 1.64 [95% CI, 1.61-1.67] for non-Hispanic Black populations; and RR, 1.38 [95% CI, 1.38-1.39] for non-Hispanic White populations) had higher RRs for deaths of despair. In counties with high income inequality and low social mobility, positive interactions were observed on the additive scale for Hispanic populations (relative excess risk due to interaction [RERI], 0.27 [95% CI, 0.17-0.37]), non-Hispanic Black populations (RERI, 0.36 [95% CI, 0.30-0.42]), and non-Hispanic White populations (RERI, 0.10 [95% CI, 0.09-0.12]). In contrast, positive interactions on the multiplicative scale were found only for non-Hispanic Black populations (ratio of RRs, 1.24 [95% CI, 1.18-1.31]) and non-Hispanic White populations (ratio of RRs, 1.03 [95% CI, 1.02-1.05]), but not for Hispanic populations (ratio of RRs, 0.98 [95% CI, 0.93-1.04]). In the sensitivity analyses using continuous Gini coefficient and social mobility, a positive interaction was observed between higher income inequality and lower social mobility with deaths of despair on both the additive and multiplicative scales for all 3 racial and ethnic groups.Conclusions and RelevanceThis cross-sectional study found that the joint exposure of unequal income distribution and lack of social mobility was associated with additional risks for deaths of despair, suggesting that addressing the underlying social and economic conditions is crucial in responding to the epidemic of deaths of despair.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

County-Level Income Inequality, Social Mobility, and Deaths of Despair in the US, 2000-2019

Kuo

Kawachi

2023

JAMA Netw Open

View full text Add to dashboard Cite

show abstract

Chasing cancer: does the social-to-medical spending ratio relate to cancer incidence and mortality in Canadian provinces? A retrospective cohort study

MacLellan,

Kershaw,

Kneebone

et al. 2024

bmjph

View full text Add to dashboard Cite

IntroductionCancer is the leading cause of death in Canada, and cases are expected to rise by 83% between 2012 and 2042. Jurisdictions with higher ratios of social-to-medical spending exhibit better population health outcomes; however, the connection between the ratio and both cancer incidence and mortality is not well established. We aim to determine the association between the ratio and both age-standardised cancer incidence and mortality.MethodsUsing linear regressions with provincial and yearly fixed effects, we measured associations between the ratio and incidence of the four most common cancers in Canada (ie, lung and bronchus, colorectal, breast and prostate cancer), and mortality from any cancer, from 1992 to 2017 (incidence) and 2000 to 2019 (mortality).ResultsA one-cent increase in social spending for each dollar spent on medical services was significantly associated with a decrease in colorectal (−0.2%), breast (−0.1%), and prostate cancer (−0.6%). The relationship is statistically insignificant and negligible for lung cancer incidence and cancer mortality.ConclusionThe ratio was significantly associated with a decrease in three out of four cancer incidence categories, but not mortality. This implies that, consistent with the social determinants of health, preventing cancer incidence might be a function of social spending, whereas medical spending is more relevant for individuals already diagnosed with cancer. This analysis points to the importance of a health-in-all-policies perspective, as social spending might be more important for population health than spending on the medical care system. We provide evidence that morbidity measures are responsive to the ratio, building on a literature focused on mortality.

show abstract

Income inequality and population health: a political-economic research agenda

Cited by 2 publications

References 40 publications

County-Level Income Inequality, Social Mobility, and Deaths of Despair in the US, 2000-2019

County-Level Income Inequality, Social Mobility, and Deaths of Despair in the US, 2000-2019

Chasing cancer: does the social-to-medical spending ratio relate to cancer incidence and mortality in Canadian provinces? A retrospective cohort study

Contact Info

Product

Resources

About