Poverty or income inequality as predictor of mortality: longitudinal cohort study.

OBJECTIVE

To determine the effect of inequality in income between communities independent of household income on individual all cause mortality in the United States.

DESIGN

Longitudinal cohort study.

SUBJECTS

A nationally representative sample of 14,407 people aged 25-74 years in the United States from the first national health and nutrition examination survey.

SETTING

Subjects were followed from initial interview in 1971-5 until 1987. Complete follow up information was available for 92.2% of the sample.

MAIN OUTCOME MEASURES

Relation between both household income and income inequality in community of residence and individual all cause mortality at follow up was examined with Cox proportional hazards survival analysis.

RESULTS

Community income inequality showed a significant association with subsequent community mortality, and with individual mortality after adjustment for age, sex, and mean income in the community of residence. After adjustment for individual household income, however, the association with mortality was lost.

CONCLUSIONS

In this nationally representative American sample, family income, but not community income inequality, independently predicts mortality. Previously reported ecological associations between income inequality and mortality may reflect confounding between individual family income and mortality.