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Research papers on Income inequality and health

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  1. World Health Organization 2020 guidelines on physical activity and sedentary behaviour

    Fiona Bull, Salih S Al-Ansari, Stuart Biddle, et al. · 2020 · British Journal of Sports Medicine · 11,673 citations

    Objectives To describe new WHO 2020 guidelines on physical activity and sedentary behaviour. Methods The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations. Results The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic co

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  2. Dissecting racial bias in an algorithm used to manage the health of populations

    Ziad Obermeyer, Brian W. Powers, Christine Vogeli, et al. · 2019 · Science · 6,945 citations

    Health systems rely on commercial prediction algorithms to identify and help patients with complex health needs. We show that a widely used algorithm, typical of this industry-wide approach and affecting millions of patients, exhibits significant racial bias: At a given risk score, Black patients are considerably sicker than White patients, as evidenced by signs of uncontrolled illnesses. Remedying this disparity would increase the percentage of Black patients receiving additional help from 17.7 to 46.5%. The bias arises because the algorithm predicts health care costs rather than illness, but unequal access to care means that we spend less money caring for Black patients than for White pati

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  3. Contribution of Primary Care to Health Systems and Health

    Bárbara Starfield, Leiyu Shi, James Macinko · 2005 · Milbank Quarterly · 5,616 citations

    Evidence of the health-promoting influence of primary care has been accumulating ever since researchers have been able to distinguish primary care from other aspects of the health services delivery system. This evidence shows that primary care helps prevent illness and death, regardless of whether the care is characterized by supply of primary care physicians, a relationship with a source of primary care, or the receipt of important features of primary care. The evidence also shows that primary care (in contrast to specialty care) is associated with a more equitable distribution of health in populations, a finding that holds in both cross-national and within-national studies. The means by wh

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  5. Socioeconomic Inequalities in Health in 22 European Countries

    Johan P. Mackenbach, Irina Stirbu, Albert‐Jan Roskam, et al. · 2008 · New England Journal of Medicine · 3,363 citations

    BACKGROUND: Comparisons among countries can help to identify opportunities for the reduction of inequalities in health. We compared the magnitude of inequalities in mortality and self-assessed health among 22 countries in all parts of Europe. METHODS: We obtained data on mortality according to education level and occupational class from census-based mortality studies. Deaths were classified according to cause, including common causes, such as cardiovascular disease and cancer; causes related to smoking; causes related to alcohol use; and causes amenable to medical intervention, such as tuberculosis and hypertension. Data on self-assessed health, smoking, and obesity according to education an

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  6. The Association Between Income and Life Expectancy in the United States, 2001-2014

    Raj Chetty, Michael Stepner, Sarah Abraham, et al. · 2016 · JAMA · 2,862 citations

    IMPORTANCE: The relationship between income and life expectancy is well established but remains poorly understood. OBJECTIVES: To measure the level, time trend, and geographic variability in the association between income and life expectancy and to identify factors related to small area variation. DESIGN AND SETTING: Income data for the US population were obtained from 1.4 billion deidentified tax records between 1999 and 2014. Mortality data were obtained from Social Security Administration death records. These data were used to estimate race- and ethnicity-adjusted life expectancy at 40 years of age by household income percentile, sex, and geographic area, and to evaluate factors associate

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  8. The COVID-19 pandemic and health inequalities

    Clare Bambra, Ryan Riordan, John Ford, et al. · 2020 · Journal of Epidemiology & Community Health · 2,064 citations

    This essay examines the implications of the COVID-19 pandemic for health inequalities. It outlines historical and contemporary evidence of inequalities in pandemics—drawing on international research into the Spanish influenza pandemic of 1918, the H1N1 outbreak of 2009 and the emerging international estimates of socio-economic, ethnic and geographical inequalities in COVID-19 infection and mortality rates. It then examines how these inequalities in COVID-19 are related to existing inequalities in chronic diseases and the social determinants of health, arguing that we are experiencing a syndemic pandemic . It then explores the potential consequences for health inequalities of the lockdown mea

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  9. Socioeconomic Factors, Health Behaviors, and Mortality

    Paula M. Lantz, James S. House, James M. Lepkowski, et al. · 1998 · JAMA · 1,528 citations

    CONTEXT: A prominent hypothesis regarding social inequalities in mortality is that the elevated risk among the socioeconomically disadvantaged is largely due to the higher prevalence of health risk behaviors among those with lower levels of education and income. OBJECTIVE: To investigate the degree to which 4 behavioral risk factors (cigarette smoking, alcohol drinking, sedentary lifestyle, and relative body weight) explain the observed association between socioeconomic characteristics and all-cause mortality. DESIGN: Longitudinal survey study investigating the impact of education, income, and health behaviors on the risk of dying within the next 7.5 years. PARTICIPANTS: A nationally represe

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  10. Inequality in income and mortality in the United States: analysis of mortality and potential pathways

    George A. Kaplan, Elsie R. Pamuk, John Lynch, et al. · 1996 · BMJ · 1,246 citations

    Abstract Objective : To examine the relation between health outcomes and the equality with which income is distributed in the United States. Design : The degree of income inequality, defined as the percentage of total household income received by the less well off 50% of households, and changes in income inequality were calculated for the 50 states in 1980 and 1990. These measures were then examined in relation to all cause mortality adjusted for age for each state, age specific deaths, changes in mortalities, and other health outcomes and potential pathways for 1980, 1990, and 1989-91. Main outcome measure : Age adjusted mortality from all causes. Results : There was a significant correlati

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  11. Is income inequality a determinant of population health? Part 1. A systematic review.

    J. Lynch, G. Smith, S. Harper, et al. · 2004 · The Milbank quarterly · 986 citations

    This article reviews 98 aggregate and multilevel studies examining the associations between income inequality and health. Overall, there seems to be little support for the idea that income inequality is a major, generalizable determinant of population health differences within or between rich countries. Income inequality may, however, directly influence some health outcomes, such as homicide in some contexts. The strongest evidence for direct health effects is among states in the United States, but even that is somewhat mixed. Despite little support for a direct effect of income inequality on health per se, reducing income inequality by raising the incomes of the most disadvantaged will impr

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  12. Income inequality, mortality, and self rated health: meta-analysis of multilevel studies

    Naoki Kondo, Grace Sembajwe, Ichiro Kawachi, et al. · 2009 · BMJ · 729 citations

    OBJECTIVE: To provide quantitative evaluations on the association between income inequality and health. DESIGN: Random effects meta-analyses, calculating the overall relative risk for subsequent mortality among prospective cohort studies and the overall odds ratio for poor self rated health among cross sectional studies. DATA SOURCES: PubMed, the ISI Web of Science, and the National Bureau for Economic Research database. Review methods Peer reviewed papers with multilevel data. Results The meta-analysis included 59 509 857 subjects in nine cohort studies and 1 280 211 subjects in 19 cross sectional studies. The overall cohort relative risk and cross sectional odds ratio (95% confidence inter

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  13. Income Inequality and Population Health in Sub-Saharan Africa: A Test of Income Inequality-Health Hypothesis

    Ibrahim Abidemi Odusanya, Anthony Enisan Akinlo, et al. · 2021 · Journal of Population and Social Studies · 232 citations

    Existing studies have shown that income inequality remains a core determinant of population health. These findings are in line with the Income Inequality-Health Hypothesis (IIHH). However, this assertion remains unclear for Sub-Saharan Africa (SSA), despite the rising trend of income disparity in the region and the vastness of the studies that tested the validity of the IIHH. This inferential study, therefore, examines the effect of income inequality on health for 31 Sub-Saharan African countries from 1995 to 2015 using life expectancy at birth, infant mortality rate, and under-five mortality rate as indicators of population health, as well as the Gini index as a measurement of income inequa

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  14. Income Inequality and Outcomes in Heart Failure: A Global Between-Country Analysis.

    P. Dewan, R. Rørth, P. Jhund, et al. · 2019 · JACC. Heart failure · 96 citations

    OBJECTIVES This study examined the relationship between income inequality and heart failure outcomes. BACKGROUND The income inequality hypothesis postulates that population health is influenced by income distribution within a society, with greater inequality associated with worse outcomes. METHODS This study analyzed heart failure outcomes in 2 large trials conducted in 54 countries. Countries were divided by tertiles of Gini coefficients (where 0% represented absolute income equality and 100% represented absolute income inequality), and heart failure outcomes were adjusted for standard prognostic variables, country per capita income, education index, hospital bed density, and health wor

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  15. Is Exposure to Income Inequality a Public Health Concern? Lagged Effects of Income Inequality on Individual and Population Health

    Jennifer M. Mellor, Jeffrey Milyo · 2003 · Health Services Research · 75 citations

    Objective. To examine the health consequences of exposure to income inequality.Data Sources. Secondary analysis employing data from several publicly available sources. Measures of individual health status and other individual characteristics are obtained from the March Current Population Survey (CPS). State‐level income inequality is measured by the Gini coefficient based on family income, as reported by the U.S. Census Bureau and Al‐Samarrie and Miller (1967). State‐level mortality rates are from the Vital Statistics of the United States; other state‐level characteristics are from U.S. census data as reported in the Statistical Abstract of the United States.Study Design. We examine the effe

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  16. Comparison of Health Outcomes among High- and Low-Income Adults Aged 55 to 64 in the US vs England

    Hwajung Choi, A. Steptoe, M. Heisler, et al. · 2020 · JAMA internal medicine · 51 citations

    Importance: Middle-aged adults in the US have worse health compared to adults in other high income countries such as England. Income inequality in the US is greater than in many other high income countries, which may contribute to especially poor health among low income adults in the US. Identifying health disparities, both within and across the US and England, is important for informing public health and public policy aimed at reducing these disparities. Objective: To compare the health of middle-aged adults in the US and England across the full distribution of income in each country. Design: Using the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA) for

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  18. Association between gender inequality and population-level health outcomes: Panel data analysis of organization for Economic Co-operation and Development (OECD) countries

    C. Veas, F. Crispi, C. Cuadrado · 2021 · EClinicalMedicine · 34 citations

    Background Gender plays a well-recognized role in shaping health inequities. However, the population-level health consequences of gender inequalities have not been measured comprehensively. The goal of this study was to evaluate the association between gender inequality and health indicators in organization for Economic Co-operation and Development (OECD) countries. Methods Ecological study based on 1990–2017 panel data for OECD member countries. Gender inequality was measured using the Gender Inequality Index (GII). The population health parameters evaluated were life expectancy (LE), healthy life expectancy (HALE), years of life lost (YLL), years lived with disability (YLD), disability-adj

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

    M. Shimonovich, M. Campbell, R. Thomson, et al. · 2024 · The Milbank Quarterly · 22 citations

    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 us

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  22. Area-level income inequality and oral health among Australian adults—A population-based multilevel study

    Ankur Singh, J. Harford, J. L. Antunes, et al. · 2018 · PLoS ONE · 22 citations

    Background A lack of evidence exists on the association between area-level income inequality and oral health within Australia. This study examined associations between area-level income inequality and oral health outcomes (inadequate dentition (<21 teeth) and poor self-rated oral health) among Australian adults. Variations in the association between area-level income inequality and oral health outcomes according to area-level mean income were also assessed. Finally, household-income gradients in oral health outcomes according to area-level income inequality were compared. Methods For the analyses, data on Australian dentate adults (n = 5,165 nested in 435 Local Government Areas (LGAs)) was o

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  23. Economic Inequality and Mental Health: Causality, Mechanisms, and Interventions.

    D. Rakesh, K. Shiba, M. Lamont, et al. · 2025 · Annual review of clinical psychology · 14 citations

    Almost all countries in the world have witnessed a rapid increase in levels of economic inequality, a measure of the distribution of income and wealth across the population, since the advent of neoliberal economic policies in the 1970s. In this review, we conceptualize inequality as an ecological construct and discuss why it matters for the mental health of populations and for individual clinical outcomes. We then discuss some of the key mechanisms through which economic inequality influences mental health beyond poverty itself: social comparison and social capital. We also consider how the effect might vary across specific vulnerable groups in the population, such as young people and minori

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  24. Income-Related Inequality in Traffic Accident Health Outcomes (Injury, Disability and Mortality): Evidence from the Nationwide Survey in Iran

    Payam Roshanfekr, Mohammad‐Reza Khodaie‐Ardakani, Homeira, et al. · 2020 · Iranian Journal of Public Health · 13 citations

    Background: Despite many efforts, Iran continues to have a high rate of traffic accidents and poor health outcomes. This study aimed to measure income-related inequality for traffic accident health outcomes in Iran, a country with one of the highest rates of traffic accidents and related health problems. Methods: The source of data was a national representative survey named the Iranian Multiple Indicator Demographic and Health Survey (IrMIDHS, 2010). Monthly household income is obtained through self-report in different quarters. Disparity rate ratio (DRR), slop index of inequality (SII) and the population attributable risk percentage measure (PAR%) were calculated. The concentration index (C

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