Background There is an inverse relation between socioeconomicstatus and mortality. Over the past several decades death ratesin the United States have declined, but it is unclear whetherall socioeconomic groups have benefited equally.
Methods Using records from the 1986 National Mortality FollowbackSurvey (n = 13,491) and the 1986 National Health Interview Survey(n = 30,725), we replicated the analysis by Kitagawa and Hauserof differential mortality in 1960. We calculated direct standardizedmortality rates and indirect standardized mortality ratios forpersons 25 to 64 years of age according to race, sex, income,and family status.
Results The inverse relation between mortality and socioeconomicstatus persisted in 1986 and was stronger than in 1960. Thedisparity in mortality rates according to income and educationincreased for men and women, whites and blacks, and family membersand unrelated persons. Over the 26-year period, the inequalitiesaccording to educational level increased for whites and blacksby over 20 percent in women and by over 100 percent in men.In whites, absolute death rates declined in persons of all educationallevels, but the reduction was greater for men and women withmore education than for those with less.
Conclusions Despite an overall decline in death rates in theUnited States since 1960, poor and poorly educated people stilldie at higher rates than those with higher incomes or bettereducations, and this disparity increased between 1960 and 1986.
Source Information
From the National Center for Health Statistics, Office of Planning and Extramural Programs, Rm. 1100, 6525 Belcrest Rd., Hyattsville, MD 20782, where reprint requests should be addressed to Dr. Pappas.
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A correction has been published: N Engl J Med 1993;329(15):1139.
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