FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 329:103-109 July 8, 1993 Number 2 Next

	Full Text Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article PubMed Citation

ABSTRACT

Background There is an inverse relation between socioeconomic status and mortality. Over the past several decades death rates in the United States have declined, but it is unclear whether all socioeconomic groups have benefited equally.

Methods Using records from the 1986 National Mortality Followback Survey (n = 13,491) and the 1986 National Health Interview Survey (n = 30,725), we replicated the analysis by Kitagawa and Hauser of differential mortality in 1960. We calculated direct standardized mortality rates and indirect standardized mortality ratios for persons 25 to 64 years of age according to race, sex, income, and family status.

Results The inverse relation between mortality and socioeconomic status persisted in 1986 and was stronger than in 1960. The disparity in mortality rates according to income and education increased for men and women, whites and blacks, and family members and unrelated persons. Over the 26-year period, the inequalities according to educational level increased for whites and blacks by over 20 percent in women and by over 100 percent in men. In whites, absolute death rates declined in persons of all educational levels, but the reduction was greater for men and women with more education than for those with less.

Conclusions Despite an overall decline in death rates in the United States since 1960, poor and poorly educated people still die at higher rates than those with higher incomes or better educations, 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.

Full Text of this Article

This article has been cited by other articles:

• Chapman, B. P., Fiscella, K., Kawachi, I., Duberstein, P. R. (2009). Personality, Socioeconomic Status, and All-Cause Mortality in the United States. Am J Epidemiol 0: kwp323v1-kwp323 [Abstract] [Full Text]  
• Jia, H., Lubetkin, E. I. (2009). The statewide burden of obesity, smoking, low income and chronic diseases in the United States. J Public Health (Oxf) 31: 496-505 [Abstract] [Full Text]  
• Gjonca, E, Tabassum, F, Breeze, E (2009). Socioeconomic differences in physical disability at older age. J. Epidemiol. Community Health 63: 928-935 [Abstract] [Full Text]  
• Beckfield, J., Krieger, N. (2009). Epi + demos + cracy: Linking Political Systems and Priorities to the Magnitude of Health Inequities--Evidence, Gaps, and a Research Agenda. Epidemiol Rev 31: 152-177 [Abstract] [Full Text]  
• Sokka, T, Kautiainen, H, Pincus, T, Toloza, S, da Rocha Castelar Pinheiro, G, Lazovskis, J, Hetland, M L, Peets, T, Immonen, K, Maillefert, J F, Drosos, A A, Alten, R, Pohl, C, Rojkovich, B, Bresnihan, B, Minnock, P, Cazzato, M, Bombardieri, S, Rexhepi, S, Rexhepi, M, Andersone, D, Stropuviene, S, Huisman, M, Sierakowski, S, Karateev, D, Skakic, V, Naranjo, A, Baecklund, E, Henrohn, D, Gogus, F, Badsha, H, Mofti, A, Taylor, P, McClinton, C, Yazici, Y (2009). Disparities in rheumatoid arthritis disease activity according to gross domestic product in 25 countries in the QUEST-RA database. Ann Rheum Dis 68: 1666-1672 [Abstract] [Full Text]  
• Ludvigsson, J. F., Montgomery, S. M., Ekbom, A., Brandt, L., Granath, F. (2009). Small-Intestinal Histopathology and Mortality Risk in Celiac Disease. JAMA 302: 1171-1178 [Abstract] [Full Text]  
• Montez, J. K., Hayward, M. D., Brown, D. C., Hummer, R. A. (2009). Why Is the Educational Gradient of Mortality Steeper for Men?. J Gerontol B Psychol Sci Soc Sci 64B: 625-634 [Abstract] [Full Text]  
• Trinidad, D. R., Perez-Stable, E. J., Emery, S. L., White, M. M., Grana, R. A., Messer, K. S. (2009). Intermittent and light daily smoking across racial/ethnic groups in the United States. Nicotine Tob Res 0: ntn018v1-ntn018 [Abstract] [Full Text]  
• Kim, J. (2008). Intercohort Trends in the Relationship Between Education and Health: Examining Physical Impairment and Depressive Symptomatology. J Aging Health 20: 671-693 [Abstract]  
• Augustin, T., Glass, T. A., James, B. D., Schwartz, B. S. (2008). Neighborhood Psychosocial Hazards and Cardiovascular Disease: The Baltimore Memory Study. AJPH 98: 1664-1670 [Abstract] [Full Text]  
• Nabi, H., Kivimaki, M., Marmot, M. G, Ferrie, J., Zins, M., Ducimetiere, P., Consoli, S. M, Singh-Manoux, A. (2008). Does personality explain social inequalities in mortality? The French GAZEL cohort study. Int J Epidemiol 37: 591-602 [Abstract] [Full Text]  
• Gerber, Y., Weston, S. A., Killian, J. M., Therneau, T. M., Jacobsen, S. J., Roger, V. L. (2008). Neighborhood Income and Individual Education: Effect on Survival After Myocardial Infarction. Mayo Clin Proc. 83: 663-669 [Abstract] [Full Text]  
• Darmon, N., Drewnowski, A. (2008). Does social class predict diet quality?. Am. J. Clin. Nutr. 87: 1107-1117 [Abstract] [Full Text]  
• Arendt, J. N., Lauridsen, J. (2008). Do risk factors explain more of the social gradient in self-reported health when adjusting for baseline health?. Eur J Public Health 18: 131-137 [Abstract] [Full Text]  
• Meara, E. R., Richards, S., Cutler, D. M. (2008). The Gap Gets Bigger: Changes In Mortality And Life Expectancy, By Education, 1981-2000. Health Aff (Millwood) 27: 350-360 [Abstract] [Full Text]  
• Lederer, D. J., Benn, E. K. T., Barr, R. G., Wilt, J. S., Reilly, G., Sonett, J. R., Arcasoy, S. M., Kawut, S. M. (2008). Racial Differences in Waiting List Outcomes in Chronic Obstructive Pulmonary Disease. Am. J. Respir. Crit. Care Med. 177: 450-454 [Abstract] [Full Text]  
• Mirowsky, J., Ross, C. E. (2008). Education and Self-Rated Health: Cumulative Advantage and Its Rising Importance. Research on Aging 30: 93-122 [Abstract]  
• Moody-Ayers, S., Lindquist, K., Sen, S., Covinsky, K. E. (2007). Childhood Social and Economic Well-Being and Health in Older Age. Am J Epidemiol 166: 1059-1067 [Abstract] [Full Text]  
• Etowa, J. B., Bernard, W. T., Oyinsan, B., Clow, B. (2007). Participatory Action Research (PAR): An Approach for Improving Black Women's Health in Rural and Remote Communities. J Transcult Nurs 18: 349-357 [Abstract]  
• Baker, D. W., Wolf, M. S., Feinglass, J., Thompson, J. A., Gazmararian, J. A., Huang, J. (2007). Health Literacy and Mortality Among Elderly Persons. Arch Intern Med 167: 1503-1509 [Abstract] [Full Text]  
• Feinglass, J., Lin, S., Thompson, J., Sudano, J., Dunlop, D., Song, J., Baker, D. W. (2007). Baseline Health, Socioeconomic Status, and 10-Year Mortality Among Older Middle-Aged Americans: Findings From the Health and Retirement Study, 1992 2002. Journals of Gerontology Series B: Psychological Sciences and Social Science 62: S209-S217 [Abstract] [Full Text]  
• Martikainen, P., Blomgren, J., Valkonen, T. (2007). Change in the total and independent effects of education and occupational social class on mortality: analyses of all Finnish men and women in the period 1971-2000. J. Epidemiol. Community Health 61: 499-505 [Abstract] [Full Text]  
• Clark, D. O., Stump, T. E., Miller, D. K., Long, J. S. (2007). Educational Disparities in the Prevalence and Consequence of Physical Vulnerability. Journals of Gerontology Series B: Psychological Sciences and Social Science 62: S193-S197 [Abstract] [Full Text]  
• Singh, G. K., Kogan, M. D. (2007). Persistent Socioeconomic Disparities in Infant, Neonatal, and Postneonatal Mortality Rates in the United States, 1969-2001. Pediatrics 119: e928-e939 [Abstract] [Full Text]  
• Stewart, A. L., Dean, M. L., Gregorich, S. E., Brawarsky, P., Haas, J. S. (2007). Race/Ethnicity, Socioeconomic Status and the Health of Pregnant Women. J Health Psychol 12: 285-300 [Abstract]  
• Blazer, D. G., Sachs-Ericsson, N., Hybels, C. F. (2007). Perception of Unmet Basic Needs as a Predictor of Depressive Symptoms Among Community-Dwelling Older Adults. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 62: 191-195 [Abstract] [Full Text]  
• Nummela, O. P., Sulander, T. T., Heinonen, H. S., Uutela, A. K. (2007). Self-rated health and indicators of SES among the ageing in three types of communities. Scand J Public Health 35: 39-47 [Abstract]  
• Minkler, M., Fuller-Thomson, E., Guralnik, J. M. (2006). Gradient of Disability across the Socioeconomic Spectrum in the United States.. NEJM 355: 695-703 [Abstract] [Full Text]  
• Singh, G. K, Siahpush, M. (2006). Widening socioeconomic inequalities in US life expectancy, 1980-2000. Int J Epidemiol 35: 969-979 [Abstract] [Full Text]  
• Regidor, E., Ronda, E., Pascual, C., Martinez, D., Calle, M. E., Dominguez, V. (2006). Decreasing Socioeconomic Inequalities and Increasing Health Inequalities in Spain: A Case Study. AJPH 96: 102-108 [Abstract] [Full Text]  
• Baker, K. S., Loberiza, F. R. Jr, Yu, H., Cairo, M. S., Bolwell, B. J., Bujan-Boza, W. A., Camitta, B. M., Garcia, J. J., Ho, W. G., Liesveld, J. L., Maharaj, D., Marks, D. I., Schultz, K. R., Wiernik, P., Zander, A. R., Horowitz, M. M., Keating, A., Weisdorf, D. J. (2005). Outcome of Ethnic Minorities With Acute or Chronic Leukemia Treated With Hematopoietic Stem-Cell Transplantation in the United States. JCO 23: 7032-7042 [Abstract] [Full Text]  
• Hemmingsson, T., Lundberg, I. (2005). Can large relative mortality differences between socio-economic groups among Swedish men be explained by risk indicator-associated social mobility?. Eur J Public Health 15: 518-522 [Abstract] [Full Text]  
• House, J. S., Lantz, P. M., Herd, P. (2005). Continuity and Change in the Social Stratification of Aging and Health Over the Life Course: Evidence From a Nationally Representative Longitudinal Study From 1986 to 2001/2002 (Americans' Changing Lives Study). Journals of Gerontology Series B: Psychological Sciences and Social Science 60: S15-S26 [Abstract] [Full Text]  
• Frye, V., Hosein, V., Waltermaurer, E., Blaney, S., Wilt, S. (2005). Femicide in New York City: 1990 to 1999. Homicide Studies 9: 204-228 [Abstract]  
• Berkman, L. F. (2005). Tracking Social and Biological Experiences: The Social Etiology of Cardiovascular Disease. Circulation 111: 3022-3024 [Full Text]  
• Moody-Ayers, S. Y., Mehta, K. M., Lindquist, K., Sands, L., Covinsky, K. E. (2005). Black-White Disparities in Functional Decline in Older Persons: The Role of Cognitive Function. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 60: 933-939 [Abstract] [Full Text]  
• Rehman, S. U., Hutchison, F. N., Hendrix, K., Okonofua, E. C., Egan, B. M. (2005). Ethnic Differences in Blood Pressure Control Among Men at Veterans Affairs Clinics and Other Health Care Sites. Arch Intern Med 165: 1041-1047 [Abstract] [Full Text]  
• Pincus, T, Lee, S J, Kavanaugh, A (2005). Disparities in health according to socioeconomic status * Authors' reply. Ann Rheum Dis 64: 795-795 [Full Text]  
• Sloan, R. P, Huang, M.-H., Sidney, S., Liu, K., Williams, O D., Seeman, T. (2005). Socioeconomic status and health: is parasympathetic nervous system activity an intervening mechanism?. Int J Epidemiol 34: 309-315 [Abstract] [Full Text]  
• Blazer, D. G., Sachs-Ericsson, N., Hybels, C. F. (2005). Perception of Unmet Basic Needs as a Predictor of Mortality Among Community-Dwelling Older Adults. AJPH 95: 299-304 [Abstract] [Full Text]  
• Regidor, E. (2004). Measures of health inequalities: part 1. J. Epidemiol. Community Health 58: 858-861 [Abstract] [Full Text]  
• Pincus, T. (2004). Will Racial and Ethnic Disparities in Health Be Resolved Primarily Outside of Standard Medical Care?. ANN INTERN MED 141: 224-225 [Full Text]  
• Steenland, K., Hu, S., Walker, J. (2004). All-Cause and Cause-Specific Mortality by Socioeconomic Status Among Employed Persons in 27 US States, 1984-1997. AJPH 94: 1037-1042 [Abstract] [Full Text]  
• Steenland, K., Henley, J., Calle, E., Thun, M. (2004). Individual- and Area-Level Socioeconomic Status Variables as Predictors of Mortality in a Cohort of 179,383 Persons. Am J Epidemiol 159: 1047-1056 [Abstract] [Full Text]  
• Ferrer, R L, Palmer, R (2004). Variations in health status within and between socioeconomic strata. J. Epidemiol. Community Health 58: 381-387 [Abstract] [Full Text]  
• Vahtera, J, Pentti, J, Kivimaki, M (2004). Sickness absence as a predictor of mortality among male and female employees. J. Epidemiol. Community Health 58: 321-326 [Abstract] [Full Text]  
• Rodriguez, C. J., Sciacca, R. R., Diez-Roux, A. V., Boden-Albala, B., Sacco, R. L., Homma, S., DiTullio, M. R. (2004). Relation Between Socioeconomic Status, Race-Ethnicity, and Left Ventricular Mass: The Northern Manhattan Study. Hypertension 43: 775-779 [Abstract] [Full Text]  
• Zimmer, Z., Chayovan, N., Lin, H.-S., Natividad, J. (2004). How Indicators of Socioeconomic Status Relate to Physical Functioning of Older Adults in Three Asian Societies. Research on Aging 26: 224-258 [Abstract]  
• Zimmer, Z., Kwong, J. (2004). Socioeconomic Status and Health among Older Adults in Rural and Urban China. J Aging Health 16: 44-70 [Abstract]  
• Roos, N. P., Forget, E., Walld, R., MacWilliam, L. (2004). Does universal comprehensive insurance encourage unnecessary use? Evidence from Manitoba says "no". CMAJ 170: 209-214 [Abstract] [Full Text]  
• Sundquist, K, Malmstrom, M, Johansson, S-E (2004). Neighbourhood deprivation and incidence of coronary heart disease: a multilevel study of 2.6 million women and men in Sweden. J. Epidemiol. Community Health 58: 71-77 [Abstract] [Full Text]  
• Margellos, H., Silva, A., Whitman, S. (2004). Comparison of Health Status Indicators in Chicago: Are Black-White Disparities Worsening?. AJPH 94: 116-121 [Abstract] [Full Text]  
• Mustard, C A, Etches, J (2003). Gender differences in socioeconomic inequality in mortality. J. Epidemiol. Community Health 57: 974-980 [Abstract] [Full Text]  
• Leinsalu, M., Vagero, D., Kunst, A. E (2003). Estonia 1989-2000: enormous increase in mortality differences by education. Int J Epidemiol 32: 1081-1087 [Abstract] [Full Text]  
• Zimmer, Z., House, J. S (2003). Education, income, and functional limitation transitions among American adults: contrasting onset and progression. Int J Epidemiol 32: 1089-1097 [Abstract] [Full Text]  
• Wilson, R. S., Bienias, J. L., Mendes de Leon, C. F., Evans, D. A., Bennett, D. A. (2003). Negative Affect and Mortality in Older Persons. Am J Epidemiol 158: 827-835 [Abstract] [Full Text]  
• Williams, R. B. (2003). Invited Commentary: Socioeconomic Status, Hostility, and Health Behaviors--Does It Matter Which Comes First?. Am J Epidemiol 158: 743-746 [Full Text]  
• Koskinen, S. (2003). Commentary: Is there a common background behind growing inequalities in mortality in Western European countries?. Int J Epidemiol 32: 838-839 [Full Text]  
• Galobardes, B., Costanza, M. C., Bernstein, M. S., Delhumeau, C., Morabia, A. (2003). Trends in Risk Factors for Lifestyle-Related Diseases by Socioeconomic Position in Geneva, Switzerland, 1993-2000: Health Inequalities Persist. AJPH 93: 1302-1309 [Abstract] [Full Text]  
• Singh, G. K. (2003). Area Deprivation and Widening Inequalities in US Mortality, 1969-1998. AJPH 93: 1137-1143 [Abstract] [Full Text]  
• Sin, D. D., Svenson, L. W., Cowie, R. L., Man, S. F. P. (2003). Can Universal Access to Health Care Eliminate Health Inequities Between Children of Poor and Nonpoor Families?: A Case Study of Childhood Asthma in Alberta. Chest 124: 51-56 [Abstract] [Full Text]  
• Fryer, G. E. Jr, Green, L. A., Dovey, S. M., Yawn, B. P., Phillips, R. L., Lanier, D. (2003). Variation in the Ecology of Medical Care. Ann Fam Med 1: 81-89 [Abstract] [Full Text]  
• Winkleby, M A, Cubbin, C (2003). Influence of individual and neighbourhood socioeconomic status on mortality among black, Mexican-American, and white women and men in the United States. J. Epidemiol. Community Health 57: 444-452 [Abstract] [Full Text]  
• Bopp, M., Minder, C. E (2003). Mortality by education in German speaking Switzerland, 1990-1997: results from the Swiss National Cohort. Int J Epidemiol 32: 346-354 [Abstract] [Full Text]  
• Spillman, B. C., Murtaugh, C. M., Warshawsky, M. J. (2003). Policy Implications of an Annuity Approach to Integrating Long-Term Care Financing and Retirement Income. J Aging Health 15: 45-73 [Abstract]  
• Blumenthal, H. T. (2003). The Aging-Disease Dichotomy: True or False?. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 58: M138-145 [Full Text]  
• Booth, G. L., Hux, J. E. (2003). Relationship Between Avoidable Hospitalizations for Diabetes Mellitus and Income Level. Arch Intern Med 163: 101-106 [Abstract] [Full Text]  
• Steinberg, A. G., Iezzoni, L. I., Conill, A., Stineman, M. (2002). Reasonable Accommodations for Medical Faculty With Disabilities. JAMA 288: 3147-3154 [Abstract] [Full Text]  
• Alegria, M., Canino, G., Rios, R., Vera, M., Calderon, J., Rusch, D., Ortega, A. N. (2002). Mental Health Care for Latinos: Inequalities in Use of Specialty Mental Health Services Among Latinos, African Americans, and Non-Latino Whites. Psychiatr. Serv. 53: 1547-1555 [Abstract] [Full Text]  
• Robert, S. A., Lee, K. Y. (2002). Explaining Race Differences in Health among Older Adults: The Contribution of Community Socioeconomic Context. Research on Aging 24: 654-683 [Abstract]  
• Steenland, K., Henley, J., Thun, M. (2002). All-Cause and Cause-specific Death Rates by Educational Status for Two Million People in Two American Cancer Society Cohorts, 1959-1996. Am J Epidemiol 156: 11-21 [Abstract] [Full Text]  
• Schulz, A. J., Parker, E. A., Israel, B. A., Allen, A., Decarlo, M., Lockett, M. (2002). Addressing Social Determinants of Health through Community-Based Participatory Research: The East Side Village Health Worker Partnership. Health Educ Behav 29: 326-341 [Abstract]  
• Singh, G. K, Siahpush, M. (2002). Increasing inequalities in all-cause and cardiovascular mortality among US adults aged 25-64 years by area socioeconomic status, 1969-1998. Int J Epidemiol 31: 600-613 [Abstract] [Full Text]  
• Colgrove, J. (2002). The McKeown Thesis: A Historical Controversy and Its Enduring Influence. AJPH 92: 725-729 [Abstract] [Full Text]  
• Astone, N. M., Ensminger, M., Juon, H. S. (2002). Early Adult Characteristics and Mortality Among Inner-City African American Women. AJPH 92: 640-645 [Abstract] [Full Text]  
• Bassuk, S. S., Berkman, L. F., Amick, B. C. III (2002). Socioeconomic Status and Mortality among the Elderly: Findings from Four US Communities. Am J Epidemiol 155: 520-533 [Abstract] [Full Text]  
• Adler, N. E., Newman, K. (2002). Socioeconomic Disparities In Health: Pathways And Policies. Health Aff (Millwood) 21: 60-76 [Abstract] [Full Text]  
• Skarbinski, J., Walker, H. K., Baker, L. C., Kobaladze, A., Kirtava, Z., Raffin, T. A. (2002). The Burden of Out-of-Pocket Payments for Health Care in Tbilisi, Republic of Georgia. JAMA 287: 1043-1049 [Abstract] [Full Text]  
• Husaini, B. A., Sherkat, D. E., Levine, R., Bragg, R., Holzer, C., Anderson, K., Cain, V., Moten, C. (2002). Race, Gender, and Health Care Service Utilization and Costs among Medicare Elderly with Psychiatric Diagnoses. J Aging Health 14: 79-95 [Abstract]  
• Zimmer, Z., Hermalin, A. I., Lin, H.-S. (2002). Whose Education Counts? The Added Impact of Adult-Child Education on Physical Functioning of Older Taiwanese. Journals of Gerontology Series B: Psychological Sciences and Social Science 57: S23-32 [Abstract] [Full Text]  
• Kapral, M. K., Wang, H., Mamdani, M., Tu, J. V., Boden-Albala, B., Sacco, R. L. (2002). Effect of Socioeconomic Status on Treatment and Mortality After Stroke * Editorial Comment. Stroke 33: 268-275 [Abstract] [Full Text]  
• Reijneveld, S. A, Stronks, K. (2001). The validity of self-reported use of health care across socioeconomic strata: a comparison of survey and registration data. Int J Epidemiol 30: 1407-1414 [Abstract] [Full Text]  
• Dandona, R., Dandona, L. (2001). Socioeconomic status and blindness. Br J Ophthalmol 85: 1484-1488 [Full Text]  
• RANK, M. R. (2001). The Effect of Poverty on America's Families: Assessing Our Research Knowledge. Journal of Family Issues 22: 882-903 [Abstract]  
• Bhatia, R., Katz, M. (2001). Estimation of Health Benefits From a Local Living Wage Ordinance. AJPH 91: 1398-1402 [Abstract] [Full Text]  
• Marmot, M. (2001). Inequalities in Health. NEJM 345: 134-136 [Full Text]  
• Dionne, C E, Von Korff, M, Koepsell, T D, Deyo, R A, Barlow, W E, Checkoway, H (2001). Formal education and back pain: a review. J. Epidemiol. Community Health 55: 455-468 [Abstract] [Full Text]  
• Hakim, R. B., Bye, B. V. (2001). Effectiveness of Compliance With Pediatric Preventive Care Guidelines Among Medicaid Beneficiaries. Pediatrics 108: 90-97 [Abstract] [Full Text]  
• House, J. S. (2001). Relating Social Inequalities in Health and Income. Journal of Health Politics, Policy and Law 26: 523-532  
• Pearson, T.A., Wall, S., Lewis, C., Jenkins, P.L., Nafziger, A., Weinehall, L. (2001). Dissecting the ``black box' ' of community intervention: Lessons from community-wide cardiovascular disease prevention programs in the US and Sweden. Scand J Public Health 29: 69-78  
• Fitzpatrick, R. (2001). Social Status and Mortality. ANN INTERN MED 134: 1001-1003 [Full Text]