Death rates in the United States have fallen since the 1960s, but improvements have not been shared equally by all groups. This study investigates the change in inequality in mortality by income level from 1967 to 1986. Comparable death rates are constructed for 1967 and 1986 using National Mortality Followback Surveys as numerators and National Health Interview Surveys as denominators. Direct age-adjusted death rates are calculated for income levels for the U.S. noninstitutionalized civilian population 35 to 64 years old. A summary measure of inequality in mortality adjusts for differences in the size and definition of income groups in the two years. In both 1967 and 1986, mortality decreased with each rise in income level. Measured in relative terms, this inverse relationship was greater in 1986 then in 1967 for men and women, blacks and whites. Between 1967 and 1986, death rates for those with maximal income declined between two and three times more rapidly than did rates for the middle and low income groups. The greatest increase in relative inequality was seen among white males.

Twenty-three volunteers participated in a double-blind, randomized trial comparing the steroid dexamethasone 4 mg to placebo every 12 h as prophylaxis against acute mountain sickness (AMS) during a rapid ascent to a shelter on Mt Chaclataya, Bolivia. From sea level, subjects were transported by air and land vehicles to 5334 m within a 72-h period. They were evaluated by cerebral scores derived from the Environmental Symptom Questionnaire and confirmed by AMS-C and AMS-R scores. After 6–8 h at high altitude (day 3), the number of ill persons in the dexamethasone group was less than those ill in the placebo group (χ2 = 7.43, p = 0.01) by chi-square and Fisher's exact tests. After 20 h at high altitude (day 4), the contrast between groups diminished (χ2 = 2.10, p = 0.214). ANOVA and t-test showed that mean cumulative AMS scores of the dexamethasone group were significantly lower ( p = 0.01, p = 0.02) than those of the placebo group for both days at high altitude, despite an approximate 82% increase in the mean cumulative score of the dexamethasone group from day 3 to day 4. We conclude that dexamethasone 4 mg every 12 h, though initially effective, was not sufficient to sustain prophylaxis from AMS symptoms at 5334 m.

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