Inequality in Place: Effects of Exposure to Neighborhood-Level Economic Inequality on Mortality

Abstract

This study contributes to the debate on whether income inequality is harmful for health by addressing several analytical weaknesses of previous studies. Using the Panel Study of Income Dynamics in combination with tract-level measures of income inequality in the United States, we estimate the effects of differential exposure to income inequality during three decades of the life course on mortality. Our study is among the first to consider the implications of income inequality within U.S. tracts for mortality using longitudinal and individual-level data. In addition, we improve upon prior work by accounting for the dynamic relationship between local areas and individuals' health, using marginal structural models to account for changes in exposure to local income inequality. In contrast to other studies that found no significant relation between income inequality and mortality, we find that recent exposure to higher local inequality predicts higher relative risk of mortality among individuals at ages 45 or older.

Does early childhood BCG vaccination improve survival into adulthood in a population with a low tuberculosis prevalence? Quasi-experimental evidence on non-specific effects from 39 Swedish birth cohorts

“…The proposed mechanism behind non-specific BCG effects is that early BCG vaccination improves general childhood immunity, which may confer a lasting health impact as individuals age (Cirovic et al, 2020; Dockrell & Smith, 2017). This hypothesis is consistent with life course theories in demography in population health that link early life conditions and events with later life morbidity and mortality (Case & Paxson, 2010; Cutler & Miller, 2005; Elo & Preston, 1992; Helgertz & Bengtsson, 2019; Masters, 2018; McEnry & Palloni, 2010; Palloni & Souza, 2013; van den Berg, Doblhammer-Reiter, & Christensen, 2011; Wen & Gu, 2011; Zhao, Hessel, Simon Thomas, & Beckfield, 2021). Despite the growing scientific interest over the past two decades, especially among laboratory scientists studying cellular-level immune response to the vaccine, it is still inconclusive whether the early childhood improvement in immune response created by the BCG vaccine has a causal impact on health in later life (Dockrell & Smith, 2017; Goodridge et al, 2016).…”

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

“…analyses included 2,916,576 individuals in 38 studies considering SRH and 14 studies with 10,727,470 million individuals considering mortality 141,[167][168][169][170][171][172][173][174][175][176][177][178][179] (study characteristics in Appendices 15 and 16, respectively). An additional seven reports considering SRH [180][181][182][183][184][185][186] and eight considering mortality, [187][188][189][190][191][192][193][194] including one natural experimental study, 191 were included in one or more of the subgroup or sensitivity analyses.…”

“…141 All but six (15.8%) were cross-sectional. 134,137,140,141,145,166 All studies considering mortality were cohort studies, with ten using the Gini coefficient 167,169,175,[177][178][179] and the other three using the median share. 141,168,176,187 Categorical measures of income inequality, using various cutoffs, were used by 12 studies considering SRH (31.6% 137,146,149,151,153,156,157,160,162,164,165 ) and five considering mortality (35.7% 172,175,178 ).…”

“…134,137,140,141,145,166 All studies considering mortality were cohort studies, with ten using the Gini coefficient 167,169,175,[177][178][179] and the other three using the median share. 141,168,176,187 Categorical measures of income inequality, using various cutoffs, were used by 12 studies considering SRH (31.6% 137,146,149,151,153,156,157,160,162,164,165 ) and five considering mortality (35.7% 172,175,178 ). In the SRH studies, income inequality was predominantly measured within countries at the regional (e.g., states; 14/38, 39.5% 134,135,140,142,144,149,151,154,156,159,162,166 ) or local (e.g., cities, neighborhoods; 16/38, 42.1% 130,131,136,…”

“…One study 145 which included a sample from multiple countries measured income inequality across regional (within-country) areas. Likewise, the mortality studies predominantly considered income inequality on a local (10/14, 71.4% 141,167,[170][171][172][173][174][175][176][177] ) or regional (28.6% 168,169,178,179 ) scale. We did not identify any that considered the relationship across multiple countries.…”