Individual income, income inequality, health, and mortality: What are the relationships?

Kevin Fiscella, Peter Franks

Research output: Contribution to journalArticlepeer-review

85 Scopus citations


Objective. To examine the pathways between income inequality, self-rated health, and mortality in the United States. Data Source. The first National Health and Nutrition Examination Survey and Epidemiologic Follow-up Study. Design. This was a longitudinal, multilevel study. Data Collection. Baseline data were collected on county income inequality, individual income, age, sex, self-rated health, level of depressive symptoms, and severity of biomedical morbidity from physical examination. Follow-up data included self-rated health assessed in 1982 through 1984 and mortality through 1987. Principal Findings. After adjustment for age and sex, income inequality had a modest independent effect on the level of depressive symptoms, and on baseline and follow-up self-rated health, but no independent effect on biomedical morbidity or subsequent mortality. Individual income had a larger effect on severity of biomedical morbidity, level of depressive symptoms, baseline and follow-up self-rated health, and mortality. Conclusion. Income inequality appears to have a small effect on self-rated health but not mortality; the effect is mediated in part by psychological, but not biomedical pathways. Individual income has a much larger effect on all of the health pathways.

Original languageEnglish (US)
Pages (from-to)307-318
Number of pages12
JournalHealth Services Research
Issue number1 II
StatePublished - Apr 2000
Externally publishedYes


  • Health status
  • Mortality
  • Social class
  • Socioeconomic factors

ASJC Scopus subject areas

  • Nursing(all)
  • Health(social science)
  • Health Professions(all)
  • Health Policy


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