Elsevier

Social Science & Medicine

Volume 56, Issue 6, March 2003, Pages 1139-1153
Social Science & Medicine

Mortality, inequality and race in American cities and states

https://doi.org/10.1016/S0277-9536(02)00115-6Get rights and content

Abstract

A number of studies have found that mortality rates are positively correlated with income inequality across the cities and states of the US. We argue that this correlation is confounded by the effects of racial composition. Across states and Metropolitan Statistical Areas (MSAs), the fraction of the population that is black is positively correlated with average white incomes, and negatively correlated with average black incomes. Between-group income inequality is therefore higher where the fraction black is higher, as is income inequality in general. Conditional on the fraction black, neither city nor state mortality rates are correlated with income inequality. Mortality rates are higher where the fraction black is higher, not only because of the mechanical effect of higher black mortality rates and lower black incomes, but because white mortality rates are higher in places where the fraction black is higher. This result is present within census regions, and for all age groups and both sexes (except for boys aged 1–9). It is robust to conditioning on income, education, and (in the MSA results) on state fixed effects. Although it remains unclear why white mortality is related to racial composition, the mechanism working through trust that is often proposed to explain the effects of inequality on health is also consistent with the evidence on racial composition and mortality.

Section snippets

Introduction and background

In recent years there has been a great deal of interest in whether income inequality is a health hazard in the sense that individuals are less healthy in places where income is more unequally distributed. The strongest advocate of the income inequality hypothesis has been Richard Deaton (2 (1992), Deaton (2 (1996), Wilkinson (1 (2000), who has put forward a variety of evidence, from individual, area, cross-country, and time-series data. A survey of the subsequent debate over this evidence is

Data and methodology

The data on mortality are taken from the Compressed Mortality Files (CMF), from the National Center for Health Statistics at the Center for Disease Control. The CMF contain a complete census of all deaths by year from 1968 to 1994, by cause of death, race, sex, age group, and county of residence, except for Alaska where only state-level data are available. The CMF files also provide population totals for each cell, which we use to calculate mortality rates as well as racial composition. We use

Basic results for states and MSAs

Table 1 shows results from the state data, including the District of Columbia, and pooling data from 1980 and 1990, so that there are 102 observations in each regression. All regressions include a dummy variable for 1990; if there is a decline in mortality rates that is unexplained by the included variables, the regression coefficient on the dummy should be negative, as is always in fact the case. The first two columns in the left-hand panels, for all males and all females irrespective of race,

Discussion and further exploration

What is it about the racial composition of places that affects their mortality rates? Or are the effects of racial composition as spurious as those of income inequality? One interpretation is that our results demonstrate, once again, the ecological fallacies and aggregation biases that are always a potential risk in using city or state level data and for which there is already a good deal of evidence in the health and education literatures; examples are Geronimus, Bound, and Neidert (1996)

Conclusions

Cross-section regressions across American states and cities show that, conditional on racial composition, income inequality does not raise the risk of mortality. The fraction of the population that is black is a significant risk-factor for mortality, not only for the population as a whole—which would follow mechanically from the fact that blacks have higher mortality rates than whites—but for both blacks and whites separately. Our empirical results provide no evidence that the association

Acknowledgements

We are grateful to Sam Bowles, Anne Case, Susan Dynarski, Vic Fuchs, Sandy Jencks, Adriana Lleras-Muney, Jeff Milyo, Christina Paxson, Robert Putnam, Richard Wilkinson, and two anonymous referees for helpful comments and discussions during the preparation of this paper. We gratefully acknowledge financial support from the John D. and Catherine T. MacArthur Foundation through its Network on Poverty and Inequality in Broader Perspectives, and from the National Institute on Aging through a grant

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