This review focuses on the widening disparities in death rates by socioeconomic class. In recent years, there has been a major increase in the availability of data linking mortality risk and measures of socioeconomic status. The result has been a virtual explosion of new empirical research showing not only the existence of large inequities in the risk of death between those at the top and those at the bottom of the socioeconomic distribution, but also that the gaps have been growing. This assessment of the empirical research finds a consistent pattern of growing disparities within the United States. However, this widening gap in death rates does appear to be a uniquely American phenomenon, as the disparities by socioeconomic class appear to be stable or even declining in Europe and Canada.


Article metrics loading...

Loading full text...

Full text loading...


Literature Cited

  1. Attanasio OP, Hoynes HW. 1.  2000. Differential mortality and wealth accumulation. J. Hum. Resour. 35:11–29 [Google Scholar]
  2. Bor J, Cohen GH, Galea S. 2.  2017. Population health in an era of rising income inequality: USA, 1980–2015. Lancet 389:1475–90 [Google Scholar]
  3. Bosworth BP, Burtless G, Zhang Z. 3.  2016. Later Retirement, Inequality in Old Age, and the Growing Gap in Longevity Between Rich and Poor Washington, DC: Brookings
  4. Bound J, Geronimus AT, Rodriguez JM, Waidman TA. 4.  2014. The implications of differential trends in mortality for Social Security policy. Health Aff 34:122167–73 [Google Scholar]
  5. Case A, Deaton A. 5.  2013. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. PNAS 112:15078–83 [Google Scholar]
  6. Case A, Deaton A. 6.  2017. Mortality and morbidity in the 21st century. Brookings Papers Econ. Act. Spring:397–476 [Google Scholar]
  7. 7. CBO (Congr. Budget Off.). 2016.a The Distribution of Household Income and Federal Taxes, 2013 Washington, DC: CBO https://www.cbo.gov/publication/51361
  8. 8. CBO (Congr. Budget Off.). 2016.b Trends in Family Wealth, 1989–2013 Washington, DC: CBO https://www.cbo.gov/publication/51846
  9. Chetty R, Stepner M, Abraham S, Lin S, Scuderi B. 9.  et al. 2016. The association between income and life expectancy in the United States, 2001–2014. JAMA 315:161750–66 [Google Scholar]
  10. Cristia JP. 10.  2009. Rising mortality and life expectancy differentials by lifetime earnings in the United States. J. Health Econ. 28:984–95 [Google Scholar]
  11. Cunningham TJ, Croft JB, Liu Y, Lu H, Eke PI, Giles WH. 11.  2017. Vital signs: racial disparities in age-specific mortality among Blacks or African Americans—United States, 1999–2015. MMWR 66:17444–56 [Google Scholar]
  12. Currie J, Schwandt H. 12.  2016. Mortality inequality: the good news from a county-level approach. J. Econ. Perspect. 30:229–52 [Google Scholar]
  13. Cutler DM, Lleras-Muney A. 13.  2006. Education and health: evaluating theories and evidence NBER Work. Pap. 12352
  14. Dowd JB, Hamoudi A. 14.  2014. Is life expectancy really falling for groups of low socio-economic status? Lagged selection bias and artefactual trends in mortality. Int. J. Epidemiol. 43:4983–88 [Google Scholar]
  15. Duleep HO. 15.  1986. Measuring the effect of income on adult mortality using longitudinal administrative record data. J. Hum. Resourc. 21:238–51 [Google Scholar]
  16. Elo IT. 16.  2009. Social class differentials in health and mortality: patterns and explanations in comparative perspective. Annu. Rev. Sociol. 35:553–72 [Google Scholar]
  17. Elo IT, Preston SH. 17.  1996. Educational differentials in the United States: 1979–85. Soc. Sci. Med. 42:147–57 [Google Scholar]
  18. Feldman JJ, Makuc DM, Kleinman JC, Cornoni-Huntley J. 18.  1989. National trends in educational differences in mortality. Am. J. Epidemiol. 129:5919–33 [Google Scholar]
  19. Hendi AS. 19.  2017. Trends in education-specific life expectancy, data quality, and shifting education distributions: a note on recent research. Demography 54:31203–13 [Google Scholar]
  20. Ho JY. 20.  2013. Mortality under age 50 accounts for much of the fact that US life expectancy lags that of other high-income countries. Health Aff 32:3459–67 [Google Scholar]
  21. Ho JY. 21.  2017. The contribution of drug overdose to educational gradients in life expectancy in the United States, 1992–2011. Demography 54:31174–202 [Google Scholar]
  22. Hummer RA, Hernandez EM. 22.  2013. The effect of educational attainment on adult mortality in the United States. Popul. Bull. 68:11–16 [Google Scholar]
  23. James PD, Wilkins R, Detsky AS, Tugwell P, Manuel DG. 23.  2007. Avoidable mortality by neighbourhood income in Canada: 25 years after the establishment of universal health insurance. J. Epidemiol. Community Health 61:287–96 [Google Scholar]
  24. Kitagawa EM, Hauser PM. 24.  1973. Differential Mortality in the United States: A Study in Socioeconomic Epidemiology Cambridge, MA: Harvard Univ. Press
  25. Krieger N, Rehkopf DH, Chen JT, Waterman PD, Marcelli E, Kennedy M. 25.  2008. The fall and rise of US inequities in premature mortality: 1960–2002. PLOS Med 5:e46 [Google Scholar]
  26. Mackenbach JP, Kulhánová I, Artnik B, Bopp M, Borrell C. 26.  et al. 2016. Changes in mortality inequalities over two decades: register based study of European. BMJ 353:i1732 [Google Scholar]
  27. Marmot MG. 27.  2004. The Status Syndrome: How Social Standing Affects Our Health and Longevity New York: Henry Holt
  28. Masters RK, Hummer RA, Powers DA, Beck A, Lin S-F, Finch BK. 28.  2014. Long-term trends in adult mortality for U.S. blacks and whites: an examination of period- and cohort-based changes. Demography 51:2047–73 [Google Scholar]
  29. Meara E, Richards S, Cutler DM. 29.  2008. The gap gets bigger: changes in mortality and life expectancy, by education, 1981–2000. Health Aff 27:2350–60 [Google Scholar]
  30. 30. Natl. Acad. Sci. Eng. Med. 2015. The Growing Gap in Life Expectancy by Income: Implications for Federal Programs and Policy Responses Washington, DC: Natl. Acad. Press
  31. 31. Natl. Res. Counc. 2011. Explaining Divergent Levels of Longevity in High-Income Countries EM Crimmins, SH Preston, B Cohen Washington, DC: Natl. Acad. Press
  32. Olshansky SJ, Antonucci T, Berkman L, Binstock RH, Boersch-Supan B. 32.  et al. 2012. Differences in life expectancy due to race and educational differences are widening, and many may not catch up. Health Aff 31:81803–13 [Google Scholar]
  33. Pappas G, Queen S, Hadden W, Fisher G. 33.  1993. The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N. Engl. Med. 329:103–9 [Google Scholar]
  34. Piketty T, Saez E. 34.  2003. Income inequality in the U.S., 1913–1998. Q. J. Econ. 118:11–39 [Google Scholar]
  35. Preston SH, Elo I. 35.  1995. Are educational differentials in adult mortality increasing in the United States?. J. Aging Health 7:476–96 [Google Scholar]
  36. Preston SH, Taubman P. 36.  1994. Socioeconomic differences in adult mortality and health status. Demography of Aging LG Martin, SH Preston 279–318 Washington, DC: Natl. Acad. Press [Google Scholar]
  37. Putnam RD. 37.  2015. Our Kids: The American Dream in Crisis New York: Simon & Schuster
  38. Rastogi S, O'Hara A. 38.  2012. 2010 census match study 2010 Census Plan. Memo. Ser., No. 247 US Bur. Census Washington, DC: https://www.census.gov/content/dam/Census/library/publications/2012/dec/2010_cpex_247.pdf
  39. Rogers RR, Hummer RA, Nam CB. 39.  2000. Living and Dying in the USA: Behavioral, Health, and Social Differentials of Adult Mortality New York: Academic
  40. Rossen LM, Bastian B, Warner M, Khan D, Chong Y. 40.  2017. Drug poisoning mortality: United States, 1999–2015 Updated Aug. 25, Natl. Center Health Stat Atlanta: https://www.cdc.gov/nchs/data-visualization/drug-poisoning-mortality/
  41. Rossen LM, Khan D, Warner M. 41.  2013. Trends and geographic patterns in drug-poisoning death rates in the U.S., 1999–2009. Am. J. Prev. Med. 45:6e19–25 [Google Scholar]
  42. Rostron BL, Boies JL, Arias E. 42.  2010. Education Reporting and Classification on Death Certificates in the United States. Vital Health Stat 2151 Washington, DC: Natl. Cent. Health Stat https://www.cdc.gov/nchs/data/series/sr_02/sr02_151.pdf
  43. Scanlan JP. 43.  2016. The mismeasure of health disparities. J. Public Health Manag. Pract. 22:4415–19 [Google Scholar]
  44. Singh G, Siahpush M. 44.  2006. Widening socioeconomic inequalities in US life expectancy, 1980–2000. Int. J. Epidemiol. 35:969–79 [Google Scholar]
  45. Singh G, Siahpush M. 45.  2014. Widening rural-urban disparities in all-cause mortality and mortality from major causes of death in the USA, 1969–2009. J. Urban Health 91:2272–92 [Google Scholar]
  46. Sorlie PD, Johnson NJ. 46.  1996. Validity of education information on the death certificate. Epidemiology 7:4437–39 [Google Scholar]
  47. Waldron H. 47.  2007. Trends in mortality differentials and life expectancy for male social security-covered workers, by socioeconomic status. Soc. Sec. Bull. 67:31–28 [Google Scholar]
  48. Wilkins R, Berthelot J-M, Ng E. 48.  2002. Trends in mortality by neighborhood income in urban Canada from 1971 to 1996. Health Rep 13:Suppl.45–71 [Google Scholar]
  49. Wilkins R, Tjepkema M, Mustard M, Choinière R. 49.  2008. The Canadian census mortality follow-up study, 1991 through 2001. Health Rep 19:325–43 [Google Scholar]
  50. Williams DR, Mohammed SA, Leavell J, Collins C. 50.  2010. Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities. Ann. N. Y. Acad. Sci. 1186:69–101 [Google Scholar]
  51. Williams DR, Priest N, Anderson N. 51.  2016. Understanding associations between race, socioeconomic status and health: patterns and prospects. Health Psychol 35:4407–11 [Google Scholar]

Data & Media loading...

  • Article Type: Review Article
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error