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Int J Health Serv. 2000;30(1):13-26.

The widening gap in death rates among income groups in the United States from 1967 to 1986.

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  • 1Massachusetts Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston 02108-4619, USA.


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.

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