The associations between US state and local social spending, income inequality, and individual all-cause and cause-specific mortality: The National Longitudinal Mortality Study

PREVENTIVE MEDICINE

卷:84

Article

Kim, Daniel^1,2,3,4 

[1] Northeastern Univ, Dept Hlth Sci, Bouve Coll Hlth Sci, Boston, MA 02115 USA

[2] Harvard Univ, Dept Social & Behav Sci, TH Chan Sch Publ Hlth, Boston, MA 02115 USA

[3] Paris Descartes Univ, Sorbonne Paris Cite, EHESP Sch Publ Hlth, Paris, France

[4] 360 Huntington Ave,Robinson Hall,Suite 209D, Boston, MA 02115 USA

关键词: Social spending;    Income inequality;    Social determinants of health;   

DOI  :  10.1016/j.ypmed.2015.11.013

来源: Elsevier

【 摘 要 】

Objective. To investigate government state and local spending on public goods and income inequality as predictors of the risks of dying. Methods. Data on 431,637 adults aged 30-74 and 375,354 adults aged 20-44 in the 48 contiguous US states were used from the National Longitudinal Mortality Study to estimate the impacts of state and local spending and income inequality on individual risks of all-cause and cause-specific mortality for leading causes of death in younger and middle-aged adults and older adults. To reduce bias, models incorporated state fixed effects and instrumental variables. Results. Each additional $250 per capita per year spent on welfare predicted a 3-percentage point (- 0.031, 95% CI: - 0.059, -0.0027) lower probability of dying from any cause. Each additional $250 per capita spent on welfare and education predicted 1.6-percentage point (-0.016, 95% CI: - 0.031, -0.0011) and 0.8-percentage point (-0.008, 95% CI: - 0.0156, -0.00024) lower probabilities of dying from coronary heart disease (CHD), respectively. No associations were found for colon cancer or chronic obstructive pulmonary disease; for diabetes, external injury, and suicide, estimates were inverse but modest in magnitude. A 0.1 higher Gini coefficient (higher income inequality) predicted 1-percentage point (0.010, 95% CI: 0.0026, 0.0180) and 0.2-percentage point (0.002, 95% CI: 0.001, 0.002) higher probabilities of dying from CHD and suicide, respectively. Conclusions. Empirical linkages were identified between state-level spending on welfare and education and lower individual risks of dying, particularly from CHD and all causes combined. State-level income inequality predicted higher risks of dying from CHD and suicide. (C) 2015 The Author. Published by Elsevier Inc.

【 授权许可】

Free