Inequality in Adult Mortality in the United States: Measurement and Determinants

Emmanuela E. Gakidou, World Health Organization (WHO)
Ajay Tandon, World Health Organization (WHO)
Gary King, Harvard University

Many studies exist on inequalities in mortality rates across subgroups of a population, defined by income, education, race, occupation, etc. This study examines inequality across individuals in the US, using the National Health Interview Survey linked to the National Death Index for 1987-97. The proposed method uses a survival analysis model with a Gompertz distribution on the baseline hazard and a gamma distribution on the random effect to predict an individual's probability of death based on the individual’s set of covariates and geographic area in which they reside. Results suggest there is more inequality in risk of death among males than females. By age and sex, the predicted average hazard rate is presented along with absolute and relative measures of inequality in the distributions of risk of death. The effect of the main determinants of inequality including income, education, self-reported health status, and use of health services is studied.