Citation

Kim D. Prev. Med. 2015; 84: 62-68.

Affiliation

Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, United States; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, United States; Department of Social and Behavioral Sciences, French School of Public Health, Rennes, France. Electronic address: dkim@neu.edu.

Copyright

(Copyright © 2015, Elsevier Publishing)

DOI

10.1016/j.ypmed.2015.11.013

PMID

26607868

Abstract

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 also predicted higher risks of dying from CHD and suicide.

Language: en