This study is designed to (1) extend previous analyses of trends in socioeconomic inequality in all cause and cause-specific mortality by age and sex in the United States, (2) investigate whether these trends have been similar among whites and African Americans, and (3) examine trends in the distribution of various risk factors, such as obesity and smoking, by socioeconomic status. The results of these analyses will help determine whether the documented increase in socioeconomic inequalities in mortality between 1960 and the 1980s has continued into the 1990s. The cause-specific investigations together with the analyses of trends in mortality risk factors by SES will point to areas where public health interventions might be most effective. The results will also provide input into further studies designed to illuminate the processes that link SES to health and mortality.
This study will extend previous analyses of trends in socioeconomic inequality in all cause and cause-specific mortality by age and sex in the United States by investigating whether these trends have been similar among whites and African Americans and by relating these findings to trends in the distribution of risk factors, such as obesity and smoking. The data come from Kitagawa and Hauser study for 1960, and the National Longitudinal Mortality Study (NLMS) and the National Health Interview Survey (1987-1994) linkage to the National Death Index for later decades. The Slope Index of Inequality (SII) is used to examine both absolute and relative differentials in inequality, as well as the percentage contribution of various cause-of-death groups to absolute inequality. The SII provides an estimate of how much change in death rates is associated with increased educational attainment. The second measure we employ is the Index of Dissimilarity, which is widely used in the social sciences as a summary measure of the difference between two distributions. In our case the two distributions to be compared are the distributions of deaths (all or cause-specific) and population at risk of dying by educational attainment. The same method will be adapted whenever possible to examine risk factor distributions by educational attainment over time. The results of these analyses will help determine whether the documented increase in socioeconomic inequalities in mortality between 1960 and the 1980s has continued into the 1990s. The cause-specific investigations together with the analyses of trends in mortality risk factors by SES will point to areas where public health interventions might be most effective. The results will also provide input into further studies designed to illuminate the processes that link SES to health and mortality.