Have We Narrowed the Gaps between the Poor and the Nonpoor?

Abstract

This report analyzes socioeconomic differentials in mortality in the United States during 1959-1961 and 1969-1971 by comparing mortality rates—overall and by age, cause of death, and race—and life expectancy for the ten highest and ten lowest states by per-capita income and for three geographic divisions. The divisions and their characteristics are: Middle Atlantic—high-income, urbanization, and industrialization, although also containing many urban poor; West North Central—high-income and rural; and East South Central—low-income and rural. An earlier study indicated that differentials had been narrowing for many years, reaching low levels by 1960. As the present study shows, during the ensuing decade the trend reversed direction and widened, due entirely to changes in rates during mid-life and at the older ages (45 to 54 and above). While mortality declined at these ages in the low-income states, the decline was much larger in the high-income states. By cause of death, it was due almost entirely to heart disease, which similarly declined more in the high-income states than in the low and also, though to a very small extent, to malignant neoplasms. Factors identified as possibly contributing to the widening include the greater availability during the 1960s to populations in the high-income states (even their urban poor) of medical and surgical advances against heart disease and malignant neoplasms, and the greater impact on the poor in these states, compared with the poor in other states, of social and medical programs, especially Medicaid.