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. 2010 Apr 1;100 Suppl 1(Suppl 1):S186-96.
doi: 10.2105/AJPH.2009.166082. Epub 2010 Feb 10.

Socioeconomic disparities in health in the United States: what the patterns tell us

Paula A Braveman  1 , Catherine Cubbin, Susan Egerter, David R Williams, Elsie Pamuk
Affiliations

Socioeconomic disparities in health in the United States: what the patterns tell us

Paula A Braveman et al. Am J Public Health. .

Abstract

Objectives: We aimed to describe socioeconomic disparities in the United States across multiple health indicators and socioeconomic groups.

Methods: Using recent national data on 5 child (infant mortality, health status, activity limitation, healthy eating, sedentary adolescents) and 6 adult (life expectancy, health status, activity limitation, heart disease, diabetes, obesity) health indicators, we examined indicator rates across multiple income or education categories, overall and within racial/ethnic groups.

Results: Those with the lowest income and who were least educated were consistently least healthy, but for most indicators, even groups with intermediate income and education levels were less healthy than the wealthiest and most educated. Gradient patterns were seen often among non-Hispanic Blacks and Whites but less consistently among Hispanics.

Conclusions: Health in the United States is often, though not invariably, patterned strongly along both socioeconomic and racial/ethnic lines, suggesting links between hierarchies of social advantage and health. Worse health among the most socially disadvantaged argues for policies prioritizing those groups, but pervasive gradient patterns also indicate a need to address a wider socioeconomic spectrum-which may help garner political support. Routine health reporting should examine socioeconomic and racial/ethnic disparity patterns, jointly and separately.

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Figures

FIGURE 1
FIGURE 1
Income and education disparities in child health by (a) infant mortality, (b) health status, (c) activity limitation, and (d) sedentary behavior: United States, 1999–2005. Note. FPL = federal poverty level; IMR = infant mortality rate; Black = non-Hispanic Black; White = non-Hispanic White. All racial/ethnic groups are mutually exclusive. Source. Data for panel a is from the Period Linked Birth/Infant Death Data File, 2000-2002. Data for panels b and c are from the National Health Interview Survey, 2001-2005. Data for panel d is from the National Health and Nutrition Examination Survey, 1999-2004.
FIGURE 2
FIGURE 2
Income and education disparities in adult health by (a) life expectancy, (b) health status, (c) heart disease, and (d) diabetes: United States, 1988–2007. Note. FPL = federal poverty level; CHD = coronary heart disease; Asian = non-Hispanic Asian; AIAN = non-Hispanic American Indian or Alaskan Native; Black = non-Hispanic Black; NH/PI = non-Hispanic Native Hawaiian or Pacific Islander; White = non-Hispanic White. All racial/ethnic groups are mutually exclusive. Source. Data for panel a is from the National Longitudinal Mortality Study, 1988–1998. Data for panel b is from the Behavioral Risk Factor Surveillance System, 2005–2007. Data for panel c is from the National Health Interview Survey, 2001–2005. Data for panel d is from the National Health and Nutrition Examination Survey, 1999–2004.
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