Abstract

ObjectiveTo investigate government state and local spending on public goods and income inequality as predictors of the risks of dying. MethodsData 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. ResultsEach 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. ConclusionsEmpirical 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 predicted higher risks of dying from CHD and suicide.

Highlights

  • 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

  • Empirical linkages were identified between state-level spending on welfare and education and lower individual risks of dying, from coronary heart disease (CHD) and all causes combined

  • The size and scope of social safety nets and non-health government spending are conceivably related to population health

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Summary

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. Individual-level data were drawn from the US National Longitudinal Mortality Study (NLMS),[29] a random sample of the non-institutionalized American population derived from 11 Current Population Survey (CPS) surveys (government household surveys conducted between 1979 and 1987, with average response rates of 90%), linked to the National Death Index (NDI), a national mortality database.[30] Linkages were successful for >98% of respondents. The primary study sample consisted of 431,637 adults aged 30–74 in the 48 contiguous US states. For the analyses of deaths from external injuries and suicide, the age range was modified to those 20–44 years (n=375,354 adults)

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