Abstract
BackgroundIncome inequality and national wealth are strong determinants for health, but few studies have systematically investigated their influence on mortality across the early life-course, particularly outside the high-income world.MethodsWe performed cross-sectional regression analyses of the relationship between income inequality (national Gini coefficient) and national wealth (Gross Domestic Product (GDP) averaged over previous decade), and all-cause and grouped cause national mortality rate amongst infants, 1–4, 5–9, 10–14, 15–19 and 20–24 year olds in low and middle-income countries (LMIC) in 2012. Gini models were adjusted for GDP.ResultsData were available for 103 (79%) countries. Gini was positively associated with increased all-cause and communicable disease mortality in both sexes across all age groups, after adjusting for national wealth. Gini was only positively associated with increased injury mortality amongst infants and 20–24 year olds, and increased non-communicable disease mortality amongst 20–24 year old females. The strength of these associations tended to increase during adolescence.Increasing GDP was negatively associated with all-cause, communicable and non-communicable disease mortality in males and females across all age groups. GDP was also associated with decreased injury mortality in all age groups except 15–19 year old females, and 15–24 year old males. GDP became a weaker predictor of mortality during adolescence.ConclusionPolicies to reduce income inequality, rather than prioritising economic growth at all costs, may be needed to improve adolescent mortality in low and middle-income countries, a key development priority.
Highlights
Income inequality and national wealth are strong determinants for health, but few studies have systematically investigated their influence on mortality across the early life-course, outside the high-income world
The strongest association was seen for communicable disease in 1–4 year olds, where a 10% increase in Gross domestic product (GDP) was associated with a 10.2% and 10.5% (12.0–9.0) decrease in mortality rate for males and females respectively
Our findings suggest that national wealth benefits younger children more than adolescents, whereas inequality is harmful for all age groups, and increases in importance with age
Summary
Income inequality and national wealth are strong determinants for health, but few studies have systematically investigated their influence on mortality across the early life-course, outside the high-income world. Societies with greater differences in income distribution have multiple worse health outcomes that include reduced life expectancy [5], higher levels of violent crime and murder [6] increased levels of obesity [7], increased infant mortality [8] and poor self reported health, after adjusting for societal wealth and poverty levels This association has been demonstrated in both high income and developing countries [9,10,11,12,13] and in the latter, income inequality has been implicated in increasing malnutrition and stunting prevalence in children under 5 [13, 14]. It has been suggested this observation reflects a “statistical artefact” due to the concave association between income and health [15], this has been challenged [16], and there is increasing evidence that the relationship is causal [1]
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