State-level Income Inequality Research Articles

State-Level Anti-Immigrant Sentiment and Policies and Health Risks in US Latino Children.

Although systemic inequities, broadly defined, are associated with health disparities in adults, there is a dearth of research linking contextual measures of exclusionary policies or prejudicial attitudes to health impairments in children, particularly among Latino populations. In this study, we examined a composite measure of systemic inequities in relation to the cooccurrence of multiple health problems in Latino children in the United States. Participants included 17 855 Latino children aged 3 to 17 years from the National Survey of Children's Health (2016-2020). We measured state-level systemic inequities using a factor score that combined an index of exclusionary state policies toward immigrants and aggregated survey data on prejudicial attitudes toward immigrants and Latino individuals. Caregivers reported on 3categories of child health problems: common health difficulties in the past year, current chronic physical health conditions, and current mental health conditions. For each category, we constructed a variable reflecting 0, 1, or 2 or more conditions. In models adjusted for sociodemographic covariates, interpersonal discrimination, and state-level income inequality, systemic inequities were associated with 1.13 times the odds of a chronic physical health condition (95% confidence interval: 1.02-1.25) and 1.24 times the odds of 2 or more mental health conditions (95% confidence interval: 1.06-1.45). Latino children residing in states with higher levels of systemic inequity are more likely to experience mental health or chronic physical health conditions relative to those in states with lower levels of systemic inequity.

The Mouth as a Site of Compound Injustices: A Structural Intersectionality Approach to the Oral Health of Working-Age US Adults.

Knowledge of and practice around health inequities have been limited by scarce investigations on intersecting forms of structural oppression, including the extent to which their effects are more severe among multiply marginalized groups. We addressed these insufficiencies by adopting a structural intersectionality approach to the study of edentulism (i.e., complete tooth loss), the dental equivalent of mortality. While individual information was gathered from approximately 200,000 adult (ages 18-64 years) respondents to the 2010 US Behavioral Risk Factor Surveillance System survey, state-level data for 2000 and 2010 were obtained from a 2021 study by Homan et al. (J Health Soc Behav. 2021;62(3):350-370) and the US Census. These 3 sources provided information on edentulism, race, sex, structural racism, structural sexism, and income inequality, in addition to multiple covariates. Analyses showed that the intersections between structural sexism and state-level income inequality and structural racism were associated with 1.4 (95% confidence interval: 1.1, 1.9) and 1.5 (95% confidence interval: 1.1, 2.2) times' increased odds of complete tooth loss, respectively. The frequency of edentulism was highest among non-Hispanic Black men residing in states with high structural racism, high structural sexism, and high economic inequality. Based on these and other findings, we highlight the importance of a structural intersectionality approach to research and policy related to health inequities in the United States and elsewhere.

Sleepless in inequality: findings from the 2018 behavioral risk factor surveillance system, a cross-sectional study

BackgroundDespite the large body of research on the adverse effects of income inequality, to date, few studies have examined its impact on sleep. The objective of this investigation is to examine the association between US state income inequality and the odds for regularly obtaining inadequate (< 7 h) and very inadequate (< 5 h) of sleep in the last 24 h.MethodsWe analysed data from 350,929 adults participating in the US 2018 Behavioral Risk Factor Surveillance System (BRFSS). Multilevel modeling was used to determine the association between state-level income inequality, as measured by the Gini coefficient, and the odds for obtaining inadequate and very inadequate sleep. We also determined if associations were heterogeneous across gender.ResultsA standard deviation increase in the Gini coefficient was associated with increased odds for inadequate (OR = 1.06, 95% CI: 1.00, 1.13) and very inadequate sleep (OR = 1.11, 95% CI: 1.03,1.20). Also, a cross-level Gini Coefficient X Gender interaction term was significant (OR = 1.07, 95% CI:1.01,1.13), indicating that increasing income inequality was more detrimental to women’s sleep behavior.ConclusionFuture work should be conducted to determine whether decreasing the wide gap between incomes can alleviate the burden of income inequality on inadequate sleep in the United States.

State level income inequality affects cardiovascular stress responses: Evidence from the Midlife in the United States (MIDUS) study

RationaleThe slow and insidious effects of income inequality on health means that their effects can be difficult to reveal, taking many years to become apparent. These effects can also be experienced differently according to subjective status and ethnicity making the relation between income inequality and health difficult to understand. Cardiovascular reactions to acute stress are indicative of future health outcomes. Objective: To examine whether short to medium term income inequality affected cardiovascular responses to acute stress whilst accounting for ethnic groups and subjective status. Method: Participants state of residence was available for 1155 people who participated in the MIDUS biomarker data project. This detail was used to merge the relevant US state level inequality data 1, 5, 10 and 15 years prior to the MIDUS biomarker data project which assessed cardiovascular responses to acute stress. Results: Our analysis demonstrated an association between inequality 5, 10 and 15 year prior and cardiovascular reactions to acute stress. Subjective community status and Black and minority ethnic group membership interacted to affect the association between inequality and cardiovascular reactions. Conclusions: In states where income inequality was high, less healthy cardiovascular responses were evident. However lower subjective community status and Black and Ethnic minority group members interacted with income inequality such that their impact was variable contingent on state level inequality. These findings extend the literature on income inequality and health and particularly highlights a psychophysiology pathway linking income inequality and health.

Income Inequality and Population Health: Examining the Role of Social Policy.

Studies of the relationship between income inequality and life expectancy often speculate about the role of policy, but direct empirical research is limited. Drawing on the neo-materialist perspective, we examine whether the longitudinal association between income inequality and life expectancy is mediated and moderated by policy liberalism in U.S. states (2000-2014). More liberal policy contexts are characterized by greater efforts to regulate the economy, redistribute income, and protect vulnerable groups and lesser efforts to penalize deviant social behavior. We find that state-level income inequality is inversely associated with policy liberalism and life expectancy. The association between income inequality and life expectancy was not mediated by policy liberalism but was moderated by it. The association is attenuated in states with more liberal policy contexts, supporting the neo-materialist perspective. This finding illustrates how states like New York and California (with liberal policy contexts) can exhibit high income inequality and high life expectancy.

How do state-level racism, sexism, and income inequality shape edentulism-related racial inequities in contemporary United States? A structural intersectionality approach to population oral health.

Research on racial oral health inequities has relied on individual-level data with the premise being that the unequal distribution of dental diseases is an intractable problem. We address these insufficiencies by examining the relationships between structural racism, structural sexism, state-level income inequality, and edentulism-related racial inequities according to a structural intersectionality approach. Data were from two sources, the 2010 survey of the U.S. Behavioral Risk Factor Surveillance System, and Patricia Homan et al.'s (2021) study on the health impacts from interlocking systems of oppression. While the first contains information on edentulism from a large probabilistic sample of older (65+) respondents, the second provides estimates of racism, sexism, and income inequality across the US states. Taking into account a range of individual characteristics and contextual factors in multilevel models, we determine the extent to which structural forms of marginalization underlie racial inequities in edentulism. Our analysis reveals that structural racism, structural sexism, and state-level income inequality are associated with the overall frequency of edentulism and the magnitude of edentulism-related racial inequities, both individually and intersectionally. Coupled with living in states with both high racism and sexism (but not income inequality), the odds of edentulism were 60% higher among non-Hispanic Blacks, relative to Whites residing where these structural oppressions were at their lowest. These findings provide evidence that racial oral health inequities cannot be disentangled from social forces that differentially allocate power and resources among population groups. Mitigating race-based inequities in oral health entails dismantling the multifaceted systems of oppression in the contemporary U.S. society.

The Great Recession Index: A Place-based Indicator for Countries, States, and Metropolitan Areas.

The Great Recession (GR) of 2007–2009 marked the most devastating economic downturn since the Great Depression of the 1930s, and its consequences dramatically changed almost every aspect of social life. This research introduces the Great Recession Index (GRI), a place-based composite measure that captures the multidimensional nature of the GR. The GRI can be used to examine macro-level outcomes and is especially well-suited for examining the spatial variation and longterm effects of the GR. The GRI is adaptable to a variety of geospatial units of analysis, and in this article, we develop measures for countries, U.S. states, and U.S. metropolitan areas. Then, using the state-based GRI, we provide a research application to demonstrate the utility of the GRI for explaining state-level income inequality in the post-Recession period. The results show that the initial shock of the GR decreased the income share of upper-class households, but the aftershock of the Recession increased their income share, resulting in increased income inequality in the U.S. since the Recession. This paper concludes by considering the feasibility of using similar measures for evaluating the effects of catastrophic events such as wars, civil unrest, climate change, natural disasters, or pestilence on societal outcomes.

Immigration Attitudes and White Americans’ Responsiveness to Rising Income Inequality

Despite decades of rising inequality, there has been little observed increase in American public support for redistribution. This is puzzling because majorities of Americans profess to be aware of and opposed to high inequality. I argue that this lack of responsiveness is not due to public ignorance of, nor apathy toward, inequality but rather, in part, to negative feelings toward immigrants, a growing, politically salient, and negatively stereotyped “out-group” that is widely viewed as a target of redistributive spending. To test this, I combine data on state-level income inequality with survey data from the 1992 to 2016 Cumulative ANES. I find that growing inequality can prompt support for redistribution but that this depends, in part, on peoples’ immigration attitudes. Overall, these results suggest that immigration has important implications for economic redistribution in an era of high, and rising inequality.

State-level income inequality and the odds for meeting fruit and vegetable recommendations among US adults.

BackgroundPrevious research indicates that income inequality is associated with risk for mortality, self-rated health status, chronic conditions, and health behavior, such as physical activity. However, little is known about the relationship between income inequality and dietary intake, which is a major risk factor for common chronic diseases including heart disease, stroke, diabetes, and certain types of cancers. The objective of this study is to determine the association between US state income inequality and fruit and vegetable consumption among adults.MethodsCross-sectional data on 270,612 U.S. adults from the U.S. 2013 Behavioral Risk Factor Surveillance System was used. Fruit and vegetable consumption was assessed from the six-item fruit and vegetable frequency questionnaire, which is part of the Behavioral Risk Factor Surveillance System. Multilevel modeling was used to determine whether US state-level income inequality (measured by the z-transformation of the Gini coefficient) was associated with fruit and vegetable consumption adjusting for individual-level and state-level covariates.ResultsIn comparison to men, women were more likely to consume fruits and vegetables ≥5 times daily, fruits ≥2 times daily, vegetables ≥3 times of daily, and less likely to consume fruit juice daily. Among both men and women, a standard deviation increase in Gini coefficient was associated with an increase in consuming fruit juice daily (OR = 1.07, 95% CI = 1.03, 1.11). However, among women, a standard deviation increase in Gini coefficient was associated with a decreased likelihood in meeting daily recommended levels of both fruits and vegetables (OR = 0.93; 0.87–0.99), fruits only (OR = 0.95; 95% CI, 0.92–0.99) and vegetables only (OR = 0.92; 95% CI, 0.89–0.96).ConclusionsThis study is one of the first to show the relationship between income inequality and fruit and vegetable consumption among U.S. adults empirically. Women’s health is more likely to be detrimentally affected when living in a state with higher income inequality.

State-Level Income Inequality and County-Level Social Capital in Relation to Individual-Level Depression in Middle-Aged Adults: A Lagged Multilevel Study.

In the US, the incidence of depression and suicide have followed escalating trends over the past several years. These trends call for greater efforts towards identifying their underlying drivers and finding effective prevention strategies and treatments. One social determinant of health that plausibly influences the risk of depression is income inequality, the gap between the rich and poor. However, research on this association is still sparse. We used data from the National Longitudinal Survey of Youth 1979 and the US Census to investigate the multilevel lagged associations of state-level income inequality with the individual-level odds of depression in middle-aged adults, controlling for state- and individual-level factors. We also examined the independent associations of county-level social capital with depression and explored whether it mediated the income inequality relationship. Higher income inequality at the state level predicted higher odds of individual-level depression nearly 2 decades later [OR for middle vs. lowest tertile of income inequality = 1.35 (95% CI: 1.02, 1.76), OR for highest vs. lowest tertile = 1.34 (95% CI: 1.01, 1.78)]. This association was stronger among men than women. Furthermore, there was evidence that county-level social capital independently predicted depression and that it mediated the income inequality association. Overall, our findings suggest that policies attenuating levels of income inequality at the US state level and that leverage social capital may protect against one’s likelihood of developing depression.

State-level income inequality and mortality among infants born in the United States 2007\u20132010: A Cohort Study

BackgroundUnited States state-level income inequality is positively associated with infant mortality in ecological studies. We exploit spatiotemporal variations in a large dataset containing individual-level data to conduct a cohort study and to investigate whether current income inequality and increases in income inequality are associated with infant and neonatal mortality risk over the period of the 2007–2010 Great Recession in the United States.MethodsWe used data on 16,145,716 infants and their mothers from the 2007–2010 United States Statistics Linked Infant Birth and Death Records. Multilevel logistic regression was used to determine whether 1) US state-level income inequality, as measured by Z-transformed Gini coefficients in the year of birth and 2) change in Gini coefficient between 1990 and year of birth (2007–2010), predicted infant or neonatal mortality. Our analyses adjusted for both individual and state-level covariates.ResultsFrom 2007 to 2010 there were 98,002 infant deaths: an infant mortality rate of 6.07 infant deaths per 1000 live births. When controlling for state and individual level characteristics, there was no significant relationship between Gini Z-score and infant mortality risk. However, the observed increase in the Gini Z-score was associated with a small but significant increase likelihood of infant mortality (AOR = 1.03 to 1.06 from 2007 to 2010). Similar findings were observed when the neonatal mortality was the outcome (AOR = 1.05 to 1.13 from 2007 to 2010).ConclusionsInfants born in states with greater changes in income inequality between 1990 and 2007 to 2010 experienced a greater likelihood of infant and neonatal mortality.

Does financial development affect income inequality in the U.S. States?

This paper examines the role of financial development on U.S. state-level income inequality in the 50 states from 1976 to 2011, using fixed-effect estimation. We find robust results whereby financial development linearly increases income inequality for the 50 states. When we divide 50 states into two separate groups of above-average and below-average inequality states than the cross-state average inequality, the effect of financial development on income inequality appears non-linear. When financial development improves, the effect increases at an increasing rate for above-average income-inequality states, whereas an inverted U-shaped relationship exists for below-average income-inequality states. To our knowledge, this paper is the first to examine the role of financial development on U.S. state-level inequality.

Income inequality and racial disparities in pregnancy-related mortality in the US.

In this ecological study, we examined the associations between state-level income inequality and pregnancy-related mortality among non-Hispanic (NH) black and NH white populations across the US. We estimated total population and race-specific 5-year pregnancy-related mortality ratios in each state based on national death and live birth records from 2011 to 2015. We obtained data on Gini coefficients for income inequality and population-level characteristics from the US Census American Community Survey. Poisson regression with robust standard errors estimated pregnancy-related mortality rate ratios (RR) and 95% confidence intervals (CI) associated with a one unit increase in income inequality overall and separately within black and white populations. Adjusted linear regression models estimated the associations between income inequality and magnitude of the absolute and relative racial inequity in pregnancy-related mortality within states. Across all states, increasing contemporaneous income inequality was associated with a 15% and 5-year lagged inequality with 14% increase in pregnancy-related mortality among black women (aRR = 1.15, 95% CI = 1.05; 1.25 and aRR = 1.14, 95% CI = 1.04; 1.24, respectively) after controlling for states’ racial compositions and socio-economic conditions. In addition, both lagged and contemporaneous income inequality were associated with larger absolute and relative racial inequities in pregnancy-related mortality. These findings highlight the role of contextual factors in contributing to pregnancy-related mortality among black women and the persistent racial inequity in maternal death in the US.

Does Financial Development Affect Income Inequality in the U.S. States? A Panel Data Analysis

This paper examines the role of financial development on U.S. state-level income inequality in the 50 states from 1976 to 2011, using fixed-effect estimation. We find robust results whereby financial development linearly increases income inequality for the 50 states. When we divide 50 states into two separate groups of above-average and below-average inequality states than the cross-state average inequality, the effect of financial development on income inequality appears non-linear. When financial development improves, the effect increases at an increasing rate for above-average income-inequality states, whereas an inverted U-shaped relationship exists for below-average income-inequality states. To our knowledge, this paper is the first to examine the role of financial development on U.S. state-level inequality.

Trust in Government and the American Public’s Responsiveness to Rising Inequality

The United States has become increasingly unequal. Income inequality has risen dramatically since the 1970s, yet public opinion toward redistribution has remained largely unchanged. This is puzzling, given Americans’ professed concern regarding, and knowledge of, rising inequality. I argue that trust in government can help to reconcile this. I combine data on state-level income inequality with survey data from the Cumulative American National Election Studies (CANES) from 1984 to 2016. I find that trust in government conditions the relationship between inequality and redistribution, with higher inequality prompting demand for government redistribution, but only among politically trustful individuals. This holds among conservatives and non-conservatives and among the affluent and non-affluent. These findings underscore the relevance of political trust in shaping attitudes toward inequality and economic redistribution and contribute to our understanding of why American public opinion has not turned in favor of redistribution during an era of rising income inequality.

State inequality, socioeconomic position and subjective cognitive decline in the United States

BackgroundSocial gradients in health have been observed for many health conditions and are suggested to operate through the effects of status anxiety. However, the gradient between education and Alzheimer’s disease is presumed to operate through cognitive stimulation. We examined the possible role of status anxiety through testing for state-level income inequality and social gradients in markers of socioeconomic position (SEP) for Alzheimer’s disease risk. MethodsUsing data from the cross-sectional 2015 and 2016 Behavioral Risk Factor Surveillance System (BRFSS) and the U.S. Census Bureau’s American Community Survey, we tested for the association between U.S. state-level income inequality and individual SEP on subjective cognitive decline (SCD) – a marker of dementia risk – using a generalized estimating equation and clustering by state. ResultsState income inequality was not significantly associated with SCD in our multivariable model (OR 1.2; 95% CI: 0.9, 1.6; p=0.49). We observed a clear linear relationship between household income and SCD where those with an annual household income of 50k to 75k had 1.4 (95% CI: 1.3, 1.6) times the odds and those with household incomes of less than $10,000 had 4.7 (95% CI: 3.8, 5.7) times the odds of SCD compared to those with household income of more than $75,000. We also found that college graduates (ref.) and those who completed high school (OR: 1.1; 95% CI 1.04, 1.2) fared better than those with some college (OR: 1.3, 95% CI 1.2, 1.4) or less than a high school degree (OR: 1.5; 95% CI: 1.4, 1.7). ConclusionsIncome inequality does not play a dominant role in SCD, though a social gradient in individual income for SCD suggests the relationship may operate in part via status anxiety.

Who feels it? Income inequality, relative deprivation, and financial satisfaction in U.S. states, 1973-2012

Many accounts posit that as income inequality rises, individuals will be less satisfied with their own financial situation as they feel increasingly deprived relative to others—driving these individuals to spend more as they engage in positional competition and increasing their anxieties as position in the income distribution becomes ever more important. I examine if and for whom income inequality reduces financial satisfaction by analyzing the 1973–2012 General Social Surveys linked to state-level administrative data based on tax returns, the Census, and the American Community Survey. I find that higher state-level income inequality decreases financial satisfaction overall, and I further find that this effect is especially pronounced for those in the middle of the income distribution. Counterfactual simulations suggest rising income inequality explains a substantial portion of a four-decade decline in financial satisfaction.

Income Inequality and Chronic Health Conditions: A Multilevel Analysis of the U.S. States

ABSTRACTRecently, scholarly work has examined the effect of rising income inequality on health outcomes. However, this work is somewhat inconclusive. The mechanisms that could produce such an association are still being sorted out. Much of this work focuses on mortality outcomes with little attention to how this process operates for actual health conditions, including chronic health problems—arguably the main public health concerns of the developed world. In a series of multilevel binary logistic regression models using data from the 2005 and 2007 Behavioral Risk Factor Surveillance System, we examine the association between state-level income inequality, poverty, and social welfare measures on spending and policy to examine the association between these factors for three chronic health outcomes: diabetes, hypertension, and coronary heart disease. We find that income inequality is conditionally positively related only to the diagnosis of diabetes and hypertension, and only in 2007. However, absolute poverty is related to the outcome across all three dependent variables. Certain social welfare measures attenuate the effects of both income inequality and absolute poverty, suggesting that some policies reduce this association.

Income Inequality and Class Divides in Parental Investments

Historic increases in income inequality have coincided with widening class divides in parental investments of money and time in children. These widening class gaps are significant because parental investment is one pathway by which advantage is transmitted across generations. Using over three decades of micro-data from the Consumer Expenditure Survey and the American Heritage Time Use Survey linked to state-year measures of income inequality, we test the relationship between income inequality and class gaps in parental investment. We find robust evidence of wider class gaps in parental financial investments in children—but not parental time investments in children—when state-level income inequality is higher. We explore mechanisms that may drive the relationship between rising income inequality and widening class gaps in parental financial investments in children. This relationship is partially explained by the increasing concentration of income at the top of the income distribution in state-years with higher inequality, which gives higher-earning households more money to spend on financial investments in children. In addition, we find evidence for contextual effects of higher income inequality that reshape parental preferences toward financial investment in children differentially by class.

Less equal, less trusting? Longitudinal and cross-sectional effects of income inequality on trust in U.S. States, 1973–2012

Does income inequality reduce social trust? Although both popular and scholarly accounts have argued that income inequality reduces trust, some recent research has been more skeptical, noting these claims are more robust cross-sectionally than longitudinally. Furthermore, although multiple mechanisms have been proposed for why inequality could affect trust, these have rarely been tested explicitly. I examine the effect of state-level income inequality on trust using the 1973–2012 General Social Surveys. I find little evidence that states that have been more unequal over time have less trusting people. There is some evidence that the growth in income inequality is linked with a decrease in trust, but these effects are sensitive to how time is accounted for. While much previous inequality and trust research has focused on status anxiety, this mechanism receives the little support, but mechanisms based on social fractionalization and on exploitation and resentment receive some support. This analysis improves on previous estimates of the effect of state-level inequality on trust by using far more available observations, accounting for more potential individual and state level confounders, and using higher-quality income inequality data based on annual IRS tax returns. It also contributes to our understanding of the mechanism(s) through which inequality may affect trust.