The role of geographic scale in testing the income inequality hypothesis as an explanation of health disparities

Zhuo Chen, Carol A. Gotway Crawford

Research output: Journal PublicationArticlepeer-review

45 Citations (Scopus)

Abstract

This study re-examined the role of geographic scale in measuring income inequality and testing the income inequality hypothesis (IIH) as an explanation of health disparities. We merged Behavioral Risk Factor Surveillance System (BRFSS) 2000 data with income inequality indices constructed at different geographic scales to test the association between income inequality and four different health indicators, i.e., self-assessed health status as a morbidity measure, vaccination against influenza as a measure of use of preventive healthcare, having any kind of health insurance as a measure of access, and obesity as a modifiable health risk factor measure. Multilevel models are used in our regression of the health indicators on measures of income inequalities and control variables. Our analysis suggests that because income inequality is a contextual variable, income inequalities measured at different geographic scales have different interpretations and relate to societal characteristics at different levels. Therefore, a rejection of the IIH at one level does not necessarily negate the possibility that income inequality affects health at another level. Assessment across a variety of scales is needed to have a comprehensive picture of the IIH in any given study. Empirical results also show that whether the IIH holds could depend on the sex group examined and the health indicator used, which implies different mechanisms of IIH exist for different sex groups and health indicators, in addition to the geographic scale. The role of geographic scale should be more rigorously considered in social determinants of health research.

Original languageEnglish
Pages (from-to)1022-1031
Number of pages10
JournalSocial Science and Medicine
Volume75
Issue number6
DOIs
Publication statusPublished - Sep 2012
Externally publishedYes

Keywords

  • Behavioral risk factor surveillance system
  • Geographic scale
  • Gini coefficient
  • Health disparity
  • Income inequality hypothesis

ASJC Scopus subject areas

  • Health(social science)
  • History and Philosophy of Science

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