Are Socioeconomic Differences in Mortality Greater in a more Equal Society?

Abstract

The magnitude of socioeconomic mortality differences changes between countries. This could be attributed to the level of social inequality and explicit policy interventions to address social inequality in health. However, the empirical evidence does not show a clear international relationship between such country features and health inequality. Denmark and the USA are analyzed in terms of socioeconomic differences in mortality for men above age 58. The data sources are Danish register data from 1980 and 2002 (n=938.427), and survey data from the Health and Retirement Study (HRS) from 1992 to 2006 (n=9374). Event history analysis is used to study the impact of SES on mortality (for Denmark by cause of death), and compare the magnitude of mortality differences between the two countries. Income is the most important predictor for mortality. Surprisingly, mortality differentials are larger in Denmark than in the USA, with the richest 75 percent of Danish men having only 30 percent of the mortality risk of the poorest 10 percent. In the USA this RR is only 0.60. These wide mortality differences in Denmark exist for all major ICD groups. Low income seems to be a fundamental and powerful risk factor for mortality from all major causes. This study adds valid empirical evidence to previous findings that more equal societies and welfare regimes do not perform better in terms of health inequalities. In addition, it offers tentative explanations for the puzzle that SES mortality differences are larger in Denmark than in the USA.