International Journal of Public Health

, Volume 60, Issue 5, pp 573–588 | Cite as

US State-level income inequality and risks of heart attack and coronary risk behaviors: longitudinal findings

  • Roman PabayoEmail author
  • Ichiro Kawachi
  • Stephen E. Gilman
Original Article



To examine prospectively the association between US state income inequality and incidence of heart attack.


We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,445). Respondents completed interviews at baseline (2001–2002) and follow-up (2004–2005). Weighted multilevel modeling was used to determine if US state-level income inequality (measured by the Gini coefficient) at baseline was a predictor of heart attack during follow-up, controlling for individual-level and state-level covariates.


In comparison to residents of US states in the lowest quartile of income inequality, those living in the second [Adjusted Odds Ratio (AOR) = 1.71, 95 % CI 1.16–2.53)], third (AOR = 1.81, 95 % CI 1.28–2.57), and fourth (AOR = 2.04, 95 % CI 1.26–3.29) quartiles were more likely to have a heart attack. Similar findings were obtained when we excluded those who had a heart attack prior to baseline.


This study is one of the first to empirically show the longitudinal relationship between income inequality and coronary heart disease. Living in a state with higher income inequality increases the risk for heart attack among US adults.


Income inequality Coronary heart disease Social determinants of health Multilevel modeling Longitudinal analysis Population-based study 



This work was supported by NIH-grant number MH087544. RP was a Canadian Institutes of Health Research postdoctoral fellowship recipient #234617.

Supplementary material

38_2015_678_MOESM1_ESM.pdf (76 kb)
Supplementary material 1 (PDF 76 kb)


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Copyright information

© Swiss School of Public Health 2015

Authors and Affiliations

  • Roman Pabayo
    • 1
    • 2
    Email author
  • Ichiro Kawachi
    • 2
  • Stephen E. Gilman
    • 2
    • 3
    • 4
  1. 1.Department of Community Health SciencesUniversity of Nevada, RenoRenoUSA
  2. 2.Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonUSA
  3. 3.Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonUSA
  4. 4.Department of PsychiatryMassachusetts General HospitalBostonUSA

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