Quality of Life Research

, Volume 15, Issue 3, pp 547–558 | Cite as

Self-Reported Health in High and Very High Incomes

  • Georgios D. Mantzavinis
  • Thomas A. Trikalinos
  • Ioannis D. K. Dimoliatis
  • John P. A. IoannidisEmail author


The objective of the present study was to investigate whether self-reported health (SRH), an overall health indicator, continues to improve as individual income increases to very high levels or whether there is a threshold above which this relationship changes direction. We used data from the 2003 US Current Population Survey, focusing on the upper income decile. We modelled the relationship between income and SRH before and after adjustment for other socio-demographic parameters that are known to influence SRH. In the unadjusted model, SRH increased with increasing income up to the threshold of $326,000, above which SRH declined. After adjustment for all major socio-demographic parameters (age, gender, race, education, and marital status), the adjusted curve showed monotonically increasing SRH with increasing income. Adjustment for each of these parameters separately revealed that the threshold effect was lost only after adjusting for education. There were more people with low levels of educational attainment among those receiving more than $500,000 per year, compared to other people in the upper income decile. Increasing income does not always improve SRH. People in the very high income bracket tend to report slightly worse health, which may be explained by their lower education.


Education Health status Income Socioeconomic factors 



self-reported health


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  1. 1.
    Idler, EL, Benyamini, Y 1997Self-rated health and mortality: A review of twenty-seven community studiesJ Health Soc Behav382137PubMedGoogle Scholar
  2. 2.
    Idler, EL, Russell, LB, Davis, D 2000Survival, functional limitations, and self-rated health in the NHANES I Epidemiologic Follow-up Study, 1992. First National Health and Nutrition Examination SurveyAm J Epidemiol152874883CrossRefPubMedGoogle Scholar
  3. 3.
    Kaplan, GA, Camacho, T 1983Perceived health and mortality: A nine-year follow-up of the human population laboratory cohortAm J Epidemiol117292304PubMedGoogle Scholar
  4. 4.
    Larsson, D, Hemmingsson, T, Allebeck, P, Lundberg, I 2002Self-rated health and mortality among young men: What is the relation and how may it be explained?Scand J Public Health30259266CrossRefPubMedGoogle Scholar
  5. 5.
    McGee, DL, Liao, Y, Cao, G, Cooper, RS 1999Self-reported health status and mortality in a multiethnic US cohortAm J Epidemiol1494146PubMedGoogle Scholar
  6. 6.
    Heistaro, S, Jousilahti, P, Lahelma, E, Vartiainen, E, Puska, P 2001Self rated health and mortality: A long term prospective study in eastern FinlandJ Epidemiol Community Health55227232PubMedGoogle Scholar
  7. 7.
    Kaplan, GA, Strawbridge, WJ, Camacho, FT, Cohen, R 1993Factors associated with change in physical functioning in the elderly: A six-year prospective studyJ Aging Health54053Google Scholar
  8. 8.
    Miilunpalo, S, Vuori, I, Oja, P, Pasanen, M, Urponen, H 1997Self-rated health status as a health measure: The predictive value of self-reported health status on the use of physician services and on mortality in the working-age populationJ Clin Epidemiol50517528CrossRefPubMedGoogle Scholar
  9. 9.
    Wilkinson, RG 1996Unhealthy Societies: The Afflictions of InequalityRutledgeLondonGoogle Scholar
  10. 10.
    Lynch, H, Kaplan, G 2000Socioeconomic positionBerkman, LKawachi, I eds. Social EpidemiologyOxford University PressNew York1335Google Scholar
  11. 11.
    Marmot, M, Wilkinson, R 1999Social Determinants of HealthOxford University PressOxfordGoogle Scholar
  12. 12.
    Lantz, PM, House, JS, Lepkowski, JM, Williams, DR, Mero, RP, Chen, J 1998Socioeconomic factors, health behaviors, and mortality: Results from a nationally representative prospective study of US adultsJAMA27917031708CrossRefPubMedGoogle Scholar
  13. 13.
    Lahelma, E, Martikainen, P, Laaksonen, M, Aittomaki, A 2004Pathways between socioeconomic determinants of healthJ Epidemiol Community Health58327332PubMedGoogle Scholar
  14. 14.
    Smith, J 1999Healthy bodies and thick wallets: The dual relationship between health and economic statusJ Econ Perspect13145166Google Scholar
  15. 15.
    Stronks, K, Mheen, H, Bos, J, Mackenbach, JP 1997The interrelationship between income, health and employment statusInt J Epidemiol26592600CrossRefPubMedGoogle Scholar
  16. 16.
    Ellison, GT 2002Letting the Gini out of the bottle? Challenges facing the relative income hypothesisSoc Sci Med54561576CrossRefPubMedGoogle Scholar
  17. 17.
    Lynch, JW, Davey Smith, G, Kaplan, GA, House, JS 2000Income inequality and mortality: Importance to health of individual income, psychosocial environment, or material conditionsBr Med J32012001204Google Scholar
  18. 18.
    Backlund, E, Sorlie, PD, Johnson, NJ 1996The shape of the relationship between income and mortality in the United States: Evidence from the National Longitudinal Mortality StudyAnn Epidemiol61220CrossRefPubMedGoogle Scholar
  19. 19.
    Ecob, R, Davey Smith, G 1999Income and health: What is the nature of the relationship?Soc Sci Med48693705CrossRefPubMedGoogle Scholar
  20. 20.
    Martikainen, P, Adda, J, Ferrie, JE, Davey Smith, G, Marmot, M 2003Effects of income and wealth on GHQ depression and poor self rated health in white collar women and men in the Whitehall II studyJ Epidemiol Community Health57718723PubMedGoogle Scholar
  21. 21.
    Mackenbach, JP, Martikainen, P, Looman, CW, Dalstra, JA, Kunst, AE, Lahelma, E 2005The shape of the relationship between income and self-assessed health: An international studyInt J Epidemiol34286293CrossRefPubMedGoogle Scholar
  22. 22.
    Easterlin, RA 2003Explaining happinessProc Natl Acad Sci USA1001117611183CrossRefPubMedGoogle Scholar
  23. 23.
    Pinquart, M, Sorensen, S 2000Influences of socioeconomic status, social network, and competence on subjective well-being in later life: A meta-analysisPsychol Aging15187224CrossRefPubMedGoogle Scholar
  24. 24.
    US Bureau of the Census, US Bureau of Labor Statistics. The Current Population Survey. Design and Methodology. Technical paper 63RV: US Bureau of the Census, US Bureau of Labor Statistics, 2002Google Scholar
  25. 25.
    Manderbacka, K, Lahelma, E, Martikainen, P 1998Examining the continuity of self-rated healthInt J Epidemiol27208213CrossRefPubMedGoogle Scholar
  26. 26.
    Mantzavinis, GD, Pappas, N, Dimoliatis, ID, Ioannidis, JP 2005Multivariate models of self-reported health often neglected essential candidate determinants and methodological issuesJ Clin Epidemiol58436443CrossRefPubMedGoogle Scholar
  27. 27.
    Singh-Manoux, A, Clarke, P, Marmot, M 2002Multiple measures of socio-economic position and psychosocial health: Proximal and distal measuresInt J Epidemiol3111921200CrossRefPubMedGoogle Scholar
  28. 28.
    Johnson, PB, Richter, L 2002The relationship between smoking, drinking, and adolescents’ self-perceived health and frequency of hospitalization: Analyses from the 1997 National Household Survey on Drug AbuseJ Adolesc Health30175183PubMedGoogle Scholar
  29. 29.
    Cheng, YH, Chi, I, Boey, KW, Ko, LS, Chou, KL 2002Self-rated economic condition and the health of elderly persons in Hong KongSoc Sci Med5514151424CrossRefPubMedGoogle Scholar
  30. 30.
    Kelleher, C, Timoney, A, Friel, S, McKeown, D 2002Indicators of deprivation, voting patterns, and health status at area level in the Republic of IrelandJ Epidemiol Community Health563644PubMedGoogle Scholar
  31. 31.
    Diaz, MD 2002Socio-economic health inequalities in Brazil: Gender and age effectsHealth Econ11141154PubMedGoogle Scholar
  32. 32.
    Angel, A, Gronfine, W 1988Use of subjective information in statistical modelsAm Soc Rev53464473Google Scholar
  33. 33.
    Robert, SA 1998Community-level socioeconomic status effects on adult healthJ Health Soc Behav391837PubMedGoogle Scholar
  34. 34.
    Mirowski, J, Hu, PN 1996Physical impairment and the diminishing effects of incomeSoc Forces7410731096Google Scholar
  35. 35.
    Kawachi, I, Kennedy, BP, Glass, R 1999Social capital and self-rated health: A contextual analysisAm J Public Health8911871193PubMedGoogle Scholar
  36. 36.
    White, IR, Blane, D, Morris, JN, Mourouga, P 1999Educational attainment, deprivation-affluence and self reported health in Britain: A cross sectional studyJ Epidemiol Community Health53535541PubMedGoogle Scholar
  37. 37.
    Blakely, TA, Lochner, K, Kawachi, I 2002Metropolitan area income inequality and self-rated health – a multi-level studySoc Sci Med546577CrossRefPubMedGoogle Scholar
  38. 38.
    Grundy, E, Sloggett, A 2003Health inequalities in the older population: The role of personal capital, social resources and socio-economic circumstancesSoc Sci Med56935947CrossRefPubMedGoogle Scholar
  39. 39.
    Arber, S, Ginn, J 1993Gender and inequalities in health in later lifeSoc Sci Med363346CrossRefPubMedGoogle Scholar
  40. 40.
    Cooper, H 2002Investigating socio-economic explanations for gender and ethnic inequalities in healthSoc Sci Med54693706CrossRefPubMedGoogle Scholar
  41. 41.
    Lahelma, E, Arber, S, Kivela, K, Roos, E 2002Multiple roles and health among British and Finnish women: The influence of socioeconomic circumstancesSoc Sci Med54727740CrossRefPubMedGoogle Scholar
  42. 42.
    Chandola, T, Jenkinson, C 2000Validating self-rated health in different ethnic groupsEthn Health5151159PubMedGoogle Scholar
  43. 43.
    Finch, BK, Hummer, RA, Reindl, M, Vega, WA 2002Validity of self-rated health among Latino(a)sAm J Epidemiol155755759CrossRefPubMedGoogle Scholar
  44. 44.
    Lund, R, Due, P, Modvig, J, Holstein, BE, Damsgaard, MT, Andersen, PK 2002Cohabitation and marital status as predictors of mortality – an eight year follow-up studySoc Sci Med55673679CrossRefPubMedGoogle Scholar
  45. 45.
    Shibuya, K, Hashimoto, H, Yano, E 2002Individual income, income distribution, and self rated health in Japan: Cross sectional analysis of nationally representative sampleBr Med J3241619Google Scholar
  46. 46.
    Fritzell, J, Nermo, M, Lundberg, O 2004The impact of income: Assessing the relationship between income and health in SwedenScand J Public Health32616CrossRefPubMedGoogle Scholar
  47. 47.
    Benzeval, M, Judge, K, Shouls, S 2001Understanding the relationship between income and health: How much can be gleaned from cross-sectional data?Soc Policy Admin35376396Google Scholar
  48. 48.
    Akaike, HA 1974A new look at the statistical model identificationIEEE Trans Automatic Control19716723Google Scholar
  49. 49.
    Ross, CE, Wu, CL 1995The links between education and healthAm Soc Rev60719745Google Scholar
  50. 50.
    Miech, RA, Hauser, RM 2001Socioeconomic status and health at midlife. A comparison of educational attainment with occupation-based indicatorsAnn Epidemiol117584CrossRefPubMedGoogle Scholar
  51. 51.
    Deaton, A 2002Policy implications of the gradient of health and wealth. An economist asks, would redistributing income improve population health?Health Aff (Millwood)211330CrossRefGoogle Scholar
  52. 52.
    Krause, NM, Jay, GM 1994What do global self-rated health items measure?Med Care32930942PubMedGoogle Scholar
  53. 53.
    Blaxter, M 1990Health and LifestylesRoutlegeLondonGoogle Scholar
  54. 54.
    Der, G 2001Commentary: Income and health: Why are curves so appealing?Int J Epidemiol3014051406CrossRefPubMedGoogle Scholar
  55. 55.
    Wagstaff, A, Doorslaer, E 2000Income inequality and health: What does the literature tell us?Annu Rev Public Health21543567CrossRefPubMedGoogle Scholar
  56. 56.
    Muennig, P, Franks, P, Jia, H, Lubetkin, E, Gold, MR 2005The income-associated burden of disease in the United StatesSoc Sci Med6120182026CrossRefPubMedGoogle Scholar
  57. 57.
    Ruhm, CJ 2000Are recessions good for your health?Q J Econ115617650CrossRefGoogle Scholar
  58. 58.
    Zolotas, X 1981Economic Growth and Declining Social WelfareNew York University PressNew YorkGoogle Scholar
  59. 59.
    Eberstadt, N 2004Health and the Income Inequality Hypothesis: A Doctrine in Search of DataAmerican Enterprise Institute PressWashingtonGoogle Scholar

Copyright information

© Springer 2006

Authors and Affiliations

  • Georgios D. Mantzavinis
    • 1
  • Thomas A. Trikalinos
    • 1
    • 2
  • Ioannis D. K. Dimoliatis
    • 1
  • John P. A. Ioannidis
    • 1
    • 2
    Email author
  1. 1.Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
  2. 2.Department of Medicine, Institute for Clinical Research and Health Policy StudiesTufts-New England Medical Center, Tufts University School of MedicineBostonUSA

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