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

  • Original Article
  • Published:
International Journal of Public Health

Abstract

Objectives

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

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

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

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Authors and Affiliations

  1. Department of Community Health Sciences, University of Nevada, Reno, Lombardi Building, 203, MS 0274, 1664 North Virginia Street, Reno, NV, 89557, USA

    Roman Pabayo

  2. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA

    Roman Pabayo, Ichiro Kawachi & Stephen E. Gilman

  3. Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, 02115, MA, USA

    Stephen E. Gilman

  4. Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, 02114, MA, USA

    Stephen E. Gilman

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  1. Roman Pabayo
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Correspondence to Roman Pabayo.

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Pabayo, R., Kawachi, I. & Gilman, S.E. US State-level income inequality and risks of heart attack and coronary risk behaviors: longitudinal findings. Int J Public Health 60, 573–588 (2015). https://doi.org/10.1007/s00038-015-0678-7

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  • DOI: https://doi.org/10.1007/s00038-015-0678-7

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