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Self-Reported Health in High and Very High Incomes

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Abstract

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.

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Abbreviations

SRH:

self-reported health

References

  1. EL Idler Y Benyamini (1997) ArticleTitleSelf-rated health and mortality: A review of twenty-seven community studies J Health Soc Behav 38 IssueID1 21–37 Occurrence Handle1:STN:280:ByiB2M7ptVQ%3D Occurrence Handle9097506

    CAS  PubMed  Google Scholar 

  2. EL Idler LB Russell D Davis (2000) ArticleTitleSurvival, functional limitations, and self-rated health in the NHANES I Epidemiologic Follow-up Study, 1992. First National Health and Nutrition Examination Survey Am J Epidemiol 152 IssueID9 874–883 Occurrence Handle10.1093/aje/152.9.874 Occurrence Handle1:STN:280:DC%2BD3M%2FkslCrsQ%3D%3D Occurrence Handle11085400

    Article  CAS  PubMed  Google Scholar 

  3. GA Kaplan T Camacho (1983) ArticleTitlePerceived health and mortality: A nine-year follow-up of the human population laboratory cohort Am J Epidemiol 117 IssueID3 292–304 Occurrence Handle1:STN:280:BiyC2cbosF0%3D Occurrence Handle6829557

    CAS  PubMed  Google Scholar 

  4. D Larsson T Hemmingsson P Allebeck I Lundberg (2002) ArticleTitleSelf-rated health and mortality among young men: What is the relation and how may it be explained? Scand J Public Health 30 IssueID4 259–266 Occurrence Handle10.1080/14034940210133997 Occurrence Handle12680501

    Article  PubMed  Google Scholar 

  5. DL McGee Y Liao G Cao RS Cooper (1999) ArticleTitleSelf-reported health status and mortality in a multiethnic US cohort Am J Epidemiol 149 IssueID1 41–46 Occurrence Handle1:STN:280:DyaK1M%2FpvValsw%3D%3D Occurrence Handle9883792

    CAS  PubMed  Google Scholar 

  6. S Heistaro P Jousilahti E Lahelma E Vartiainen P Puska (2001) ArticleTitleSelf rated health and mortality: A long term prospective study in eastern Finland J Epidemiol Community Health 55 IssueID4 227–232 Occurrence Handle1:STN:280:DC%2BD3Mzgt1ehtQ%3D%3D Occurrence Handle11238576

    CAS  PubMed  Google Scholar 

  7. GA Kaplan WJ Strawbridge FT Camacho R Cohen (1993) ArticleTitleFactors associated with change in physical functioning in the elderly: A six-year prospective study J Aging Health 5 40–53

    Google Scholar 

  8. S Miilunpalo I Vuori P Oja M Pasanen H Urponen (1997) ArticleTitleSelf-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 population J Clin Epidemiol 50 IssueID5 517–528 Occurrence Handle10.1016/S0895-4356(97)00045-0 Occurrence Handle1:STN:280:ByiA38vltl0%3D Occurrence Handle9180644

    Article  CAS  PubMed  Google Scholar 

  9. RG Wilkinson (1996) Unhealthy Societies: The Afflictions of Inequality Rutledge London

    Google Scholar 

  10. H Lynch G Kaplan (2000) Socioeconomic position L Berkman I Kawachi (Eds) Social Epidemiology Oxford University Press New York 13–35

    Google Scholar 

  11. M Marmot R Wilkinson (1999) Social Determinants of Health Oxford University Press Oxford

    Google Scholar 

  12. PM Lantz JS House JM Lepkowski DR Williams RP Mero J Chen (1998) ArticleTitleSocioeconomic factors, health behaviors, and mortality: Results from a nationally representative prospective study of US adults JAMA 279 IssueID21 1703–1708 Occurrence Handle10.1001/jama.279.21.1703 Occurrence Handle1:STN:280:DyaK1c3osFGjsQ%3D%3D Occurrence Handle9624022

    Article  CAS  PubMed  Google Scholar 

  13. E Lahelma P Martikainen M Laaksonen A Aittomaki (2004) ArticleTitlePathways between socioeconomic determinants of health J Epidemiol Community Health 58 IssueID4 327–332 Occurrence Handle1:STN:280:DC%2BD2c7lvFWnsw%3D%3D Occurrence Handle15026449

    CAS  PubMed  Google Scholar 

  14. J Smith (1999) ArticleTitleHealthy bodies and thick wallets: The dual relationship between health and economic status J Econ Perspect 13 145–166

    Google Scholar 

  15. K Stronks H Mheen Particlevan de J Bos Particlevan den JP Mackenbach (1997) ArticleTitleThe interrelationship between income, health and employment status Int J Epidemiol 26 IssueID3 592–600 Occurrence Handle10.1093/ije/26.3.592 Occurrence Handle1:STN:280:ByiA28rpsFw%3D Occurrence Handle9222785

    Article  CAS  PubMed  Google Scholar 

  16. GT Ellison (2002) ArticleTitleLetting the Gini out of the bottle? Challenges facing the relative income hypothesis Soc Sci Med 54 IssueID4 561–576 Occurrence Handle10.1016/S0277-9536(01)00052-1 Occurrence Handle11858212

    Article  PubMed  Google Scholar 

  17. JW Lynch G Davey Smith GA Kaplan JS House (2000) ArticleTitleIncome inequality and mortality: Importance to health of individual income, psychosocial environment, or material conditions Br Med J 320 IssueID7243 1200–1204 Occurrence Handle1:STN:280:DC%2BD3c3kslSmsQ%3D%3D

    CAS  Google Scholar 

  18. E Backlund PD Sorlie NJ Johnson (1996) ArticleTitleThe shape of the relationship between income and mortality in the United States: Evidence from the National Longitudinal Mortality Study Ann Epidemiol 6 IssueID1 12–20 Occurrence Handle10.1016/1047-2797(95)00090-9 Occurrence Handle1:STN:280:BymB1cvgtVI%3D Occurrence Handle8680619

    Article  CAS  PubMed  Google Scholar 

  19. R Ecob G Davey Smith (1999) ArticleTitleIncome and health: What is the nature of the relationship? Soc Sci Med 48 IssueID5 693–705 Occurrence Handle10.1016/S0277-9536(98)00385-2 Occurrence Handle1:STN:280:DyaK1M7nvVCmtg%3D%3D Occurrence Handle10080369

    Article  CAS  PubMed  Google Scholar 

  20. P Martikainen J Adda JE Ferrie G Davey Smith M Marmot (2003) ArticleTitleEffects of income and wealth on GHQ depression and poor self rated health in white collar women and men in the Whitehall II study J Epidemiol Community Health 57 IssueID9 718–723 Occurrence Handle1:STN:280:DC%2BD3svitFCjsA%3D%3D Occurrence Handle12933779

    CAS  PubMed  Google Scholar 

  21. JP Mackenbach P Martikainen CW Looman JA Dalstra AE Kunst E Lahelma (2005) ArticleTitleThe shape of the relationship between income and self-assessed health: An international study Int J Epidemiol 34 IssueID2 286–293 Occurrence Handle10.1093/ije/dyh338 Occurrence Handle15561750

    Article  PubMed  Google Scholar 

  22. RA Easterlin (2003) ArticleTitleExplaining happiness Proc Natl Acad Sci USA 100 IssueID19 11176–11183 Occurrence Handle10.1073/pnas.1633144100 Occurrence Handle1:CAS:528:DC%2BD3sXnslyms7s%3D Occurrence Handle12958207

    Article  CAS  PubMed  Google Scholar 

  23. M Pinquart S Sorensen (2000) ArticleTitleInfluences of socioeconomic status, social network, and competence on subjective well-being in later life: A meta-analysis Psychol Aging 15 IssueID2 187–224 Occurrence Handle10.1037/0882-7974.15.2.187 Occurrence Handle1:STN:280:DC%2BD3M%2FhsVGhsA%3D%3D Occurrence Handle10879576

    Article  CAS  PubMed  Google Scholar 

  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, 2002

  25. K Manderbacka E Lahelma P Martikainen (1998) ArticleTitleExamining the continuity of self-rated health Int J Epidemiol 27 IssueID2 208–213 Occurrence Handle10.1093/ije/27.2.208 Occurrence Handle1:STN:280:DyaK1c3msFWisg%3D%3D Occurrence Handle9602400

    Article  CAS  PubMed  Google Scholar 

  26. GD Mantzavinis N Pappas ID Dimoliatis JP Ioannidis (2005) ArticleTitleMultivariate models of self-reported health often neglected essential candidate determinants and methodological issues J Clin Epidemiol 58 IssueID5 436–443 Occurrence Handle10.1016/j.jclinepi.2004.08.016 Occurrence Handle15845329

    Article  PubMed  Google Scholar 

  27. A Singh-Manoux P Clarke M Marmot (2002) ArticleTitleMultiple measures of socio-economic position and psychosocial health: Proximal and distal measures Int J Epidemiol 31 IssueID6 1192–1200 Occurrence Handle10.1093/ije/31.6.1192 Occurrence Handle12540721

    Article  PubMed  Google Scholar 

  28. PB Johnson L Richter (2002) ArticleTitleThe relationship between smoking, drinking, and adolescents’ self-perceived health and frequency of hospitalization: Analyses from the 1997 National Household Survey on Drug Abuse J Adolesc Health 30 IssueID3 175–183 Occurrence Handle11869924

    PubMed  Google Scholar 

  29. YH Cheng I Chi KW Boey LS Ko KL Chou (2002) ArticleTitleSelf-rated economic condition and the health of elderly persons in Hong Kong Soc Sci Med 55 IssueID8 1415–1424 Occurrence Handle10.1016/S0277-9536(01)00271-4 Occurrence Handle1:STN:280:DC%2BD38vntFenuw%3D%3D Occurrence Handle12231018

    Article  CAS  PubMed  Google Scholar 

  30. C Kelleher A Timoney S Friel D McKeown (2002) ArticleTitleIndicators of deprivation, voting patterns, and health status at area level in the Republic of Ireland J Epidemiol Community Health 56 IssueID1 36–44 Occurrence Handle1:STN:280:DC%2BD38%2FntlyksQ%3D%3D Occurrence Handle11801618

    CAS  PubMed  Google Scholar 

  31. MD Diaz (2002) ArticleTitleSocio-economic health inequalities in Brazil: Gender and age effects Health Econ 11 IssueID2 141–154 Occurrence Handle11921312

    PubMed  Google Scholar 

  32. A Angel W Gronfine (1988) ArticleTitleUse of subjective information in statistical models Am Soc Rev 53 464–473

    Google Scholar 

  33. SA Robert (1998) ArticleTitleCommunity-level socioeconomic status effects on adult health J Health Soc Behav 39 IssueID1 18–37 Occurrence Handle1:STN:280:DyaK1c3js1Kitw%3D%3D Occurrence Handle9575702

    CAS  PubMed  Google Scholar 

  34. J Mirowski PN Hu (1996) ArticleTitlePhysical impairment and the diminishing effects of income Soc Forces 74 1073–1096

    Google Scholar 

  35. I Kawachi BP Kennedy R Glass (1999) ArticleTitleSocial capital and self-rated health: A contextual analysis Am J Public Health 89 IssueID8 1187–1193 Occurrence Handle1:STN:280:DyaK1MzmtFGksg%3D%3D Occurrence Handle10432904

    CAS  PubMed  Google Scholar 

  36. IR White D Blane JN Morris P Mourouga (1999) ArticleTitleEducational attainment, deprivation-affluence and self reported health in Britain: A cross sectional study J Epidemiol Community Health 53 IssueID9 535–541 Occurrence Handle1:STN:280:DC%2BD3c%2FivVKitQ%3D%3D Occurrence Handle10562877

    CAS  PubMed  Google Scholar 

  37. TA Blakely K Lochner I Kawachi (2002) ArticleTitleMetropolitan area income inequality and self-rated health – a multi-level study Soc Sci Med 54 IssueID1 65–77 Occurrence Handle10.1016/S0277-9536(01)00007-7 Occurrence Handle11820682

    Article  PubMed  Google Scholar 

  38. E Grundy A Sloggett (2003) ArticleTitleHealth inequalities in the older population: The role of personal capital, social resources and socio-economic circumstances Soc Sci Med 56 IssueID5 935–947 Occurrence Handle10.1016/S0277-9536(02)00093-X Occurrence Handle12593868

    Article  PubMed  Google Scholar 

  39. S Arber J Ginn (1993) ArticleTitleGender and inequalities in health in later life Soc Sci Med 36 IssueID1 33–46 Occurrence Handle10.1016/0277-9536(93)90303-L Occurrence Handle1:STN:280:ByyC2c3gslE%3D Occurrence Handle8424182

    Article  CAS  PubMed  Google Scholar 

  40. H Cooper (2002) ArticleTitleInvestigating socio-economic explanations for gender and ethnic inequalities in health Soc Sci Med 54 IssueID5 693–706 Occurrence Handle10.1016/S0277-9536(01)00118-6 Occurrence Handle11999487

    Article  PubMed  Google Scholar 

  41. E Lahelma S Arber K Kivela E Roos (2002) ArticleTitleMultiple roles and health among British and Finnish women: The influence of socioeconomic circumstances Soc Sci Med 54 IssueID5 727–740 Occurrence Handle10.1016/S0277-9536(01)00105-8 Occurrence Handle11999489

    Article  PubMed  Google Scholar 

  42. T Chandola C Jenkinson (2000) ArticleTitleValidating self-rated health in different ethnic groups Ethn Health 5 IssueID2 151–159 Occurrence Handle1:STN:280:DC%2BD3M%2FnvFChuw%3D%3D Occurrence Handle10984833

    CAS  PubMed  Google Scholar 

  43. BK Finch RA Hummer M Reindl WA Vega (2002) ArticleTitleValidity of self-rated health among Latino(a)s Am J Epidemiol 155 IssueID8 755–759 Occurrence Handle10.1093/aje/155.8.755 Occurrence Handle11943694

    Article  PubMed  Google Scholar 

  44. R Lund P Due J Modvig BE Holstein MT Damsgaard PK Andersen (2002) ArticleTitleCohabitation and marital status as predictors of mortality – an eight year follow-up study Soc Sci Med 55 IssueID4 673–679 Occurrence Handle10.1016/S0277-9536(01)00219-2 Occurrence Handle12188471

    Article  PubMed  Google Scholar 

  45. K Shibuya H Hashimoto E Yano (2002) ArticleTitleIndividual income, income distribution, and self rated health in Japan: Cross sectional analysis of nationally representative sample Br Med J 324 IssueID7328 16–19

    Google Scholar 

  46. J Fritzell M Nermo O Lundberg (2004) ArticleTitleThe impact of income: Assessing the relationship between income and health in Sweden Scand J Public Health 32 IssueID1 6–16 Occurrence Handle10.1080/14034950310003971 Occurrence Handle14757543

    Article  PubMed  Google Scholar 

  47. M Benzeval K Judge S Shouls (2001) ArticleTitleUnderstanding the relationship between income and health: How much can be gleaned from cross-sectional data? Soc Policy Admin 35 376–396

    Google Scholar 

  48. HA Akaike (1974) ArticleTitleA new look at the statistical model identification IEEE Trans Automatic Control 19 716–723

    Google Scholar 

  49. CE Ross CL Wu (1995) ArticleTitleThe links between education and health Am Soc Rev 60 719–745

    Google Scholar 

  50. RA Miech RM Hauser (2001) ArticleTitleSocioeconomic status and health at midlife. A comparison of educational attainment with occupation-based indicators Ann Epidemiol 11 IssueID2 75–84 Occurrence Handle10.1016/S1047-2797(00)00079-X Occurrence Handle1:STN:280:DC%2BD3M7ptlGrsg%3D%3D Occurrence Handle11164123

    Article  CAS  PubMed  Google Scholar 

  51. A Deaton (2002) ArticleTitlePolicy implications of the gradient of health and wealth. An economist asks, would redistributing income improve population health? Health Aff (Millwood) 21 IssueID2 13–30 Occurrence Handle10.1377/hlthaff.21.2.13

    Article  Google Scholar 

  52. NM Krause GM Jay (1994) ArticleTitleWhat do global self-rated health items measure? Med Care 32 IssueID9 930–942 Occurrence Handle1:STN:280:ByuA2snlt1I%3D Occurrence Handle8090045

    CAS  PubMed  Google Scholar 

  53. M Blaxter (1990) Health and Lifestyles Routlege London

    Google Scholar 

  54. G Der (2001) ArticleTitleCommentary: Income and health: Why are curves so appealing? Int J Epidemiol 30 IssueID6 1405–1406 Occurrence Handle10.1093/ije/30.6.1405 Occurrence Handle1:STN:280:DC%2BD38%2Fpt1ansQ%3D%3D Occurrence Handle11821354

    Article  CAS  PubMed  Google Scholar 

  55. A Wagstaff E Doorslaer Particlevan (2000) ArticleTitleIncome inequality and health: What does the literature tell us? Annu Rev Public Health 21 543–567 Occurrence Handle10.1146/annurev.publhealth.21.1.543 Occurrence Handle1:STN:280:DC%2BD3M%2FhsVCqsw%3D%3D Occurrence Handle10884964

    Article  CAS  PubMed  Google Scholar 

  56. P Muennig P Franks H Jia E Lubetkin MR Gold (2005) ArticleTitleThe income-associated burden of disease in the United States Soc Sci Med 61 IssueID9 2018–2026 Occurrence Handle10.1016/j.socscimed.2005.04.005 Occurrence Handle15913866

    Article  PubMed  Google Scholar 

  57. CJ Ruhm (2000) ArticleTitleAre recessions good for your health? Q J Econ 115 617–650 Occurrence Handle10.1162/003355300554872

    Article  Google Scholar 

  58. X Zolotas (1981) Economic Growth and Declining Social Welfare New York University Press New York

    Google Scholar 

  59. N Eberstadt (2004) Health and the Income Inequality Hypothesis: A Doctrine in Search of Data American Enterprise Institute Press Washington

    Google Scholar 

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Authors and Affiliations

  1. Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, 45110, Greece

    Georgios D. Mantzavinis, Thomas A. Trikalinos, Ioannis D. K. Dimoliatis & John P. A. Ioannidis

  2. Department of Medicine, Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, USA

    Thomas A. Trikalinos & John P. A. Ioannidis

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  1. Georgios D. Mantzavinis
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  2. Thomas A. Trikalinos
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  3. Ioannis D. K. Dimoliatis
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  4. John P. A. Ioannidis
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Correspondence to John P. A. Ioannidis.

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Mantzavinis, G.D., Trikalinos, T.A., Dimoliatis, I.D.K. et al. Self-Reported Health in High and Very High Incomes. Qual Life Res 15, 547–558 (2006). https://doi.org/10.1007/s11136-005-1770-x

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