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John Lynch, PhD, MPH, Sam Harper, MPH, George A. Kaplan, PhD and George Davey Smith, MD, PhD

John Lynch, Sam Harper, and George A. Kaplan are with the Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan, Ann Arbor. John Lynch is also with the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec. George Davey Smith is with the Department of Social Medicine, University of Bristol, Bristol, England.

Correspondence: Requests for reprints should be sent to John Lynch, PhD, MPH, Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan, 1214 South University, Ann Arbor, MI 48104-2548 (e-mail: jwlynch{at}umich.edu).

Objectives. We used census data to examine associations between income inequality and mortality among US states for each decade from 1949 to 1999 and tax return income data to estimate associations for 1989.

Methods. Cross-sectional correlation analyses were used to assess income inequality–mortality relationships.

Results. Census income analyses revealed little association between income inequality and mortality for 1949, 1959, or 1969. An association emerged for 1979 and strengthened for 1989 but weakened for 1999. When income inequality was based on tax return data, associations were weaker for both 1989 and 1999.

Conclusions. The strong association between income inequality and mortality observed among US states for 1989 was not observed for other periods from 1949 through 1999. In addition, when tax return rather than census data were used, the association was weaker for 1989 and 1999. The potential for distal social determinants of population health (e.g., income inequality) to affect mortality is contingent on how such determinants influence levels of proximal risk factors and the time lags between exposure to those risk factors and effects on specific health outcomes.

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