Relations of income inequality and family income to chronic medical conditions and mental health disorders: national survey

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Abstract
Objectives: To analyse the relation between geographical inequalities in income and the prevalence of common chronic medical conditions and mental health disorders, and to compare it with the relation between family income and these health problems. Design: Nationally representative household telephone survey conducted in 1997-8. Setting: 60 metropolitan areas or economic areas of the United States. Participants: 9585 adults who participated in the community tracking study. Main outcome measures: Self report of 17 common chronic medical conditions; current depressive disorder or anxiety disorder assessed by clinical screeners. Results: A strong continuous association was seen between health and education or family income. No relation was found between income inequality and the prevalence of chronic medical problems or depressive disorders and anxiety disorders, either across the whole population or among poorer people. Only self reported overall health, the measure used in previous studies, was significantly correlated with inequality at the population level, but this correlation disappeared after adjustment for individual characteristics. Conclusions: This study provides no evidence for the hypothesis that income inequality is a major risk factor for common disorders of physical or mental health. What is already known on this topic Several studies have found a relation between income inequality and self reported health or mortality What this study adds There is a strong social gradient in health, as measured by the prevalence of chronic medical conditions and specific mental health disorders, by income or education No such association is seen between income inequality and health