Online Program

Income inequality and cause-specific mortality in Taiwan: A multilevel analysis

Tuesday, November 5, 2013 : 1:14 p.m. - 1:32 p.m.

Chun-Tung Kuo, MS, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
Tung-liang Chiang, Institute of Health Policy and Management, National Taiwan University, School of Public Health, Taipei, Taiwan
OBJECTIVES: Income inequality has been associated with worse population health in various studies. However, few studies were used multilevel approach to test the effect of income inequality on cause-specific mortality. Thus, we used multilevel analysis to examine the association between income inequality and cause-specific mortality for both genders in Taiwan. METHODS: Data on age-standardized mortality in 2005-2009 were obtained from the Department of Health. Data on the Gini coefficient and median disposable income came from the family income and expenditure survey in 2000. Additionally, township-level educational attainment data were obtained from the Ministry of the Interior, Taiwan. Using a multilevel framework of 349 townships nested within 22 cities/counties, we examined associations of city/county-level income inequality with township-level mortality before and after adjustment for income and educational level. RESULTS: Multilevel models showed that the Gini coefficient at were positive associated with all-cause mortality, as well as cancer, heart disease, pneumonia, and injury mortality. After controlling for city/county-level income and township-level education level, we found that a 0.01 rise in the Gini coefficient increases 12.9 all-cause deaths per 100,000 population (P<0.05), as well as pneumonia (1.01 per 100,000, P<0.05) and injury mortality (2.55 per 100,000, P<0.01). For gender-stratified analysis, the relationship between Income inequality and mortality were greater among male than female in all the causes of death, except for diabetes mellitus. CONCLUSIONS: These findings show new evidence for the contextual effects of income inequality on different cause-specific mortality in Taiwan, suggesting that we may use it to explore the mechanisms linking income inequality to population health.

Learning Areas:

Administration, management, leadership
Public health administration or related administration
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Demonstrate the association between income inequality and cause-specific mortality rates. Identify the gender difference in the contextual effects of income inequality on cause-specific mortality. Discuss the possible mechanisms linking income inequality to population health.

Keyword(s): Social Inequalities, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a published author and a PhD candidate in public health policy, health promotion and social epidemiology.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.