Fundamental cause theory, technological innovation, and health disparities: the case of cholesterol in the era of statins

J Health Soc Behav. 2009 Sep;50(3):245-60. doi: 10.1177/002214650905000301.


Although fundamental cause theory has been highly influential in shaping the research literature on health disparities, there have been few empirical demonstrations of the theory, particularly in dynamic perspective. In this study, we examine how income disparities in cholesterol levels have changed with the emergence of statins, an expensive and potent new drug technology. Using nationally representative data from 1976 to 2004, we find that income gradients for cholesterol were initially positive, but then reversed and became negative in the era of statin use. While the advantaged were previously more likely to have high levels of cholesterol, they are now less likely. We consider our case study against a broader theoretical framework outlining the relationship between technology innovation and health disparities. We find that the influence of technologies on socioeconomic disparities is subject to two important modifiers: (1) the nature of the technological change and (2) the extent of its diffusion and adoption.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Biomedical Technology*
  • Cholesterol / blood
  • Cross-Sectional Studies
  • Female
  • Healthcare Disparities*
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors*
  • Hypercholesterolemia / drug therapy
  • Hypercholesterolemia / epidemiology
  • Hypercholesterolemia / etiology*
  • Hypercholesterolemia / therapy
  • Male
  • Middle Aged
  • Models, Theoretical
  • United States / epidemiology


  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Cholesterol