The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986

N Engl J Med. 1993 Jul 8;329(2):103-9. doi: 10.1056/NEJM199307083290207.


Background: There is an inverse relation between socioeconomic status and mortality. Over the past several decades death rates in the United States have declined, but it is unclear whether all socioeconomic groups have benefited equally.

Methods: Using records from the 1986 National Mortality Followback Survey (n = 13,491) and the 1986 National Health Interview Survey (n = 30,725), we replicated the analysis by Kitagawa and Hauser of differential mortality in 1960. We calculated direct standardized mortality rates and indirect standardized mortality ratios for persons 25 to 64 years of age according to race, sex, income, and family status.

Results: The inverse relation between mortality and socioeconomic status persisted in 1986 and was stronger than in 1960. The disparity in mortality rates according to income and education increased for men and women, whites and blacks, and family members and unrelated persons. Over the 26-year period, the inequalities according to educational level increased for whites and blacks by over 20 percent in women and by over 100 percent in men. In whites, absolute death rates declined in persons of all educational levels, but the reduction was greater for men and women with more education than for those with less.

Conclusions: Despite an overall decline in death rates in the United States since 1960, poor and poorly educated people still die at higher rates than those with higher incomes or better educations, and this disparity increased between 1960 and 1986.

MeSH terms

  • Adult
  • Black or African American / psychology
  • Black or African American / statistics & numerical data
  • Educational Status
  • Female
  • Follow-Up Studies
  • Health Surveys
  • Humans
  • Income
  • Male
  • Middle Aged
  • Mortality / trends*
  • Sex Factors
  • Social Class
  • Socioeconomic Factors*
  • United States / epidemiology
  • White People / psychology
  • White People / statistics & numerical data