Neighborhood Socioeconomic Status and Health: Context or Composition?

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. 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. 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. 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.

Urbanization, rising income inequality, and increasing class segregation have produced a geographic concentration of affluence and poverty throughout the world, creating a radical change in the geographic basis of human society. As the density of poverty rises in the environment of the world's poor, so will their exposure to crime, disease, violence, and family disruption. Meanwhile the spatial concentration of affluence will enhance the benefits and privileges of the rich. In the twenty-first century the advantages and disadvantages of one's class position will be compounded and re-inforced through ecological mechanisms made possible by the geographic concentration of affluence and poverty, creating a deeply divided and increasingly violent social world.