The Income-Associated Burden of Disease in the United States
In this chapter, we estimate and discuss the total burden of disease associated with income in the United States. We calculate the relationships between income and life expectancy, health-adjusted life expectancy, annual years of life lost (YLLs), and quality adjusted life years (QALYs). We used the 2000 United States Medical Expenditure Panel Survey to derive quality of life estimates by income and age, the 1990–1992 United States National Health Interview Survey linked to National Death Index data through the end of 1995 to derive mortality risks by income and by age, and 2000 United States mortality data from the National Center for Health Statistics to derive current mortality estimates for the United States population by age-group. The bottom 80% of adult income earners’ life expectancy is calculated as 4.3 years and 5.8 QALYs shorter relative to those in the top 20% of earnings. This translates into the loss of 11 million YLLs and 17.4 million QALYs each year. Compared with persons living above the poverty threshold, those living below the poverty threshold live an average of 3.2 million fewer QALYs per year – a difference of 8.5 QALYs per individual between age 18 and death. The income-associated burden of disease appears to be a leading cause of morbidity and mortality in the United States. Studies are needed to ascertain which policies might best mitigate income-associated health effects.
KeywordsLife Expectancy Medical Expenditure Panel Survey Poverty Threshold Disability Insurance Quality Adjusted Life Expectancy
List of Abbreviations:
health-related quality of life
medical expenditure panel survey
National Death Index
National Health Interview Survey
quality-adjusted life expectancy
quality-adjusted life year
years of life lost
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