Objectives. We assessed whether economic opportunity was independently associated with health behaviors and outcomes in the United States.
Methods. Using newly available, cross-sectional, county-level data from the Equality of Opportunity Project Database and vital statistics, we estimated associations between all-cause mortality rates (averaged over 2000-2012) and economic opportunity, adjusting for socioeconomic, demographic, and health system covariates. Our measure of economic opportunity was the county-average rank in the national income distribution attained by individuals born to families in the bottom income quartile. Secondary outcomes included rates of age- and race-specific mortality, smoking, obesity, hypertension, and diabetes.
Results. An increase in economic opportunity from the lowest to the highest quintile was associated with a 16.7% decrease in mortality. The magnitudes of association were largest for working-age adults and African Americans. Greater economic opportunity was also associated with health behaviors and risk factors.
Conclusions. Economic opportunity is a robust, independent predictor of health. Future work should investigate underlying causal links and mechanisms.
- Atheendar S. Venkataramani is with the Division of General Internal Medicine, Massachusetts General Hospital, and the Harvard Center for Population and Development Studies, Boston, MA. Paula Chatterjee is with the Department of Medicine, Brigham and Women’s Hospital, Boston. Ichiro Kawachi is with the Department of Social and Behavioral Sciences, Harvard H. T. Chan School of Public Health, Boston. Alexander C. Tsai is with the Department of Psychiatry, Massachusetts General Hospital, and the Harvard Center for Population and Development Studies.
