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Association between income inequality and area-based educational disparities in mortality in Taiwan
Methods: Township-level all-cause age-standardized mortality data in 2005-2007 came from the Ministry of Health and Welfare. City-level Gini coefficient and median disposable income data were obtained from 1999-2001 family income and expenditure survey. Township-level education attainment level (the percentage of population aged 15 years and over who have obtained college education) and population size in 2004 were from the Ministry of the Interior. We defined health disparities based on the Slope Index of Inequality (SII), as the regression coefficient of township mortality on township education level. Using a multilevel ecological framework of 349 townships nested within 20 cities in Taiwan, we examined associations between income inequality and area-based educational health disparities while controlling for median income and population size.
Results: Multilevel models showed higher Gini coefficient was associated with steeper area-level educational gradients in mortality. After controlling for median income and population size, the slope of township education level on mortality was -13.19 all-cause deaths per 100,000 population (P<0.001), and a 0.01 rise in the Gini coefficient further increases the slope by -1.24 deaths per 100,000 population (P<0.001). Additionally, we found a 0.01 rise in the Gini coefficient increases total mortality by 28.15 deaths per 100,000 population (P<0.001).
Conclusions: Income inequality is related to area-based educational gradients in mortality in Taiwan, and narrowing the gap between rich and poor may improve population health and reduce health disparities.
Learning Areas:
Administration, management, leadershipEpidemiology
Public health administration or related administration
Public health or related public policy
Public health or related research
Social and behavioral sciences
Learning Objectives:
Identify area-level socioeconomic health disparities in Taiwan.
Demonstrate the associations between income inequality and area-based educational gradients in mortality.
Discuss the effect of income inequality on population health and health disparities.
Keyword(s): Health Disparities/Inequities, Taiwan Health
Qualified on the content I am responsible for because: I am a visiting research fellow at Department of Social and Behavioral Sciences in Harvard T.H. Chan School of Public Health. Also, I am a doctoral candidate at the Institute of Health Policy and Management, National Taiwan University in Taipei. My research interests focus on social determinants of population health and health inequalities. I am specifically interested in how income inequalities influence population health and health disparities.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.