Social Science & Medicine
Volume 61, Issue 9 , November 2005, Pages 2018-2026

The income-associated burden of disease in the United States

Peter Muenniga, , , Peter Franksb, Haomiao Jiac, Erica Lubetkind and Marthe
R Goldd

aDepartment of Health Policy and Management, Mailman School of Public
Health, Columbia University, 600 W 168th St., 6th Floor, New York, NY
10032, US
bCenter for Health Services Research in Primary Care, Department of Family
& Community Medicine, University of California, Davis, US
cDepartment of Community Medicine, Mercer University School of Medicine,
Macon, GA, US
dCommunity Health and Social Medicine, The City University of New York
Medical School, New York, NY, US

Abstract
In this study, we estimate the total burden of disease associated with
income in the US. We calculate the relationships between income and life
expectancy, health-adjusted life expectancy, annual years of life lost
(YLLs), and health adjusted life years (HALYs).We used the 2000 US Medical
Expenditure Panel Survey to derive quality of life estimates by income and
age, the 1990–1992 US 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 US mortality data from the National Center for
Health Statistics to derive current mortality estimates for the US
population by age-group. The bottom 80% of adult income earners’ life
expectancy is 4.3 years and 5.8 HALYs shorter relative to those in the top
20% of earnings. This translates into the loss of 11 million YLLs and 17.4
million HALYs each year. Compared with persons living above the poverty
threshold, those living below the poverty threshold live an average of 3.2
mill
ion fewer HALYs per year—a difference of 8.5 HALYs 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 US.

Keywords: US; Health inequalities; Poverty; Burden of disease analysis



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