Income inequality and limitations in activities of daily living: a multilevel analysis of the 2003 American Community Survey

Esme Fuller-Thomson, Tahany Gadalla
Public Health 2008, 122 (3): 221-8

OBJECTIVES: This study examined whether state income inequality was associated with an individual's limitations in activities of daily living (ADL) when controlling for the individual's demographic and socio-economic characteristics.

STUDY DESIGN AND METHODS: The study was based on secondary analyses of data collected in the 2003 American Community Survey (ACS). The ACS is a national survey of Americans with a 96.7% response rate. The sample used for this research included 645,835 participants aged 25 years and older. A multilevel model with a non-linear logit link function was used.

RESULTS: A 0.05 increase in the Gini coefficient (a measure of state level income inequality) was associated with an increase of 11% in the odds of ADL limitations [odds ratio (OR) 1.11, 95% confidence intervals 1.01-1.22] even after controlling for the individual's demographic and socio-economic characteristics. These elevated odds are comparable with those associated with women in comparison with men (OR 1.12). A separate analysis indicated that individuals in the three least equitable states had consistently higher probabilities of ADL limitations across the whole economic spectrum when compared with individuals in the three most equitable states.

CONCLUSIONS: State-level income inequality and individual income levels were significant independent predictors of ADL limitations. The impact of any future changes in state-level income inequality or shifts in individual income levels in the USA could be used to further investigate if this relationship is causal.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"