Looking through a different lens: Examining the inequality-mortality association in U.S. counties using spatial panel models

Two areas still need further examination in the ecological study of inequality and mortality. First, the evidence for the relationship between income inequality and mortality remains inconclusive, particularly when the analytic unit is small (e.g., county in the U.S.). Second, most previous studies are cross-sectional and are unable to address the recent diverging patterns whereby mortality has decreased and income inequality increased. This study aims to contribute to both topic areas by studying the relationship between inequality and mortality via a spatiotemporal approach that simultaneously considers the spatial structure and the temporal trends of inequality and mortality using county panel data between 1990 and 2010 for the conterminous U.S. Using both spatial panel random effect and spatial panel fixed effect models, we found that (a) income inequality was not a significant factor for mortality after taking into account the spatiotemporal structure and the most salient factors for mortality (e.g., socioeconomic status); (b) the spatial panel fixed effect model indicated that income inequality was negatively associated with mortality over the time, a relationship mirroring the diverging patterns; and (c) the significant spatial and temporal fixed effects suggested that both dimensions are critical factors in understanding the inequality-mortality relationship in the U.S. Our findings lend support to the argument that income inequality does not affect mortality and suggest that the cross-sectional findings may be a consequence of ignoring the temporal trends.