Mortality, Income, and Income Inequality Over Time in Britain and the United States

We investigate age-specific mortality in Britain and the United States since 1950. Neither trends in income nor in income inequality provide plausible explanations. Britain and the US had different patterns of income growth but similar patterns of mortality decline. Patterns of income inequality were similar in both countries, but adult and elderly mortality rates declined most rapidly during the period when inequality increased. Changes in the rate of mortality decline in the US led changes in Britain by about four years, most notably for infant and older adult mortality where there have been significant technical improvements in treatment. British mortality is lower, but the schedules cross at around age 65. This pattern was established before Medicare, and most likely comes from rationing by age in Britain. Merged income, income inequality, and mortality data on an age/year (or cohort/year) basis show no evidence that income has any effect on mortality in Britain. Education is protective, but less so than in the US. Understanding the effect of income on mortality presents many puzzles, between countries, and between analyses at different levels of aggregation. Our results suggest an important role for medical technology in determining the rate of mortality decline since 1950.