Today's clinicians and health care leaders are perhaps unaware of the decline in household income and the widening of income disparities that are occurring in the United States. The effects of these trends may not become apparent in hospitals or examination rooms until late in the careers of today's physicians or in their children's generation, but the potentially harmful influence on the health care system and, ultimately, on patients deserves attention now.
Income is a significant determinant of health. The connections between poverty and disease have been well documented, but even modest reductions in income among more affluent persons can also influence health. For example, results from the US National Longitudinal Mortality Study indicated that individuals with an income of $25 000 to $49 999 in 1979-1989 had a shorter life expectancy than those with an income of $50 000 or greater.1 A more recent British study found that people in the fourth income quintile were 29% more likely to report poor health than those in the highest (fifth) income quintile.2 Although income reductions and resulting health effects tend to be less severe in the middle and upper classes than the poor, by sheer numbers their subtle economic experience may ultimately exert greater influence on population disease burden.
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