Poverty and Death in the United States—1973 and 1991

We conducted a survival analysis to determine the effect of poverty on mortality in a national sample of blacks and whites 25–74 years of age (in the First National Health and Nutrition Examination Survey and National Health Examination Follow-up Survey). We estimated the proportion of mortality associated with poverty from 1973 through 1984 and in 1991 by calculating the population attributable risk. We assessed confounding by major known risk factors, such as smoking, serum total cholesterol, and inactivity. In 1973, 16.1% of U.S. mortality among black and white persons 25–74 years of age was attributable to poverty; in 1991, the proportion increased to 17.7%. In 1991, the population attributable risk of poverty on mortality was lowest for white women, 1.7 times higher for white men, 2.6 times higher for black women, and 3.6 times higher for black men. Potential confounders explained 40% of the effect of poverty on mortality among women. The proportion of mortality attributable to poverty among U.S. black and white adults has increased in recent decades and is comparable to that attributable to cigarette smoking. The effect of poverty on mortality must be explained by conditions other than commonly recognized risk factors.