Opportunity for Health

Economic Opportunity, Health Behaviors, and Mortality in the United States

Atheendar S. Venkataramani, MD, PhD · Alexander C. Tsai, MD, PhD · Paula Chatterjee, MD, MPH · Ichiro Kawachi, PhD, MBChB
American Public Health Association · October 8, 2015


We assessed whether economic opportunity was independently associated with health behaviors and outcomes in the United States.


Using newly available, cross-sectional, county-level data from the Equality of Opportunity Project Database and vital statistics, we estimated associations between all-cause mortality rates (averaged over 2000-2012) and economic opportunity, adjusting for socioeconomic, demographic, and health system covariates. Our measure of eco- nomic opportunity was the county-average rank in the national income distribution attained by individuals born to families in the bottom income quartile. Secondary out- comes included rates of age- and race-specific mortality, smoking, obesity, hypertension, and diabetes.


An increase in economic opportunity from the lowest to the highest quintile was associated with a 16.7% decrease in mortality. The magnitudes of association were largest for working-age adults and African Americans. Greater economic opportunity was also associated with health behaviors and risk factors.


Economic opportunity is a robust, independent predictor of health. Future work should investigate underlying causal links and mechanisms.