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 ag e (in the First National Health and Nutrition Examination Survey and N ational Health Examination Follow-up Survey). We estimated the proport ion of mortality associated with poverty from 1973 through 1984 and in 1991 by calculating the population attributable risk. We assessed con founding by major known risk factors, such as smoking, serum total cho lesterol, 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 attri butable risk of poverty on mortality was lowest for white women, 1.7 t imes higher for white men, 2.6 times higher for black women, and 3.6 t imes higher fur black men. Potential confounders explained 40% of the effect of poverty on mortality among women. The proportion of mortalit y attributable to poverty among U.S. black and white adults has increa sed in recent decades and is comparable to that attributable to cigare tte smoking. The effect of poverty on mortality must: be explained by conditions other than commonly recognized risk factors.