The decrease in socioeconomic differences in mortality from 1920 to 2000 in the United States and England

This study found that the effect of socioeconomic status (SES) on mortality decreased steadily during the twentieth century. It examined trends in age-specific adult mortality rates for employed men and infants in a number of social classes based on occupation in England and Wales and for black, white, and immigrant nationality groups of men, women, and infants in the United States. Both countries experienced continuing decreases in mortality rates and narrowing of SES differences in mortality rates from 1920 to the end of the century. Most of the decrease and narrowing in England and Wales occurred before the establishment of the National Health Service and the unprecedented improvements in clinical and preventive medicine after midcentury. Current cancer mortality rates in both countries show no consistent relationship with SES. The very low mortality rates of some low SES immigrant nationality groups in the United States throughout the century demonstrate that other social factors can have a greater effect on health than SES.