Stratification and Accumulation?: Explaining Changing Mortality Inequities Between Business Owners and Non-owners in...

Given established relationships between social class and mortality, the growing concentration of income, wealth, and power among business owners in the United States may have increased mortality inequities across classes. To investigate this hypothesis, we analyzed temporal changes in mortality inequities between owners and non-owners.

Our sample included respondents ages 25-64 in the 1984, 1989, 1994, and 1999-2013 Panel Study of Income Dynamics with mortality follow-up through 2022 (respondents: 22,103; observations: 103,965). Business owners were individuals with personal or family ownership of, or direct financial interest in, a business in the prior year. Using g-computation, we estimated how inequities between owners and non-owners in 10-year age-adjusted mortality risks changed from 1984 to 2013. Next, we analyzed whether any changes were attributable to shifting social stratification. Finally, we analyzed whether growing income and wealth disparities between owners and non-owners exacerbated inequities.

In 1984, non-owners had 1.4 times (95% confidence interval [CI]: 1.1, 1.8) greater 10-year age-adjusted mortality risks than owners. In 2013, the figure was 2.3 (95% CI: 1.8, 3.0), yielding a ratio of risk ratios of 1.7 (95% CI: 1.1, 2.5). After social-stratification adjustment, within-year inequities lessened; however, increases across years attenuated only somewhat (2013 vs. 1984 ratio of risk ratios: 1.5 [95% CI: 0.99, 2.2]). Finally, we did not find that increases in inequities across years would have lessened if income and wealth distributions had remained at 1984 levels.

Mortality inequities between owners and non-owners have increased and cannot be fully explained by social stratification and individual-level income and wealth distributions.