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 Researchers followed income changes for 8,989 middle-aged adults
over six years, starting when they were 53 years old, on average.
Most people had relatively steady income during this period, but 10%
saw their pay cut by more than half and 20% had their income surge
by at least 50%.
None of the participants had a history of heart attack, stroke or
heart failure at the start of the study period. After an average
follow-up of 17 years, people who experienced a huge pay reduction
were 17% more likely to have a heart attack, stroke, or heart
failure than participants with steady or rising income.
The increased risk might be due to a biological response to stress
in addition to financial hardship, said Dr. Edward Havranek, author
of an editorial accompanying the study and director of Medicine at
Denver Health Medical Center in Colorado.
"While chronic stress raises blood pressure and probably causes
inflammation that affects blood vessels, I tend to believe the
social and economic effects are more important," Havranek said by
email.
"A sudden income drop likely makes it harder to afford healthcare,
and forces people to pay attention to money rather than taking good
care of themselves," Havranek added. And not everyone loses income
because they lose their job, he noted. "Loss of a spouse through
death or divorce can cause a large income drop; these things
obviously pay a toll on us."
Among participants who experienced substantial income declines,
average household income dropped from $40,516 to $14,655,
researchers report in JAMA Cardiology.
For individuals with steady earnings, average household income
dipped slightly from $43,897 to $43,057.
And, for the lucky ones whose fortunes improved dramatically,
average household income rose from $26,099 to $53,347. These people
with large income gains were 14% less likely to have a heart attack,
stroke, or heart failure than their counterparts with steady
earnings.
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Diminished income appeared to negatively impact heart health more
for white than for black individuals in the study.
Improved earnings appeared to positively impact heart health more
for women than for men, the study also found.
One limitation of the study is the potential for "reverse
causation," in other words, it's possible failing health caused the
loss of income or employment, instead of the reduced earnings
causing heart problems, the study team acknowledges.
Still, less income can lead to a variety of issues that might
compromise heart health including a loss of health insurance,
financial stress, eating more high-calorie and unhealthy foods, and
drinking and smoking, said the study's lead author, Stephen Wang.
"Social factors like income can have a significant impact on an
individual's health," Wang said.
Banking three to six months of expenses to use in case of job loss
or an emergency might help people minimize the risk of heart
problems associated with a substantial reduction in earnings, Wang,
who did the research while at Brigham and Women's Hospital and
Harvard Medical School in Boston, said by email.
"Having close friends and family for support during financially
stressful times may also reduce risk," added Wang, who is currently
at the Geisel School of Medicine at Dartmouth in Hanover, New
Hampshire. "Lastly, since income drops are so common, it's important
for our society to create safety nets to support individuals when
these situations occur."
SOURCE: https://bit.ly/2VOg3Dq and https://bit.ly/2Bgwtv9 JAMA
Cardiology, online October 9, 2019.
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