A serious financial setback in middle age or later is associated with an increase in the risk for death during the next 20 years by as much as 50% compared with people who do not experience such losses, the authors of a new study warn.
The findings “offer new evidence for a potentially important social determinant of health that so far has not been recognized: sudden loss of wealth in late middle or older age,” senior author Carlos Mendes de Leon, PhD, professor of epidemiology and global public health at the School of Public Health, University of Michigan, Ann Arbor, said in a news release about the study.
The authors also note that such events were more common than might have been expected: More than 25% of the participants experienced a loss of 75% or more of household wealth during the study period, the authors found.
The researchers also found that mortality risk for people who had never accumulated wealth was 67% higher than those in more stable circumstances. However, strong evidence already correlates lower socioeconomic status with poorer health outcomes, lead author Lindsay R. Pool, PhD, said in the news release.
“The most surprising finding was that having wealth and losing it is almost as bad for your life expectancy as never having wealth,” she said.
“[C]linicians need to have an awareness of their patients’ financial circumstances,” added Pool, research assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine, Chicago, Illinois. “It’s something they need to ask about to understand if their patients may be at an increased health risk.”
The findings were published in the April 3 issue of JAMA.
The authors studied participants in the Health and Retirement Study, which began in 1990 and follows a nationally representative cohort of American adults 51 years of age or older. Every 2 years, the participants answer questions about their health and financial status, with interviews covering topics such as the value of their homes, businesses, checking and savings accounts, investments, and other assets, and liabilities such as medical bills, credit card debt, mortgages, and home equity loans.
For this analysis, the authors divided the participants into 3 groups: those who experienced a “negative wealth shock” during follow-up, defined as a loss of at least 75% of net household worth during a 2-year period; people with continuous positive wealth, who experienced no serious loss of assets; and people who had “asset poverty,” defined as no or negative net worth at baseline.
All-cause mortality from 1994 to 2014 was the outcome of interest. The analysis was adjusted for numerous covariates including race, educational status, household net worth, and health behaviors such as smoking, alcohol consumption, and physical activity.
The 8714 participants (53% women; mean age, 55 years) were followed for a mean of 17.7 years. Of those people, 2430 experienced at least one negative wealth shock, and another 749 had asset poverty at baseline. “Accounting for the complex survey design of the [Health and Retirement Study], this amounted to 26.2% (95% [confidence interval (CI)], 24.8%-27.7%) experiencing a negative wealth shock and 6.9% (95% CI, 6.3%-7.6%) having long-term asset poverty of the US population aged 51 years or older during the study period,” the authors write.
Overall, 2823 participants died during the follow-up period. Among people in the continuous wealth group, the unadjusted mortality rate was 30.6 deaths per 1000 person-years (95% CI, 29.1 – 32.1 deaths), whereas for those in the wealth shock and asset poverty groups, the rates were 64.9 (95% CI, 60.4 – 69.3) and 73.4 (95% CI, 66.1 – 80.7) deaths, respectively.
After adjusting for other factors, the hazard ratios for mortality among those who experienced a negative wealth shock or long-term asset poverty were 1.50 (95% CI, 1.36 – 1.67) and 1.67 (95% CI, 1.44 – 1.94), respectively, compared with people in the continuous wealth group.
These findings add to the growing body of research demonstrating an association between negative wealth shocks and adverse short-term health outcomes such as depression, suicide, anxiety, substance abuse, and impaired cardiac function, as well as causes of death that have longer latency, the authors write. Also, “in this study, wealth shocks with loss of home had a stronger association with mortality than wealth shocks without loss of home, though these shocks were still associated with increased mortality risk.”
Financially strapped individuals may delay medical care or avoid filling prescriptions, resulting in poorer health, the authors suggest. The psychosocial toll of economic loss may also make them more vulnerable to stress-related illnesses such as cardiovascular disease, or to mental disorders and substance abuse, all of which are associated with a higher risk for mortality.
In an accompanying editorial, Alan M. Garber, MD, PhD, provost of Harvard University, Cambridge, Massachusetts, points out that wealth shocks were surprisingly common, “occurring in nearly a quarter of this middle-aged to elderly group over 2 decades.” He adds, “[i]t is sobering to contemplate that mortality rates were even greater among people who had no assets to lose.”
Compared with those who had continuous positive wealth, individuals who experienced wealth shocks also had lower income and less wealth, reported poorer health, and were more likely to smoke. In other words, they more closely resembled those who had asset poverty at baseline, Garber writes. This raises the possibility that unmeasured factors such as “health behaviors and refined measures of health status at baseline might contribute to the excess mortality attributed to the wealth shocks.”
Although no specific intervention can yet be recommended to patients who go through a wealth shock, such an event clearly has serious implications for their health and well-being, he concludes. “An opportunity to build empathy and offer support will elude clinicians who fail to recognize such a profound event and its meaning for their patient’s future.”
The authors note several study limitations including lack of information on less acute wealth shocks that may have occurred over longer periods of time, inability to capture information on wealth shocks that may have occurred before people enrolled in the study, inability to control for all residual confounding factors or to generalize the findings to people who experience wealth shocks before 51 years of age, and lack of information on the causes of the wealth shocks.
The study authors have disclosed no relevant financial relationships. Garber has reported that he is on the boards of Exelixis and Vertex.
JAMA. 2018;319:1341-1350; 1327-1328. Article full text, Editorial extract
For more news, join us on Facebook and Twitter
Tidak ada komentar:
Posting Komentar