By Lisa Rapaport
(Reuters Health) – Experiencing a substantial drop in income may raise the risk of having a heart attack or stroke years later, a recent study suggests.
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.
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.