Intersections Between Income Fluctuation, Heart Health, and Death

Photo of Kim Stitzel, M.S., R.D.Kim Stitzel, M.S., R.D., Senior Vice President, Center for Health Metrics and Evaluation

It’s a well-known reality that money problems are often stressful. So is the fact that stress is a risk factor for some health problems.

Now, a new study reports on the relationship between personal financial difficulties and health outcomes. Young adults who had two or more significant drops in income over a 15-year period had nearly double the risk of cardiovascular disease or dying prematurely over the next 10 years, according to the study, which was published in the American Heart Association’s journal Circulation.

Income volatility (i.e., fluctuating income) was more common among people who experienced income drops. People with the biggest income fluctuations had more than double the risk of death and risk for cardiovascular diseases (such as heart attacks, strokes, heart failure) or death during the following 10 years compared to a similar group of people with less income volatility. Women and African-Americans were more likely to experience high-income volatility and income drops than white men.

The study researchers analyzed data collected between 1990 and 2005 from nearly 4,000 geographically diverse black and white young adult participants in the Coronary Artery Risk Development in Young Adults (or CARDIA) study. In 1990, these participants were 23-35 years old. From then until 2005, they participated in five assessments where income data were collected.

Researchers calculated participants’ income volatility, defined as the percent change in income from one measurement to the next. They also measured income drop, defined as a decrease of 25 percent or more from the previous assessment. These periodic measures are important, because many studies that have examined the relationship between income and heart health have measured income only at a single point in time.

Income volatility as a public health threat

The study was observational, which means that it was not designed to prove cause and effect between income volatility and health. But its findings suggest that income volatility and income drops experienced in early to mid-adulthood are important independent predictors of CVD risk and overall mortality. And given the current economic environment of increasing income instability, the health threat from income volatility may be growing.

It’s likely that specific psychosocial and biologic pathways are involved in the relationship between income volatility and CVD and premature death. Factors like behavior changes, psychological stress, and access to medical care might mediate the relationship.

As we learn more about the interplay between income volatility and health, we’ll be better-informed about how to intervene while there’s still time. For example, people experiencing income volatility may be a high-priority group for CVD screening and clinical intervention.