Cumulative Health Effects of Sustained Economic Hardship

The relationship between health status and economic status is clear. The poor suffer a greater burden of ills, and the resources to combat these illnesses to which they more likely to fall prey are less plentiful. Most of our information about the effect of socioeconomic status on health has examined such status on a one-time basis, rather than assessing whether persons who are only transiently, cyclically, or chronically in a state of economic deprivation suffer differing health burdens of consequence.

Using information from 1965, 1974, and 1983 collected as part of the Alameda (California) County Study, a prospective study investigating health and function predictors in adults (initial n = 6982), the authors assessed the effect of repetitive economic hardship (defined as < 200% of the federal poverty level). Outcomes measures included difficulties with independent activities of daily living (e.g., cooking, shopping), difficulties in activities of daily living (e.g., walking, dressing, toilet use), and depression.

Persons suffering economic hardship at more than one time period were more than three times as likely to experience decrements in the outcomes measures. There was little evidence that illness had caused economic hardship (i.e., reverse causation). The authors conclude that sustained economic hardship increases the likelihood of physical, psychological, and cognitive dysfunction.

Lynch JW, et al. N Engl J Med 1997; 337:1889-1895.