Cumulative impact of sustained economic hardship on physical, cognitive, psychological, and social functioning
Cumulative impact of sustained economic hardship on physical, cognitive, psychological, and social functioning
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DOI：
10.1056/nejm199712253372606
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发表时间：
1997-12-25
影响因子：
158.5
通讯作者：
Shema, SJ
中科院分区：
文献类型：
--
作者：
Lynch, JW;Kaplan, GA;Shema, SJ
背景虽然低收入与健康状况差之间的关系已经确立，但大多数先前的研究只测量了一次收入。方法我们使用1965年、1974年和1983年从加利福尼亚州阿拉米达县有代表性的成年人样本收集的收入信息，来检验经济困难(定义为家庭总收入低于联邦贫困水平的200%)对1994年在世的参与者的累积影响。结果由于信息缺失，分析基于1081到1124名参与者(1994年的中位年龄为65岁)。在对年龄和性别进行调整后，收入低于贫困水平的200%的次数(范围从0到3)与所检查的除社会隔离之外的所有功能指标之间存在显著的分级关联。与没有经济困难的受试者相比，1965、1974和1983年有经济困难的人在日常生活的独立活动(如做饭、购物和理财)(优势比，3.38；95%可信区间，1.49-7.64)、日常生活活动(如行走、饮食、穿衣和如厕)(优势比，3.79；95%可信区间，1.32-9.81)和临床抑郁(优势比，3.24；95%的可信区间，1.32至7.89)。我们几乎没有发现反向因果关系的证据--也就是说，疾病发作可能导致了随后的经济困难。结论持续的经济困难导致身体、心理和认知功能较差。
Background Although the relation between low income and poor health is well established, most previous research has measured income at only one time.Methods We used income information collected in 1965, 1974, and 1983 from a representative sample of adults in Alameda County, California, to examine the cumulative effect of economic hardship (defined as a total household income of less than 200 percent of the federal poverty level) on participants who were alive in 1994.Results Because of missing information, analyses were based on between 1081 and 1124 participants (median age, 65 years in 1994). After adjustment for age and sex, there were significant graded associations between the number of times income was less than 200 percent of the poverty level (range, 0 to 3) and all measures of functioning examined except social isolation. As compared with subjects without economic hardship, those with economic hardship in 1965, 1974, and 1983 were much more likely to have difficulties with independent activities of daily living (such as cooking, shopping, and managing money) (odds ratio, 3.38; 95 percent confidence interval, 1.49 to 7.64), activities of daily living (such as walking, eating, dressing, and using the toilet) (odds ratio, 3.79; 95 percent confidence interval, 1.32 to 9.81), and clinical depression (odds ratio, 3.24; 95 percent confidence interval, 1.32 to 7.89) in 1994. We found little evidence of reverse causation - that is, that episodes of illness might have caused subsequent sconomic hardship.Conclusions Sustained economic hardship leads to poorer physical, psychological, and cognitive functioning.