The Price of Debt: The Unequal Burden of Financial Debt and Its Impact on Health

描述(由申请人提供)：在过去的30年里，美国的平均家庭债务增加了两倍。这种负担很大程度上是由种族/族裔少数群体和收入较低的人不平等地承担的，他们在获得贷款方面面临歧视，必须将更多的家庭资源用于偿还债务。负债是自杀、抑郁和其他不利心理健康后果的强烈预测因素。然而，它对身体健康的影响还没有得到充分的研究。该项目的主要目标是阐明债务是健康的社会经济决定因素，重点是阐明具体化的机制，并查明具体类别的风险和差距。我们采取混合方法，利用主要和次要数据来源以及结合流行病学、定性和机械性方法的分层研究设计，为我们的调查提供广度和深度。这项研究的结果旨在阐明债务对健康影响的性质和模式，并为制定有针对性的未来干预战略奠定基础。我们利用我们多学科团队多样但互补的专业知识，创建了一个综合的混合方法研究计划，将统计创新与深入的定性分析和债务相关疾病风险的生物标记物相结合。具体目标是：1)使用收入动态小组研究(PSID)的国家纵向数据，记录债务的基本方面(绝对债务、债务收入比、有担保债务和无担保债务)与健康和社会健康差距之间的联系。具体地说，我们将使用边际结构模型来考虑复杂的时变因素，并将测试债务是否调节关键的健康不平等，以及种族/民族或社会经济地位是否调节债务与健康的关联。2)进行定性研究，更深入地阐述债务的显著维度，并考察它们作为心理社会压力源的作用。我们将定性地阐述芝加哥不同成年人中债务的显著维度，并使用结构化的民族志方法来澄清这些维度的结构。3)开展一项以社区为基础的密集生物标记物研究，以检验债务维度与作为疾病易感性指标的关键压力生物标记物的关联。我们将在不同的社区样本中确定最能预测压力相关疾病、生物标记物和健康的债务暴露类型，并测试主观压力是否在债务和健康结果之间起中介作用。4)综合三项研究，采用综合的混合方法。除了利用定性结果为研究的其他方面提供信息外，还应根据PSID初步发现的见解改进生物标记物研究方法，并综合所有三项研究的数据，以确定与债务相关的疾病风险概况。

DESCRIPTION (provided by applicant): Average household debt in America has tripled in the past 30 years. Much of this burden is unequally borne by racial/ethnic minorities and those with lower incomes, who face discrimination in obtaining loans and must devote more household resources to paying off debts. Being indebted is a strong predictor of suicide, depression, and other adverse mental health outcomes. However, its impact on physical health is underexplored. The overarching aim of this project is to elucidate debt as a socioeconomic determinant of health, with emphasis on elucidating mechanisms of embodiment and pinpointing specific categories of risk and disparity. We take a mixed-methods approach, utilizing primary and secondary data sources and a layered study design that incorporates epidemiologic, qualitative, and mechanistic approaches, to provide both breadth and depth in our investigation. Findings from this study are intended to shed light on the nature and patterns of debt's impact on health and lay groundwork for the development of targeted future intervention strategies. We capitalize on the diverse, yet complementary, expertise of our multidisciplinary team to create an integrated mixed-methods research program that blends statistical innovations with in-depth qualitative analysis and biological markers of debt-related disease risk. Specific aims are: 1) Use national, longitudinal data from the Panel Study of Income Dynamics (PSID) to document the association of basic dimensions of debt (absolute debt, debt-to-income ratio, secured and unsecured debt) with health and social disparities in health over time. Specifically, we will use marginal structural models to account for complex time-varying factors, and will test whether debt mediates key health inequalities and whether race/ethnicity or SES moderate associations of debt with health. 2) Conduct a qualitative study to elaborate salient dimensions of debt in greater depth and examine their role as psychosocial stressors. We will qualitatively elaborate salient dimensions of debt among diverse adults in Chicago and use structured ethnographic methods to clarify the structure of those dimensions. Findings will inform interpretation of quantitative analyses and guide measurement of debt exposure in Aim 3. 3) Conduct an intensive community-based biomarker study to examine the associations of debt dimensions with key stress biomarkers that are indicators of disease susceptibility. We will identify the type of debt exposure that are most predictive of stress-related disease biomarkers and health in a diverse community sample and test whether subjective stress mediates associations between debt and health outcomes. 4) Synthesize all three studies with an integrated mixed methods approach. In addition to drawing on qualitative findings to inform other aspects of the study, refine the biomarker study approach based on insights from initial PSID findings and synthesize data from all three studies to identify debt-related disease risk profiles.