Measuring Health Effects of the Great Recession

描述(由申请人提供)：尽管长期以来有证据表明，从最低社会经济地位(SES)到最高社会经济地位(SES)，健康状况越来越好的梯度很强，但SES-健康关系的因果性质尚未明确确立，这种关系背后的机制也没有得到很好的理解。从2008年开始，“大衰退”是一场影响绝大多数美国人的重大且基本上没有预料到的经济冲击，它对健康的影响有可能为SES对健康的因果影响提供科学证据。假设衰退的时间和规模在很大程度上是意想不到的，那么大衰退可以被视为一种外生的经济冲击，它提供了更多的机会来确定SES对健康的因果影响的程度。R21将经验性地评估在经济衰退之前和之后为相同的4655人测量的独特丰富的纵向、客观的生物数据(反映与主要发病率和死亡率有关的生理过程)是否可以用于确定经济衰退对健康的影响。这些来自动脉粥样硬化多种族研究(MESA)的数据将与当地劳动力和住房市场(住房市场的200多个邮政编码和至少200个特定地点的劳动力市场人口子组)的不同地区和年龄、性别、种族和教育的具体衡量标准联系在一起。在2008年秋季(衰退开始)之前收集了四波MESA数据，并在2010年7月至2011年12月期间进行了第五次考试。与之前许多关于经济衰退对健康影响的工作中使用的自我报告健康数据不同，MESA提供了对主要健康生理标记物的标准化、客观评估的独特力量，包括收缩压、脉压、血糖、血脂、身体质量指数和腰臀比。将这些丰富的健康数据与在大衰退开始之前和之后对相同个人进行的经济状况测量相结合，并与特定地区和特定人口的经济衰退风险敞口相结合，提供了无与伦比的机会来评估经济压力对客观评估的重要健康指标的影响。这项研究将描述这些健康标记物如何随着时间的推移而变化，以及它们如何随着地区和人口特定的经济压力的暴露而变化。R21旨在为更大范围、更全面的调查(R01)提供初步证据，以确定大衰退对生物学(包括从储存的血液样本中分析出的新生物标记物)、行为(如锻炼、吸烟、酗酒)、亚临床疾病(如颈动脉和外周动脉粥样硬化)、显性疾病(如心血管事件、住院)和总死亡率的影响。此外，广泛的台地遗传学数据还将允许在未来的工作中探索可能的基因与环境(衰退)相互作用的影响。

DESCRIPTION (provided by applicant): Despite long-standing evidence of strong gradients of increasingly better health from the lowest to the highest levels of socioeconomic status (SES), the causal nature of SES-health relationships has not been clearly established, and mechanisms underlying the relationships are not well understood. Beginning in 2008, the "Great Recession" was a major, and largely unanticipated, economic shock that impacted the vast majority of Americans and its impact on health has the potential to provide scientific evidence on the causal impact of SES on health. Assuming the timing and magnitude of the recession was largely unanticipated, the Great Recession can be treated as an exogenous economic shock that offers enhanced opportunities to establish the extent to which there are causal effects of SES on health. This R21 will empirically evaluate whether uniquely rich longitudinal, objective biological data (reflecting physiological processes linked to major morbidity and mortality) measured for the same 4,655 individuals before and after the Recession can be used to establish health effects of the Recession. These data from the Multi-Ethnic Study of Atherosclerosis (MESA) will be linked with time-varying area- and age-sex-race-education-specific measures of the local labor and housing markets (with over 200 zip-codes for housing markets and at least 200 location-specific demographic subgroups for labor markets). Four waves of MESA data were collected before Fall 2008 (onset of the Recession) with a 5th exam between July 2010 and December 2011. In contrast to the self-report health data used in much prior work on health effects of economic downturns, MESA offers the unique strength of standardized, objective assessments of major physiological markers of health, including systolic blood pressure, pulse pressure, blood glucose, serum lipids, body mass index and waist-hip ratio. Combining these rich health data with economic status measured on the same individuals before and after the onset of the Great Recession, and with local area- and demographic-specific exposures to the recession provides unparalleled opportunities to evaluate the effects of economic stress on objectively assessed and important health markers. The research will describe how these health markers change over time and how they change as exposure to area- and demographic-specific economic stress varies. This R21 is designed to provide initial evidence to establish feasibility and power for a larger, more comprehensive investigation (R01) of the impact of the Great Recession on biology (including new biomarkers assayed from stored blood samples), behaviors (e.g., exercise, smoking, heavy drinking), subclinical disease (e.g., carotid and peripheral atherosclerosis), overt disease (e.g., cardiovascular events, hospitalizations), and total mortality. Moreover, extensive MESA genetics data will also allow exploration of possible gene-by-environment (Recession) interaction effects in future work.