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，从社会经济地位（SES）的最低水平到最高水平，健康状况越来越好，但社会经济地位与健康关系的因果性质尚未明确确立，而且这种关系的潜在机制尚未得到很好的理解。从2008年开始，“大衰退”是一场重大的、很大程度上出乎意料的经济冲击，影响了绝大多数美国人，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。假设经济衰退的时间和程度在很大程度上是没有预料到的，那么大衰退可以被视为一种外源性经济冲击，它为确定社会经济状况对健康的因果影响程度提供了更多的机会。本R21将经验性地评估在经济衰退前后测量的相同4,655个人的独特丰富的纵向客观生物学数据（反映与主要发病率和死亡率相关的生理过程）是否可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民族研究（MESA）的数据将与当地劳动力和住房市场的时变区域和年龄、性别、种族、教育程度的具体测量相关联（住房市场有超过200个邮政编码，劳动力市场至少有200个特定地点的人口统计子组）。在2008年秋季（经济衰退开始）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检查。与之前许多研究经济衰退对健康影响的工作中使用的自我报告健康数据相比，MESA提供了对主要生理健康指标的标准化、客观评估的独特优势，包括收缩压、脉压、血糖、血脂、体重指数和腰臀比。将这些丰富的健康数据与在大衰退开始前后测量的同一个人的经济状况相结合，并与当地和人口特定的经济衰退风险相结合，为评估经济压力对客观评估的重要健康指标的影响提供了无与伦比的机会。这项研究将描述这些健康指标是如何随时间变化的，以及它们是如何随着地区和人口特定经济压力的变化而变化的。本R21旨在提供初步证据，以确定大衰退对生物学（包括从储存的血液样本中检测的新生物标志物）、行为（如运动、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）和总死亡率影响的可行性和能力（R01）。此外，广泛的MESA遗传学数据也将允许在未来的工作中探索可能的基因-环境（衰退）相互作用效应。

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.