An Experimental Investigation into the Impact of Socioeconomic Context on Biological Markers of Aging, Health and Mortality

贫困对少数民族和农村人口的影响尤为严重，并且与贫困密切相关 生命周期中的健康状况，并被假设会导致更短、更不健康的衰老过程。贫困 与吸烟和肥胖相比所带来的疾病负担更大，并且占大部分 不同种族的健康差异。人们普遍认为反贫困政策——例如所得税 信贷（EITC）——可以改善工作年龄低收入成年人整个生命周期的健康老龄化。确实如此 因此，通过增加物质困难和心理压力——这两个风险因素与 过早衰老的生物标志物（例如，端粒较短、胆固醇水平较高、血液浓度较高） 压力。）然而，将贫困与健康联系起来的文献主要建立在相关数据的基础上，这些数据受到 混淆和颠倒因果关系。经验丰富的研究公司 MDRC 已获得私人和公共 资助一项突破性的多中心随机对照试验（RCT），以检查因果影响 佐治亚州亚特兰大和纽约州纽约市为没有受抚养子女的工作成年人提供四倍的 EITC 薪水加（PP）。随机化使治疗组的 PP 高达 2000 美元，而相比之下，治疗组的 PP 高达 2000 美元。 对照组为 496 美元。然而，MDRC 并未研究 PP 对健康的影响。我们建议 利用 MDRC 的现有基础设施以及我们与 MDRC 的长期合作历史来增加临床、 调查和行政措施探讨 PP 是否改善成人的健康和生存 没有受抚养子女的接受者。随着这项研究在亚特兰大启动，我们建议亲自进行健康检查 收集慢性病重要生物标志物的筛查，例如血压、体重 指数 (BMI)、血糖、胆固醇和 C 反应蛋白（概念上与 贫困）。对于纽约市和亚特兰大队列，我们建议添加衡量健康相关的调查数据 生活质量和抑郁症。由于并非随机分配到治疗组的每个人都会报税（这是必要的 对于治疗组接受PP或对照组接受传统EITC），我们将分析我们的健康状况 使用意向治疗 (ITT) 与治疗治疗 (ToT) 分析的结果。这将产生 PP 增加对健康的无偏影响的局部平均治疗效果 (LATE) 估计。在 此外，我们将收集两个治疗地点死亡率的长期随访数据。我们将通过链接来做到这一点 个人标识符来自国家死亡指数的行政死亡率数据。最后，我们将建模 相对于传统的 EITC，PP 可以提高健康和寿命。该项目的创新之处在于 利用有计划且资金充足的社会科学实验来探索未曾实施过的结果衡量标准 最初是政策制定者考虑的。作为反贫困RTC项目，该项目也具有一定的创新性。 该计划以非常低的成本使用管理和临床健康数据。我们预计 PP 将成为 通过帮助没有受抚养子女的成年人摆脱贫困来促进健康老龄化的有效方法。

Poverty disproportionately impacts minority and rural populations and is very strongly correlated with poor health over the life cycle, and has been hypothesized to lead to a shorter, less healthy aging process. Poverty is associated with a greater burden of disease than smoking and obesity combined and accounts for the bulk of health disparities by race. It is widely believed that an anti-poverty policy—such as Earned Income Tax Credit (EITC)—could improve healthy aging among working-age low-income adults over the life cycle. It does so by increasing material hardship and psychological stress—two risk factors that are strongly correlated with biological markers of premature aging (e.g., shorter telomeres, higher cholesterol levels, and higher blood pressure.) However, the literature linking poverty to health is largely built on correlational data, which is subject to confounding and reverse causation. The experienced research firm MDRC has secured private and public funding for a groundbreaking multicenter Randomized Controlled Trial (RCT) that examines the causal impacts of quadrupling EITC for working adults without dependent children in Atlanta, GA and New York City, NY called Paycheck Plus (PP). Randomization exposes the treatment group to up to $2000 in PP compared to up to $496 in the control group. However, MDRC is not studying the impacts of PP on health. We propose leveraging MDRC’s existing infrastructure and our long history of collaboration with MDRC to add clinical, survey, and administrative measures to explore whether PP improves the health and survival of adult recipients without dependent children. Timed with launch of the study in Atlanta, we propose in-person health screenings with collection of important biomarkers of chronic disease, such as blood pressure, Body Mass Index (BMI), blood glucose, cholesterol, and C-reactive protein (measures that are conceptually linked to poverty). For both the NYC and Atlanta Cohorts, we propose adding survey data that measures health-related quality of life and depression. Since not everybody randomized to the treatment group will file taxes (a requisite for the treated group to receive PP or the control group to receive traditional EITC), we will analyze our health outcomes using an Intent to Treat (ITT) versus Treatment on the Treated (ToT) analysis. This will produce Local Average Treatment Effect (LATE) estimates of the unbiased impact of increased PP on health. In addition, we will collect long-term follow up data on mortality for both treatment sites. We will do so by linking individual identifiers administrative mortality data from the National Death Index. Finally, we will model the health and longevity gains associated with PP relative to traditional EITC. This project is innovative for exploiting a planned and fully funded social science experiment to explore outcome measures that were not originally considered by the policymakers. This project is also innovative for being a RTC of an anti-poverty program that uses administrative and clinical health data at a very low cost. We anticipate that PP will be an efficient approach to promoting healthy aging by lifting adults without dependent children out of poverty.