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

贫穷对少数群体和农村人口的影响特别大， 健康的生命周期，并已假设导致一个较短的，不太健康的衰老过程。贫困 与疾病负担有关的疾病负担比吸烟和肥胖加起来还要大， 种族的健康差异。人们普遍认为，反贫困政策-如所得税- 信贷（EITC）-可以改善工作年龄低收入成年人在生命周期中的健康老龄化。它确实 因此，通过增加物质困难和心理压力，这两个风险因素与 过早老化的生物学标记（例如，更短的端粒，更高的胆固醇水平，更高的血液 压力。）然而，将贫困与健康联系起来的文献主要是建立在相关数据的基础上的， 混淆和反转因果关系经验丰富的研究公司MDRC已经获得了私人和公共 为一项开创性的多中心随机对照试验（RCT）提供资金， 佐治亚州亚特兰大市和纽约州纽约市没有受抚养子女的工作成年人的EITC翻了两番， Paycheck Plus（PP）.随机化使治疗组暴露于高达2000美元的PP， 对照组496元。然而，MDRC没有研究PP对健康的影响。我们提出 利用MDRC现有的基础设施和我们与MDRC的长期合作历史， 调查和行政措施，以探讨PP是否改善成人的健康和生存 没有受抚养子女的受助人。随着这项研究在亚特兰大的启动，我们建议在人的健康 收集慢性疾病的重要生物标志物进行筛查，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，我们建议增加测量健康相关的调查数据， 生活质量和抑郁症。由于不是每个随机分配到治疗组的人都会报税（这是一个必要条件， 对于接受PP的治疗组或接受传统EITC的对照组），我们将分析我们的健康状况 使用意向治疗（ITT）对比治疗组治疗（ToT）分析的结局。这将产生 局部平均治疗效应（LATE）估计PP增加对健康的无偏影响。在 此外，我们将收集两个治疗中心死亡率的长期随访数据。我们将通过链接 国家死亡指数中的行政死亡率数据。最后，我们将对 相对于传统的EITC，与PP相关的健康和长寿收益。该项目具有创新性， 利用一个有计划的和完全资助的社会科学实验，探索结果的措施， 这是决策者最初考虑的。该项目也是一个创新的反贫困RTC 该计划以非常低的成本使用行政和临床健康数据。我们预计，PP将是一个 通过帮助没有受抚养子女的成年人摆脱贫困，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.