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不成比例，与贫困密切相关。 生命周期中的健康，并被假设会导致较短的、不太健康的衰老过程。贫困 与疾病相关的负担比吸烟和肥胖的总和还要大，占了大部分 按种族划分的健康差距。人们普遍认为，一项反贫困政策--如劳动所得税 信贷(EITC)-可以改善处于工作年龄的低收入成年人在整个生命周期中的健康老龄化。的确如此。 因此，通过增加物质困难和心理压力-这两个风险因素与 过早衰老的生物标记物(例如，端粒较短、胆固醇水平较高和血液较高 压力。)然而，将贫困与健康联系起来的文献在很大程度上是建立在相关数据的基础上的，这是主题 混淆和颠倒因果关系。经验丰富的研究公司MDRC已经获得了私人和公共部门 为一项突破性的多中心随机对照试验(RCT)提供资金，以检查因果影响 在佐治亚州亚特兰大和纽约纽约市，为没有子女的在职成年人提供四倍的EITC 工资加(PP)。随机化使治疗组面临高达2000美元的PP，而不是 对照组496美元。然而，MDRC没有研究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， 调查和行政措施，以探讨PP是否改善成年人的健康和生存 无受扶养子女的受助人。在亚特兰大启动这项研究的时间，我们建议面对面的健康 通过收集慢性疾病的重要生物标记物进行筛查，如血压、体重 指数(BMI)、血糖、胆固醇和C反应蛋白(在概念上与 贫困)。对于纽约和亚特兰大的队列，我们建议增加衡量健康相关的调查数据 生活质量和抑郁。因为并不是每个被随机分配到治疗组的人都会报税(一个必备条件 对于接受PP治疗的治疗组或接受传统EITC治疗的对照组)，我们将分析我们的健康状况 使用意向治疗(ITT)与治疗(TOT)分析的结果。这将产生 局部平均治疗效果(晚期)对PP增加对健康的无偏见影响的估计。在……里面 此外，我们将收集两个治疗地点的死亡率的长期随访数据。我们将通过链接 个人标识来自国家死亡指数的行政死亡率数据。最后，我们将对 与传统的EITC相比，PP带来的健康和长寿收益。该项目具有创新性 利用计划和全额资助的社会科学实验来探索没有 最初是政策制定者考虑的。该项目也是一个创新，成为一个反贫困的RTC 以非常低的成本使用管理和临床健康数据的计划。我们预计PP将是一个 通过帮助无子女的成年人脱贫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.