Cardiovascular Health Effects of the Great Recession

项目摘要/摘要 很少美国人没有受到大衰退(GR)的影响。尽管人们可能会认为主要的经济 像这样的衰退会对身体健康造成负面影响，事实上，证据是喜忧参半的。这个项目将 将生物信息丰富的经验方法与独特丰富的个人和地方纵向数据相结合 市场层面测试GR经济压力对心血管疾病影响的假说 (心血管疾病)风险因素和事件。来自多种族的六波CVD危险因素和有效的CVD事件 GR前后收集的动脉粥样硬化(MESA)研究将与详细的时间变化联系起来 衡量当地劳动力和住房市场状况的地区和人口统计指标。前四波 在2000年年中至2007年年中期间收集的MESA将被用来估计 个体特有的衰老轨迹。第五波收集于2010年至2012年，紧随GR之后，以及 2016年和2017年收集的第六波将被用来调查经济衰退的短期和长期影响。 经济衰退超出了预期的年龄相关变化，我们允许每个人的变化不同。具体目标 这个项目的目的是：(1)检验关于暴露于不同经济压力来源的影响的假设 关于心血管疾病的六大生物危险因素，控制个人特有的生物学轨迹，利用 看似合理的GR严重程度和衰退后复苏的外生差异，以隔离因果影响。 例如，这包括比较住房市场状况变化对拥有住房的人的影响。 经济衰退前的房屋与那些没有衰退的房屋。(2)测试关于时间和时间的生物知情假说 这些影响在系统中的持久性；(3)测试GR对生物风险因素的影响是否得到反映 心血管事件发生率的增加--这是一种难的临床结果；(4)测试潜在的通路变量：健康 行为、健康保险、药物使用(抗高血压药、糖尿病药物和他汀类药物)， 抑郁和社会支持随着GR的经济压力而变化；以及(5)测量 储存来自MESA的血浆，以供本次研究和整个研究界未来使用。集成 来自生物学和经济学的见解，这个项目将提供新的、可信的证据来证明 通过利用MESA的独特优势来测试生物信息对健康的经济条件 关于GR随时间对不同生物标记物的不同影响的假设，使用创新模型 这控制了生物学上特定于个人的老龄化趋势，同时利用了不同地区经济压力的差异 从对当地住房和劳动力的意外变化的不同暴露中获得的人口分组 市场。从这项工作中对不同经济水平对健康影响程度的经验估计 压力将为经济衰退的因果影响提供全面和可信的证据。 美国人口健康状况的剧变。

PROJECT SUMMARY/ABSTRACT Few Americans were untouched by the Great Recession (GR). Though one might expect major economic downturns such as this to negatively affect physical health, the evidence is, in fact, mixed. This project will integrate biologically-informed empirical methods with uniquely rich longitudinal data at the individual and local market level to test hypotheses about the effects of economic stress from the GR on cardiovascular disease (CVD) risk factors and events. Six waves of CVD risk factors and validated CVD events from the Multi-Ethnic Study of Atherosclerosis (MESA) collected before and after the GR will be linked with detailed time-varying area- and demographic-specific measures of local labor and housing market conditions. The first four waves of MESA, collected between mid-2000 and mid-2007, before the onset of the GR in 2008, will be used to estimate individual-specific aging trajectories. The fifth wave, collected in 2010 through 2012 immediately post GR, and the sixth wave, collected in 2016 and 2017, will be used to investigate both short and longer-term effects of the Recession beyond the expected age-related changes that we allow to differ for each individual. Specific aims of this project are to: (1) test hypotheses about effects of exposures to different sources of economic stress on six major biological risk factors for CVD, controlling for individual-specific trajectories of biology, exploiting plausibly exogenous variation in the severity of the GR and post-recession recovery to isolate causal effects. This includes, for example, comparing effects of changes in housing market conditions on those who owned homes pre-Recession vs. those who did not. (2) test biologically informed hypotheses about the timing and persistence of these effects across systems; (3) test whether GR effects on biological risk factors are reflected in increased rates of CVD events – a hard clinical outcome; (4) test whether potential pathway variables: health behaviors, health insurance, medication use (anti-hypertensives, diabetes medications, and statins), depression, and social support changed with the economic stresses of the GR; and (5) measure CRP levels in stored plasma from MESA for this research and for future use by the entire research community. Integrating insights from biology and economics, this project will provide new, credible evidence on the causal effects of economic conditions on health by leveraging unique strengths of MESA to test biologically informed hypotheses regarding differential impacts of the GR on different biomarkers over time, using innovative models that control for individual-specific aging trends in biology, while exploiting variation in economic stress across population sub-groups from differential exposures to the unanticipated changes in local housing and labor markets. Empirical estimates from this work of the magnitude of health impacts of varying levels of economic stress will provide a comprehensive and credible body of evidence on the causal impacts of economic upheavals on health outcomes in the U.S. population.