The Price of Debt: The Unequal Burden of Financial Debt and Its Impact on Health

描述（由申请人提供）：在过去的30年里，美国的平均家庭债务增加了两倍。少数种族/族裔和低收入者不平等地承担了大部分负担，他们在获得贷款方面面临歧视，必须将更多的家庭资源用于偿还债务。负债是自杀、抑郁和其他不良心理健康后果的一个强有力的预测因素。然而，它对身体健康的影响尚未得到充分研究。该项目的总体目标是阐明债务作为健康的社会经济决定因素，重点是阐明体现机制，并查明风险和差异的具体类别。我们采用混合方法，利用主要和次要数据源以及分层研究设计，结合流行病学，定性和机械方法，以提供我们调查的广度和深度。这项研究的结果旨在揭示债务对健康影响的性质和模式，并为制定有针对性的未来干预战略奠定基础。我们利用我们的多学科团队的多样化，但互补的专业知识，创建一个综合的混合方法研究计划，将统计创新与深入的定性分析和债务相关疾病风险的生物标志物相结合。具体目标是：1）使用收入动态小组研究（PSID）的国家纵向数据，记录债务的基本维度（绝对债务，债务与收入比率，有担保和无担保债务）与健康和健康的社会差异之间的关系。具体来说，我们将使用边际结构模型来解释复杂的时变因素，并将测试债务是否介导关键的健康不平等，以及种族/民族或SES是否会调节债务与健康的关联。2)进行定性研究，更深入地阐述债务的突出方面，并审查其作为心理社会压力源的作用。我们将定性地阐述芝加哥不同成年人之间债务的突出维度，并使用结构化人种志方法来阐明这些维度的结构。调查结果将为定量分析的解释提供信息，并指导目标3中债务风险的衡量。3)进行一项密集的基于社区的生物标志物研究，以检查债务维度与作为疾病易感性指标的关键压力生物标志物之间的关联。我们将在一个多样化的社区样本中确定最能预测压力相关疾病生物标志物和健康的债务暴露类型，并测试主观压力是否介导债务和健康结果之间的关联。4)综合所有三个研究与综合混合方法的方法。除了利用定性研究结果为研究的其他方面提供信息外，还应根据初步PSID研究结果的见解完善生物标志物研究方法，并综合所有三项研究的数据，以确定债务相关疾病的风险特征。

DESCRIPTION (provided by applicant): Average household debt in America has tripled in the past 30 years. Much of this burden is unequally borne by racial/ethnic minorities and those with lower incomes, who face discrimination in obtaining loans and must devote more household resources to paying off debts. Being indebted is a strong predictor of suicide, depression, and other adverse mental health outcomes. However, its impact on physical health is underexplored. The overarching aim of this project is to elucidate debt as a socioeconomic determinant of health, with emphasis on elucidating mechanisms of embodiment and pinpointing specific categories of risk and disparity. We take a mixed-methods approach, utilizing primary and secondary data sources and a layered study design that incorporates epidemiologic, qualitative, and mechanistic approaches, to provide both breadth and depth in our investigation. Findings from this study are intended to shed light on the nature and patterns of debt's impact on health and lay groundwork for the development of targeted future intervention strategies. We capitalize on the diverse, yet complementary, expertise of our multidisciplinary team to create an integrated mixed-methods research program that blends statistical innovations with in-depth qualitative analysis and biological markers of debt-related disease risk. Specific aims are: 1) Use national, longitudinal data from the Panel Study of Income Dynamics (PSID) to document the association of basic dimensions of debt (absolute debt, debt-to-income ratio, secured and unsecured debt) with health and social disparities in health over time. Specifically, we will use marginal structural models to account for complex time-varying factors, and will test whether debt mediates key health inequalities and whether race/ethnicity or SES moderate associations of debt with health. 2) Conduct a qualitative study to elaborate salient dimensions of debt in greater depth and examine their role as psychosocial stressors. We will qualitatively elaborate salient dimensions of debt among diverse adults in Chicago and use structured ethnographic methods to clarify the structure of those dimensions. Findings will inform interpretation of quantitative analyses and guide measurement of debt exposure in Aim 3. 3) Conduct an intensive community-based biomarker study to examine the associations of debt dimensions with key stress biomarkers that are indicators of disease susceptibility. We will identify the type of debt exposure that are most predictive of stress-related disease biomarkers and health in a diverse community sample and test whether subjective stress mediates associations between debt and health outcomes. 4) Synthesize all three studies with an integrated mixed methods approach. In addition to drawing on qualitative findings to inform other aspects of the study, refine the biomarker study approach based on insights from initial PSID findings and synthesize data from all three studies to identify debt-related disease risk profiles.