Income volatility and heart health

Income volatility, or fluctuations of household income over time, has become an increasingly important financial issue in the 21st century. With the rise of the “gig economy,” unstable schedules, and unstable government benefits, households often experience sharp rises and falls in income from month to month, and even week to week. Nearly half of all households experience an income gain or loss of more than 25 percent over any two-year period, and about a quarter of people see half their income rise or fall from year to year.

Previous studies have shown that income fluctuations, without savings to buffer these swings, can lead to debt, financial insecurity, and stress. Now, new research is showing that income volatility may have an impact on heart health as well. Earlier this year, a study in Circulation found that sudden income dips in early adulthood are associated with a nearly two-fold increase in risk of cardiovascular disease and all-cause mortality. 

In a recent study in JAMA, a team of cardiologists and public health researchers found that individuals whose households experienced a 50% drop in income over 6 years were 17% more likely to have a cardiovascular incident (heart attack, heart failure, or stroke) compared to those with a stable income. On the other hand, individuals whose households experienced a rise in income over that time period were 14% less likely to have a cardiovascular incident.

These findings make sense, given that income volatility has been shown to increase stress, which can negatively impact heart health. Unfortunately, this can create a vicious cycle, because the cost of treating health care problems can create more financial problems. These studies add to the large base of evidence showing that financial difficulties, including those caused by the high cost of health care, contribute to poor health. 

Social programs designed to provide income support can positively impact health even more if they help stabilize household incomes and provide buffers for income downswings. For example, unemployment insurance should be more easily accessible to all workers, when people are experiencing income drops after unemployment. The positive health effects of the Earned Income Tax Credit could be boosted by giving people the option to get monthly payments rather than annual, and increasing the amount of the monthly credit. 

Clinicians should also be aware of the negative impact of income downturns on health and be able to refer patients to income support in their community, if possible. Clinicians should also be sure to consider the cost of care when helping patients make treatment decisions.

“We don’t often think about the social factors that can contribute to cardiovascular health. It’s a different way of thinking that we as cardiologists are not used to,” said Dr. Scott D. Solomon, a professor of medicine at Brigham and Women’s Hospital and senior author of the JAMA paper, in The New York Times.