Economic opportunity, health behaviours, and health outcomes in the USA: a population-based cross-sectional study

Abstract

Summary Background Inequality of opportunity, defined as differences in the prospects for upward social mobility, might have important consequences for health. Diminished opportunity can lower the motivation to invest in future health by reducing economic returns to health investments and undermining hope. We estimated the association between county-level economic opportunity and individual-level health in young adults in the general US population. Methods In this population-based cross-sectional study, we used individual-level data from the 2009–12 United States Behavioral Risk Factor Surveillance Surveys. Our primary outcomes were current self-reported overall health and the number of days of poor physical and mental health in the last month. Economic opportunity was measured by the county-averaged national income rank attained by individuals born to families in the lowest income quartile. We restricted our sample to adults aged 25–35 years old to match the data used to assign exposure. Multivariable ordinary least squares and probit models were used to estimate the association between the outcomes and economic opportunity. We adjusted for a range of demographic and socioeconomic characteristics, including age, sex, race, education, income, access to health care, area income inequality, segregation, and social capital. Findings We assessed nearly 147 000 individuals between the ages of 25 years and 35 years surveyed from 2009 to 2012. In models adjusting for individual-level demographics and county-level socioeconomic characteristics, increases in county-level economic opportunity were associated with greater self-reported overall health. An interdecile increase in economic opportunity was associated with 0·76 fewer days of poor mental health (95% CI −1·26 to −0·25) and 0·53 fewer days of poor physical health (−0·96 to −0·09) in the last month. The results were robust to sensitivity analyses. Interpretation Economic opportunity is independently associated with self-reported health and health behaviours. Policies seeking to expand economic opportunities might have important spillover effects on health. Funding Robert Wood Johnson Foundation Health and Society Scholars Program.

Health consequences of the US Deferred Action for Childhood Arrivals (DACA) immigration programme: a quasi-experimental study

“…20 Second, expanded economic opportunities might raise future aspirations and thereby increase perceived returns on health investments, both of which can in turn affect health outcomes. 21 Third, eliminating the risk of deportation and providing access to employment opportunities could raise hope and reduce psychosocial stress, which might directly improve mental health and indirectly affect physical health by leading to improved health behaviours. 22,23 Despite these strong theoretical links, the health consequences of the DACA programme have not yet been explored.…”

Limited Effect of Beta-blockade on Postoperative Outcome After Laparoscopic Gastric Bypass Surgery

“…An association between lower socioeconomic status and postoperative adverse outcome has recently been reported [27], and this is supported by the present study. However, the association is complex and multifactorial, and related to a multitude of factors from health-promoting activities and behavior and good nutritional status, to the ability to understand and utilize healthcare information more often seen in patients with higher socioeconomic status [28][29][30].…”

Co-occurring epidemics, syndemics, and population health

“…Given the explicitly multilevel emphasis of the theory of syndemics, 10, 27 multilevel models could provide a needed bridge between ecological study designs and cohort/case-control/cross-sectional study designs to show how epidemics (e.g., violence 46–48 ) and large-scale social forces (e.g., foreclosure and neighborhood degradation, 44, 49 or lack of economic opportunity 50–54 ) interact at both the population and individual levels to worsen the burden of disease. Studies that ignore interactions with ecological influences to focus exclusively on how individual-level risk factors interact to affect disease outcomes within relatively homogeneous populations may erroneously conclude that interactions between individual-level risk factors are the principal determinants of disease.…”