ArticleSSM - population health2021
Social inequalities, debt, and health in the United States.
Article in SSM - population health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
6 citing papers in PubMed.
- Factors Affecting Acceptance of Life Education in Mainland China: National Cross-Sectional Study.JMIR public health and surveillance · 2026Article
- Unsecured debt in early adulthood and premature mortality in adults in the USA: a longitudinal analysis of prospective national cohort data.The Lancet. Public health · 2025Article
- Relationship between household financial debt and depressive symptoms: a longitudinal study in China.BMJ open · 2023Article
- The Impact Mechanism of Household Financial Debt on Physical Health in China.International journal of environmental research and public health · 2023Article
- Editorial: Geographic inequalities in health and mortality: factors contributing to trends and differentials.Frontiers in public health · 2023Article
- Payday lenders and premature mortality.Frontiers in public health · 2022Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
backgroundHousehold financial debt has more than tripled since the 1980s in the United States. The experience of indebtedness is socially structured and there is mounting evidence that debt is linked to decrements in health. However, it is unclear whether debt contributes to social disparities in health.
objectiveWe examined whether household debt, measured by debt in excess of income and wealth, mediated education-based social inequalities in health, including cardiovascular risk factors (hypertension) and chronic conditions (diabetes, coronary heart disease, and psychiatric problems).
methodWe used longitudinal data from a sample of over 10,500 adults aged 18 years and older surveyed biennially between 1999 and 2015 as part of the Panel Study of Income Dynamics (PSID). We estimated the total effect of education on our health outcomes. To assess mediation by levels of household debt, we then estimated the controlled direct effect of education through pathways not mediated by levels of household debt, after accounting for lagged time-varying confounders and loss to follow-up using marginal structural models.
resultsCompared to respondents with at least a high school education, respondents with less than a high school education reported higher household debts in excess of income and wealth; they also reported a higher incidence of hypertension [risk ratio (RR) = 1.25, 95%CI = 1.13, 1.39), coronary heart disease (RR = 1.42, 95%CI: 1.25, 1.62), diabetes (RR = 1.50, 95%CI: 1.34, 1.68), and psychiatric problems (RR = 1.39, 95%CI: 1.24, 1.56). Compared to the total effects, the controlled direct effects of education on health were attenuated, particularly for death or first onset of hypertension and coronary heart disease, after fixing levels of household debt-to-income and debt-to-wealth.
conclusionOur results provide early evidence that household debt in excess of wealth partly mediates education-based inequalities in hypertension and coronary heart disease in the United States, with less consistent evidence for other chronic conditions.
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