Landfall After the Perfect Storm: Cohort Differences in the Relationship Between Debt and Risk of Heart Attack
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Landfall After the Perfect Storm: Cohort Differences in the Relationship Between Debt and Risk of Heart Attack Angela M. O’Rand 1 & Jenifer Hamil-Luker 1 # Population Association of America 2020
Abstract Analyses of the Health and Retirement Study (HRS) between 1992 and 2014 compare the relationship between different levels and forms of debt and heart attack risk trajectories across four cohorts. Although all cohorts experienced growing household debt, including the increase of both secured and unsecured debt, they nevertheless encountered different economic opportunity structures and crises at sensitive times in their life courses, with implications for heart attack risk trajectories. Results from frailty hazards models reveal that unsecured debt is associated with increased risk of heart attack across all cohorts. Higher levels of housing debt, however, predict higher rates of heart attack among only the earlier cohorts. Heart attack risk trajectories for Baby Boomers with high levels of housing debt are lower than those of same-aged peers with no housing debt. Thus, the relationship between debt and heart attack varies by level and form of debt across cohorts but distinguishes Baby Boomer cohorts based on their diverse exposures to volatile housing market conditions over the sensitive household formation period of the life course. Keywords Cohort . Debt . Heart attack . Inequality . Frailty hazards
Introduction The incidence and prevalence of some mortality risks, such as heart attack in aging cohorts, have declined or leveled off over recent decades. Socioeconomic status (SES) disparities in these risks across cohorts, however, appear to be widening. Higher levels
* Angela M. O’Rand [email protected] Jenifer Hamil-Luker [email protected]
1
Department of Sociology, Duke University, 417 Chapel Drive, Durham, NC 27708-0088, USA
A.M. O’Rand, J. Hamil-Luker
of education, income, and wealth are typically buffers against stress, operating through healthy behaviors, access to health care resources, and reduced risks of disease and mortality with age. An ignored SES-related factor is debt, even though its level has risen across cohorts that have experienced different educational, labor, and housing markets, business cycles, and earnings trajectories across the life course and its form has differentiated into several types of secured and unsecured debt with differential impact on subgroups of aging populations (Dwyer 2018). Few studies have examined trends in the effects of different levels and forms of debt on morbidity or mortality risk. Furthermore, research on the relationship between debt and health has focused more on general health indicators despite evidence showing that the socioeconomic gradient in health varies by disease, and is particularly strong for cardiovascular diseases (Sommer et al. 2015). This study analyzes data from the Health and Retirement Study (HRS) between 1992 and 2014 to compare the relationship between secured and unsecured debt to the risk of heart attack across four HRS cohorts
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