Pool Lindsay R, Burgard Sarah A, Needham Belinda L, Elliott Michael R, Langa Kenneth M, Mendes de Leon Carlos F
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Department of Sociology, University of Michigan, Ann Arbor.
JAMA. 2018 Apr 3;319(13):1341-1350. doi: 10.1001/jama.2018.2055.
A sudden loss of wealth-a negative wealth shock-may lead to a significant mental health toll and also leave fewer monetary resources for health-related expenses. With limited years remaining to regain lost wealth in older age, the health consequences of these negative wealth shocks may be long-lasting.
To determine whether a negative wealth shock was associated with all-cause mortality during 20 years of follow-up.
DESIGN, SETTING, AND PARTICIPANTS: The Health and Retirement Study, a nationally representative prospective cohort study of US adults aged 51 through 61 years at study entry. The study population included 8714 adults, first assessed for a negative wealth shock in 1994 and followed biennially through 2014 (the most recent year of available data).
Experiencing a negative wealth shock, defined as a loss of 75% or more of total net worth over a 2-year period, or asset poverty, defined as 0 or negative total net worth at study entry.
Mortality data were collected from the National Death Index and postmortem interviews with family members. Marginal structural survival methods were used to account for the potential bias due to changes in health status that may both trigger negative wealth shocks and act as the mechanism through which negative wealth shocks lead to increased mortality.
There were 8714 participants in the study sample (mean [SD] age at study entry, 55 [3.2] years; 53% women), 2430 experienced a negative wealth shock during follow-up, 749 had asset poverty at baseline, and 5535 had continuously positive wealth without shock. A total of 2823 deaths occurred during 80 683 person-years of follow-up. There were 30.6 vs 64.9 deaths per 1000 person-years for those with continuously positive wealth vs negative wealth shock (adjusted hazard ratio [HR], 1.50; 95% CI, 1.36-1.67). There were 73.4 deaths per 1000 person-years for those with asset poverty at baseline (adjusted HR, 1.67; 95% CI, 1.44-1.94; compared with continuously positive wealth).
Among US adults aged 51 years and older, loss of wealth over 2 years was associated with an increased risk of all-cause mortality. Further research is needed to better understand the possible mechanisms for this association and determine whether there is potential value for targeted interventions.
财富的突然丧失——负面财富冲击——可能会对心理健康造成重大影响，同时也会减少用于健康相关支出的资金。由于老年人恢复损失财富的年限有限，这些负面财富冲击对健康的影响可能是长期的。
确定负面财富冲击是否与20年随访期间的全因死亡率相关。
设计、背景和参与者：健康与退休研究，一项对研究开始时年龄在51至61岁的美国成年人具有全国代表性的前瞻性队列研究。研究人群包括8714名成年人，于1994年首次评估是否遭受负面财富冲击，并每两年随访一次，直至2014年（可获得数据的最近一年）。
经历负面财富冲击，定义为在两年内总净值损失75%或更多，或资产贫困，定义为研究开始时总净值为零或负数。
从国家死亡指数和对家庭成员的尸检访谈中收集死亡率数据。采用边际结构生存方法来解释由于健康状况变化可能引发负面财富冲击并作为负面财富冲击导致死亡率增加的机制而产生的潜在偏差。
研究样本中有8714名参与者（研究开始时的平均[标准差]年龄为55[3.2]岁；53%为女性），2430人在随访期间经历了负面财富冲击，749人在基线时处于资产贫困状态，5535人拥有持续的正财富且未遭受冲击。在80683人年的随访期间共发生2823例死亡。拥有持续正财富与经历负面财富冲击的人群每1000人年的死亡人数分别为30.6例和64.9例（调整后的风险比[HR]为1.50；95%置信区间为1.36 - 1.67）。基线时处于资产贫困状态的人群每1000人年有73.4例死亡（调整后的HR为1.67；95%置信区间为1.44 - 1.94；与持续正财富相比）。
在51岁及以上的美国成年人中，两年内的财富损失与全因死亡率风险增加相关。需要进一步研究以更好地理解这种关联的可能机制，并确定针对性干预措施是否具有潜在价值。
