Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor.
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor.
JAMA Health Forum. 2022 Jun 10;3(6):e221537. doi: 10.1001/jamahealthforum.2022.1537. eCollection 2022 Jun.
Income has a negative, nonlinear association with all-cause mortality. Income support policies may prevent deaths among low-income populations by raising their incomes.
To estimate the deaths that could be averted among working-age adults age 18 to 64 years with hypothetical income support policies in the US.
An open, multicohort life-table model was developed that simulated working-age adults age 18 to 64 years in the US over 5 to 40 years. Publicly available household income data and previous estimates of the income-mortality association were used to generate mortality rates by income group. Deterministic sensitivity analyses were conducted to evaluate the effect of parameter uncertainty and various model assumptions on the findings.
In addition to a no-intervention scenario, 4 hypothetical income support policies were modeled: universal basic income, modified LIFT Act, poverty alleviation, and negative income tax.
The main outcome was the number of deaths averted, which was calculated by subtracting the number of deaths experienced in the no-intervention scenario from the number of deaths experienced with the various income support policies.
Base-case assumptions used average mortality rates by age, sex, and income group, a 20-year time horizon, and a 3-year lag time. Universal basic income worth $12 000 per year per individual was estimated to avert the most deaths among working-age adults (42 000-104 000 per year), followed by a negative income tax that guaranteed an income of 133% of the federal poverty level (19 000-67 000 per year). A modified LIFT Act that provided $6000 to individuals with annual household incomes less than $100 000 was estimated to avert 17 000 to 52 000 deaths per year. A targeted approach that alleviated poverty was estimated to prevent 12 000 to 32 000 deaths among the lowest-income, working-age adult population. Results were most sensitive to several inputs and assumptions, primarily the income-based mortality rates, analytic time horizon, and assumed time lag between when a policy was implemented and when individuals experienced the mortality benefit of having higher incomes.
In this modeling study, 4 hypothetical income support policies were estimated to avert thousands of deaths among working-age US adults every year. Additional research is needed to understand the true association of income gains with mortality. Discussions about the costs and benefits of income support policies should include potential gains in health.
收入与全因死亡率呈负相关，非线性关系。通过提高低收入人群的收入，收入支持政策可能会防止他们死亡。
估计在美国，通过假设的收入支持政策，18 至 64 岁工作年龄成年人可能避免的死亡人数。
设计、设定和人群：开发了一种开放的多队列生命表模型，该模型模拟了美国 18 至 64 岁工作年龄成年人在 5 至 40 年内的情况。使用公开的家庭收入数据和之前对收入与死亡率关系的估计来按收入组生成死亡率。进行了确定性敏感性分析，以评估参数不确定性和各种模型假设对研究结果的影响。
除了无干预方案外，还模拟了 4 种假设的收入支持政策：全民基本收入、改良 LIFT 法案、扶贫和负所得税。
主要结果是通过从无干预方案中减去各种收入支持政策所经历的死亡人数来计算避免的死亡人数。
基本案例假设使用按年龄、性别和收入组划分的平均死亡率、20 年时间范围和 3 年滞后时间。每年为每个个人提供 12000 美元的全民基本收入被估计可以避免工作年龄成年人中最多的死亡人数（每年 42000-104000 人），其次是保证收入为联邦贫困线 133%的负所得税（每年 19000-67000 人）。为年收入低于 100000 美元的个人提供 6000 美元的改良 LIFT 法案估计每年可避免 17000 至 52000 人死亡。一项旨在减轻贫困的有针对性的方法估计可以防止收入最低的工作年龄成年人中 12000 至 32000 人死亡。结果对几个输入和假设最为敏感，主要是基于收入的死亡率、分析时间范围以及政策实施与个人获得更高收入的死亡率益处之间的假定时间滞后。
在这项建模研究中，估计每年在美国工作年龄成年人中通过 4 种假设的收入支持政策可避免数千人死亡。需要进一步研究以了解收入增加与死亡率之间的真实关联。关于收入支持政策的成本和收益的讨论应包括健康方面的潜在收益。
