Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15th Ave NE, Seattle, WA, USA.
Urban Institute, 500 L'Enfant Plaza SW, Washington, DC, USA.
Soc Sci Med. 2023 Jul;329:116010. doi: 10.1016/j.socscimed.2023.116010. Epub 2023 Jun 13.
The deleterious effects that debt can have on health outcomes are well documented, yet comprehensive studies of the debt-health link for older adults remain limited even as their indebtedness has increased dramatically in recent decades. Additionally, the literature cannot explain the causal pathway linking poor health with debt. Using data from the Health and Retirement Study (1998-2016), we examine a range of physical and mental health measures and assess how they may be shaped by the amount and type of debt held by older adults. To address the likely endogeneity of debt and health, we employ marginal structural models, developed specifically as an identification strategy in the presence of possible endogeneity, alongside population-averaged models that allow us to compare outcomes for populations with and without debt without relying on unverifiable assumptions regarding the underlying population distribution as is the case with random- and fixed-effects models. Findings indicate that carrying any debt has a negative effect on a range of health outcomes for older adults, including objective and subjective physical and mental health. In addition, the more debt older adults carry, the more detrimental it is for their health. Finally, the type of debt matters: while secured debt has a limited, if any, negative impact on health outcomes, unsecured debt has a substantial negative impact on health. Policymakers should design policies that promote the prudent use of debt and discourage carrying large debt burdens, especially unsecured debt, into retirement as this would promote better health outcomes for older Americans.
债务对健康结果的有害影响已有充分记录，但即使老年人的债务在近几十年来急剧增加，关于债务与健康之间联系的综合研究仍然有限。此外，文献无法解释将健康状况不佳与债务联系起来的因果途径。我们使用来自健康与退休研究（1998-2016 年）的数据，研究了一系列身体和心理健康指标，并评估了它们可能如何受到老年人持有的债务数量和类型的影响。为了解决债务和健康的可能内生性问题，我们采用了边缘结构模型，该模型是专门作为可能存在内生性情况下的识别策略而开发的，同时还采用了基于人群的模型，这些模型允许我们在不依赖于潜在人群分布的不可验证假设的情况下比较有债务和无债务人群的结果，而随机效应和固定效应模型则需要依赖这些假设。研究结果表明，对于老年人来说，持有任何债务都会对一系列健康结果产生负面影响，包括客观和主观的身体和心理健康。此外，老年人持有的债务越多，对他们的健康就越不利。最后，债务的类型很重要：虽然有担保债务对健康结果的负面影响有限，如果有的话，但无担保债务对健康有实质性的负面影响。政策制定者应制定政策，促进审慎使用债务，并阻止老年人在退休时背负大量债务，尤其是无担保债务，因为这将促进美国老年人更好的健康结果。
