Two studies underscore how sustained financial strain undermines long-term health
A new study by Columbia University Mailman School of Public Health researchers says adults who experience poverty-level family income—whether sustained or intermittent—over two decades spanning young to mid-adulthood face a significantly higher risk of dying prematurely than those who are never in poverty. A companion study by the same research team finds that rising unsecured debt—such as credit card debt not tied to an asset—may be one mechanism linking early-life financial hardship to higher mortality risk. Findings from both studies are published in the same issue of The Lancet Public Health(link is external and opens in a new window).
Both studies used data from the National Longitudinal Survey of Youth 1979 (NLSY79). The poverty study tracked income data from 1985 to 2004, when participants were between 23 and 42 years old, and followed mortality outcomes through 2019, when participants were between 53 and 62 years old. Adults who spent more years in poverty had more than twice the rate of premature mortality compared with those who were never in poverty.
“Greater cumulative exposure to poverty across emerging and established adulthood is associated with a greater risk for premature mortality,” said Adina Zeki Al Hazzouri, PhD, assistant professor of Epidemiology at Columbia Mailman School and senior author. “By only considering income at a single time point, previous studies may have missed the nuanced and dynamic nature of poverty and the health consequences of even intermittent financial hardship.” Their findings underscore the significance of interventions targeting poverty reduction during critical life stages, particularly for vulnerable groups. However, further research is necessary to fully comprehend the long-term health implications of support during these periods.
In the second study, Zeki Al Hazzouri and colleagues analysed data from 6,954 NLSY79 participants to assess how trajectories of unsecured debt across 20 years of early adulthood relate to premature mortality in midlife (ages 41–62). They found that individuals whose unsecured debt increased over time had an 89 per cent higher risk of death compared with those whose debt remained consistently low.
“This category of debt carries higher interest rates and does not contribute to wealth accumulation. It may be more stressful and burdensome than other types of debt, signalling additional resource constraints. So, it is imperative to study as a social determinant of health,” said Zeki Al Hazzouri.
Together, these two studies show that experiences with poverty and strained financial resources are important determinants of health outcomes, including premature mortality. Importantly, the researchers’ results draw attention to economic well-being as a dynamic factor that may have varying effects on long-term health across different periods.
An accompanying commentary (link is external and opens in a new window) by Harvard Medical School and CUNY Professors David Himmelstein and Steffie Woolhandler highlights a striking dose–response relationship between years spent in poverty or burdened by unsecured debt and premature mortality. They suggest that the results of both studies may help explain why poverty in the U.S. appears more damaging to health or why individuals in low wealth quintiles are far less likely to transition to a higher income quartile than those in similarly wealthy nations, because insufficient social and medical support in the U.S. may amplify these effects. They call for policies that “prevent and mitigate the consequences of financial burden or otherwise deepen poverty” as a core public health strategy.
Co-authors are Calvin L Colvin, Xuexin Yu, Zihan Chen, Columbia Mailman School of Public Health; Samuel L Swift, University of New Mexico College of Population Health; Sebastian Calonico, University of California, Davis; and Katrina L Kezios, Columbia Mailman School and Boston University School of Public Health.
