Abstract P309: Foreclosure Rates During Economic Recession and Cardiovascular Health: Paradoxical Results from the Survey of the Health of Wisconsin
Contrary to conventional wisdom, research has shown that economic recessions are associated with decreases in mortality and, conversely, mortality increases during times of economic expansion. Most of these studies are based on unemployment data and few have examined morbidity data as outcomes.
The present analyses used data from the 2008-11 waves of the Survey of the Health of Wisconsin (SHOW) to study the association between county rates of foreclosures during the 2009-10 economic recession and cardiovascular health. SHOW is based on a probabilistic statewide sample of adult (21-74 years old, n = 1,643) residents in Wisconsin. The cardiovascular health (CVH) index was defined using a combination of “ideal or intermediate” levels of seven risk factors and health behaviors (body mass index, cholesterol, glucose, diet, physical activity, blood pressure and smoking). Foreclosure rates for the 72 counties of Wisconsin were obtained from commercially available data for the period 2000-2012. Other covariates included Census-based neighborhood socioeconomic status (SES), individual-level SES, and measures of mental wellbeing (using the Depression, Anxiety and Stress Scale, DASS).
Of the 1,643 participants, 1.0% had ideal CVH (“ideal” in all 7 metrics) and 25.6% had overall “good” (ideal or intermediate) CVH (at least one “intermediate,” but no “poor” in any of the 7 components). The prevalence of good CVH was higher in younger, white, higher education and income participants, and those living in suburban areas. Participants recruited from counties in the top quartile of foreclosure rates in 2009 (at the peak of the economic recession) had higher prevalence of good CVH. Compared to the lowest quartile, the demographics-adjusted odds ratio of good CVH were 2.0 (95% CL 1.4-2.9), 2.1 (1.4-3.1) and 2.7 (2.8-3.9) for the 2nd, 3rd, and 4th quartile of foreclosure rates, respectively (p-trend=0.003). Additional adjustment of individual/county SES and measures of individuals’ mental health did not materially change these results. These paradoxical associations were not present when using foreclosure data from years preceding the recession as primary exposures (2000-07).
In conclusion, county foreclosure rates, a marker of the severity of the 2009 economic recession in local communities, appears to be associated with better cardiovascular health. These results are consistent with previous research linking recessions with better health outcomes. However, interpreting these results as meaning that foreclosures improve health at the individual level might be subject to ecological fallacy. Additional analyses controlling for unmeasured confounders and possible selection biases are needed to further understand the significance of these findings.
Author Disclosures: F. Nieto: None. K.M.C. Malecki: None. J. Tapia Granados: None.
- © 2014 by American Heart Association, Inc.