New York Times
February 21, 2006

MONEY AND MEDICINE: RICHER OR POORER, HEALTH AND WEALTH ARE LINKED

[Rachel's introduction: A new study published in the Journal of the American Medical Association confirms that people with lower "socioeconomic status" are twice as likely to die in any given period of time, even after taking into account age, sex, race and current smoking habits.]

By Nicholas Bakalar

A new report{1} issued last week adds support to the premise that poor people are in worse physical condition and have an increased risk for death compared with those who are better off.

The findings, published last week in The Journal of the American Medical Association, examined more than 30,000 patients consecutively referred to the Cleveland Clinic for stress testing. The researchers assigned a socioeconomic status score to each patient by matching the home address to economic data in the 2000 census.

Patients exercised on a treadmill while being measured for the maximum amount of oxygen they consumed during exercise, usually called functional capacity, and for heart rate recovery, or the amount the heart rate decreases during the first minute after exercise.

Both slower heart rate recovery and lower functional capacity were associated with lower socioeconomic status, even after controlling for age, race, smoking and body mass index.

The subjects were then followed for an average of six and a half years, through February 2004, to track their survival.

There were 2,174 deaths during the period, and patients in the lowest quarter of socioeconomic status score were twice as likely to have died as those in the highest quarter, even though the two groups did not differ in age, sex, race or current smoking habits.

Dr. Michael S. Lauer, the study's senior author and a professor of medicine and epidemiology at Case Western Reserve University, said that poverty itself could be a cause of disease or death.

"Some people think that poverty causes stress to the autonomic nervous system, the part that regulates blood pressure and heart rate," Dr. Lauer said. "Stress to the autonomic nervous system can manifest as hypertension and poor fitness."

{1} http://www.precaution.org/lib/06/socio-econ_status_and_mortality060215.pdf