Title:
Net Worth, Debt Stress, and Ambulatory Blood Pressure in African American Women
Author Names:
Telisa Spikes, RN, PHD, Raphiel Murden, MS, Izraelle McKinnon, MPH, Miriam Van Dyke, PhD, Samantha Bromfield, PhD, Renee Moore, PhD, Bianca Booker, MA, Frederic Rahbari-Oskoui MD, Arshed Quyyumi, MD, Viola Vaccarino, MD, PhD, Tené T. Lewis, PhD
Background:
Low socioeconomic status (SES) is an established predictor of higher cardiovascular disease (CVD) incidence and mortality. Research suggests that neither higher education nor income have been consistently associated with lower CVD risk or outcomes in African Americans (AAs). Net worth and debt stress are two underexamined indices of SES that may be more important for CVD risk, especially in AAs, due to attenuated returns of traditional indicators of SES on health, and the high rates of debt in this group.
Objective:
To examine the associations of net worth and debt stress, independent of education and income, with ambulatory blood pressure (ABP) in AA women.
Methods:
Participants were AA women (n=422), mean age 37±4.2 years from various sociodemographic backgrounds recruited from a large metropolitan southeastern region. Net worth was measured using a single item (“Suppose you and others in your household were to sell all of your major possessions including your home, turn all of your investments and other assets into cash, and pay off all of your debts. Would you have something left over, break even, or be in debt?”) with three response categories,
left over
,
break-even
, and
debt
. Debt stress was measured using the four-item Debt Stress Index (e.g. “Overall, how often do you worry about the total amount you and your spouse/partner owe in overall debt?”). ABP was assessed over 48 hours. Multiple linear regression was used to evaluate associations between SES indicators and continuous ABP outcomes adjusting for age, education, income, BMI, BP meds, and depressive symptoms.
Results:
Overall, 48% of the cohort was categorized as having a positive (“left over”) net worth, while 30% and 22% were categorized as having a neutral (“break-even”), and negative (“debt”) net worth, respectively. Compared to the positive net worth group, negative net worth was associated with higher daytime (ß=5.2; CI: 2.44-8.05
)
and nighttime systolic blood pressure (SBP) (ß=5.3; CI: 2.59-8.06
)
in unadjusted analyses. Findings remained significant for both daytime (ß=4.3; CI:1.38-7.24
)
and nighttime (ß=4.1; CI:1.26-6.90
)
SBP in fully adjusted models. There were no significant unadjusted or fully-adjusted associations between debt stress and daytime, or nighttime SBP.
Discussion:
Negative net worth was associated with a 4.3 mm Hg higher daytime, and 4.1 mm Hg nighttime SBP independent of education and income. Future research is needed to determine the prospective impact of net worth on long-term CVD risk in AA women.
Genetic and Environmental Risks for High Blood Pressure Among African American Mothers and Daughters