Despite long-standing evidence of strong gradients of increasingly better health from the lowest to the highest levels of socioeconomic status (SES), the causal nature of SES-health relationships has not been clearly established, and mechanisms underlying the relationships are not well understood. Beginning in 2008, the """"""""Great Recession"""""""" was a major, and largely unanticipated, economic shock that impacted the vast majority of Americans and its impact on health has the potential to provide scientific evidence on the causal impact of SES on health. Assuming the timing and magnitude of the recession was largely unanticipated, the Great Recession can be treated as an exogenous economic shock that offers enhanced opportunities to establish the extent to which there are causal effects of SES on health. This R21 will empirically evaluate whether uniquely rich longitudinal, objective biological data (reflecting physiological processes linked to major morbidity and mortality) measured for the same 4,655 individuals before and after the Recession can be used to establish health effects of the Recession. These data from the Multi-Ethnic Study of Atherosclerosis (MESA) will be linked with time-varying area- and age-sex-race-education-specific measures of the local labor and housing markets (with over 200 zip-codes for housing markets and at least 200 location-specific demographic subgroups for labor markets). Four waves of MESA data were collected before Fall 2008 (onset of the Recession) with a 5th exam between July 2010 and December 2011. In contrast to the self-report health data used in much prior work on health effects of economic downturns, MESA offers the unique strength of standardized, objective assessments of major physiological markers of health, including systolic blood pressure, pulse pressure, blood glucose, serum lipids, body mass index and waist-hip ratio. Combining these rich health data with economic status measured on the same individuals before and after the onset of the Great Recession, and with local area- and demographic-specific exposures to the recession provides unparalleled opportunities to evaluate the effects of economic stress on objectively assessed and important health markers. The research will describe how these health markers change over time and how they change as exposure to area- and demographic-specific economic stress varies. This R21 is designed to provide initial evidence to establish feasibility and power for a larger, more comprehensive investigation (R01) of the impact of the Great Recession on biology (including new biomarkers assayed from stored blood samples), behaviors (e.g., exercise, smoking, heavy drinking), subclinical disease (e.g., carotid and peripheral atherosclerosis), overt disease (e.g., cardiovascular events, hospitalizations), and total mortality. Moreover, extensive MESA genetics data will also allow exploration of possible gene-by-environment (Recession) interaction effects in future work.

Public Health Relevance

This project will examine whether the Great Recession, the most significant economic upheaval since the 1930's Great Depression, has had a negative impact on key physiological markers of the physical health of Americans. Using longitudinal data from the Multi-Ethnic Study of Atherosclerosis (MESA), analyses will examine whether time trends from before and after the onset of the Recession suggest an acceleration in health risks (indexed by systolic blood pressure, pulse pressure, blood glucose and lipid levels, and body mass index) and whether the acceleration in trends varies by age, sex, race/ethnicity and local area/neighborhood- level and individual-level economic exposure to the Recession.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (SSPA)
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Phillips, John
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University of California Los Angeles
Internal Medicine/Medicine
Schools of Medicine
Los Angeles
United States
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Seeman, Teresa; Thomas, Duncan; Merkin, Sharon Stein et al. (2018) The Great Recession worsened blood pressure and blood glucose levels in American adults. Proc Natl Acad Sci U S A 115:3296-3301
Crawford, Natalie D; Moore, Kari; Christine, Paul J et al. (2018) Examining the Role of Neighborhood-Level Foreclosure in Smoking and Alcohol Use Among Older Adults in the Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol 187:1863-1870
Christine, Paul J; Moore, Kari; Crawford, Natalie D et al. (2017) Exposure to Neighborhood Foreclosures and Changes in Cardiometabolic Health: Results From MESA. Am J Epidemiol 185:106-114
Merkin, Sharon Stein; Karlamangla, Arun; Elashoff, David et al. (2015) Change in cardiometabolic score and incidence of cardiovascular disease: the multi-ethnic study of atherosclerosis. Ann Epidemiol 25:912-7.e1