Association of Low Hourly Wages in Middle Age With Faster Memory Decline in Older Age: Evidence From the Health and Retirement Study

Kezios, Katrina; Zhang, Adina; Kim, Soohyun; Lu, Peiyi; Glymour, M. Maria; Elfassy, Tali; Hazzouri, Adina Zeki Al

doi:10.1093/aje/kwac166

Cited by 7 publications

(5 citation statements)

References 38 publications

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“…Low hourly wage is a proposed occupational health hazard and has been previously shown in observational studies to be associated with faster cognitive decline, higher BMI, and hypertension, all of which may predict earlier mortality. Relatedly, prior studies capitalizing on changes in minimum wage policy and using quasi-experimental and design-based analytic approaches (eg, difference in difference) have examined various health impacts of differences in state- and federal-level minimum wages .…”

Section: Discussionmentioning

confidence: 99%

History of Low Hourly Wage and All-Cause Mortality Among Middle-aged Workers

Kezios

Calónico

et al. 2023

JAMA

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ImportanceEarning a low wage is an increasingly recognized public health concern, yet little research exists on the long-term health consequences of sustained low-wage earning.ObjectiveTo examine the association of sustained low-wage earning and mortality in a sample of workers with hourly wage reported biennially during peak midlife earning years.Design, Setting, and ParticipantsThis longitudinal study included 4002 US participants, aged 50 years or older, from 2 subcohorts of the Health and Retirement Study (1992-2018) who worked for pay and reported earning hourly wages at 3 or more time points during a 12-year period during their midlife (1992-2004 or 1998-2010). Outcome follow-up occurred from the end of the respective exposure periods until 2018.ExposuresLow-wage—less than the hourly wage for full-time, full-year work at the federal poverty line—earning history was categorized as never earning a low wage, intermittently earning a low wage, and sustained earning a low wage.Main Outcomes and MeasuresCox proportional hazards and additive hazards regression models sequentially adjusted for sociodemographics, and economic and health covariates were used to estimate associations between low-wage history and all-cause mortality. We examined interaction with sex or employment stability on multiplicative and additive scales.ResultsOf the 4002 workers (aged 50-57 years at the beginning of exposure period and 61-69 years at the end), 1854 (46.3%) were female; 718 (17.9%) experienced employment instability; 366 (9.1%) had a history of sustained low-wage earning; 1288 (32.2%) had intermittent low-wage earning periods; and 2348 (58.7%) had never earned a low wage. In unadjusted analyses, those who had never earned low wages experienced 199 deaths per 10 000 person-years, those with intermittent low wages, 208 deaths per 10 000 person-years, and those with sustained low wages, 275 deaths per 10 000 person-years. In models adjusted for key sociodemographic variables, sustained low-wage earning was associated with mortality (hazard ratio [HR], 1.35; 95% CI, 1.07-1.71) and excess deaths (66; 95% CI, 6.6-125); these findings were attenuated with additional adjustments for economic and health covariates. Significant excess death and elevated mortality risk were observed for workers with sustained low-wage exposure and employment fluctuations (eg, for sustained low-wage × employment fluctuated, HR, 2.18; 95% CI, 1.35-3.53; for sustained low-wage × stable employment, HR, 1.17; 95% CI, 0.89,-1.54; P for interaction = .003).Conclusions and RelevanceSustained low-wage earning may be associated with elevated mortality risk and excess deaths, especially when experienced alongside unstable employment. If causal, our findings suggest that social and economic policies that improve the financial standing of low-wage workers (eg, minimum wage laws) could improve mortality outcomes.

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Section: Discussionmentioning

confidence: 99%

History of Low Hourly Wage and All-Cause Mortality Among Middle-aged Workers

Kezios

Calónico

et al. 2023

JAMA

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“…To avoid a substantial loss in sample size and retain middle-aged adults in our sample, we focused this analysis on memory function, using a previously validated composite score. 31 , 32 , 33 , 34 , 35 In brief, HRS respondents’ memory is assessed directly via immediate and delayed word recall tasks. For respondents unable to complete the cognitive tasks independently (ie, those with cognitive impairment), proxy informants (typically their spouses or family members) provide assessments of their cognitive function using validated instruments (ie, a 5-point Likert scale for memory performance and a 16-item version of the Informant Questionnaire for Cognitive Decline).…”

Section: Methodsmentioning

confidence: 99%

Associations of Food Insecurity and Memory Function Among Middle to Older–Aged Adults in the Health and Retirement Study

Kezios

Jawadekar

et al. 2023

JAMA Netw Open

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ImportanceFood insecurity is a leading public health issue in the US. Research on food insecurity and cognitive aging is scarce, and is mostly cross-sectional. Food insecurity status and cognition both can change over the life course, but their longitudinal relationship remains unexplored.ObjectiveTo examine the longitudinal association between food insecurity and changes in memory function during a period of 18 years among middle to older–aged adults in the US.Design, Setting, and ParticipantsThe Health and Retirement Study is an ongoing population-based cohort study of individuals aged 50 years or older. Participants with nonmissing information on their food insecurity in 1998 who contributed information on memory function at least once over the study period (1998-2016) were included. To account for time-varying confounding and censoring, marginal structural models were created, using inverse probability weighting. Data analyses were conducted between May 9 and November 30, 2022.Main outcomes and MeasuresIn each biennial interview, food insecurity status (yes/no) was assessed by asking respondents whether they had enough money to buy food or ate less than they felt they should. Memory function was a composite score based on self-completed immediate and delayed word recall task of a 10-word list and proxy-assessed validated instruments.ResultsThe analytic sample included 12 609 respondents (mean [SD] age, 67.7 [11.0] years, 8146 [64.60%] women, 10 277 [81.51%] non-Hispanic White), including 11 951 food-secure and 658 food-insecure individuals in 1998. Over time, the memory function of the food-secure respondents decreased by 0.045 SD units annually (β for time, −0.045; 95% CI, −0.046 to −0.045 SD units). The memory decline rate was faster among food-insecure respondents than food-secure respondents, although the magnitude of the coefficient was small (β for food insecurity × time, −0.0030; 95% CI, −0.0062 to −0.00018 SD units), which translates to an estimated 0.67 additional (ie, excess) years of memory aging over a 10-year period for food-insecure respondents compared with food-secure respondents.Conclusions and RelevanceIn this cohort study of middle to older–aged individuals, food insecurity was associated with slightly faster memory decline, suggesting possible long-term negative cognitive function outcomes associated with exposure to food insecurity in older age.

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“…There are hypotheses that explain these findings. Low wages can result in poverty-related stress, 26 and the stress, in turn, could lead to less desire or ability to quit smoking. College students who are smokers are less inclined to quit during stressful finals week than at other times.…”

Section: Discussionmentioning

confidence: 99%

Estimating Effects of Wages on Smoking Prevalence Using Labor Unions as Instrumental Variables

Leigh¹,

Chakalov²

2023

J Occup Environ Med

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Objectives: To test for the effects of wages on smoking using labor unions as instrumental variables. Methods: We analyzed four waves of the Panel Study of Income Dynamics (2013 to 2019 alternate years). The overall sample included workers aged 18 to 70 years in 2013 and subsamples within blue + clerical/white-collar and private/public sector jobs (N = 37,117 to 8446 personyears). We used two instrumental variables: worker's union membership and states' right-to-work laws. Results: $1 (2019 US dollars) increases in wagesper-hour resulted in 1.3 (P < 0.001) percentage point decreases in smoking prevalence (8.2% decreases at the smoking mean). Larger effect sizes and strong statistical significance were found for blue-collar + clerical and private-sector subsamples; smaller sizes and insignificance were found for public-sector and white-collar subsamples. Conclusions: Unions increase wages, and higher wages, in turn, reduce smoking. Wages and labor unions are underappreciated social determinants of health.

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Association of Low Hourly Wages in Middle Age With Faster Memory Decline in Older Age: Evidence From the Health and Retirement Study

Cited by 7 publications

References 38 publications

History of Low Hourly Wage and All-Cause Mortality Among Middle-aged Workers

History of Low Hourly Wage and All-Cause Mortality Among Middle-aged Workers

Associations of Food Insecurity and Memory Function Among Middle to Older–Aged Adults in the Health and Retirement Study

Estimating Effects of Wages on Smoking Prevalence Using Labor Unions as Instrumental Variables

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