Lost individual income due to severe health events: life-course perspective in the Northern Finland Birth Cohort 1966

Abstract

Background Severe health events may lead to reduced income among survivors. Importantly, individuals’ risks for both severe health events and for lower income are shaped by early life course. Our aim was to consider early-life factors in determining lost individual income after stroke, heart attack and cancer between ages 18 and 50. Methods A population-based Northern Finland Birth Cohort 1966 (N = 12 058) was used. Early-life factors were collected since mid-pregnancy until age 16 years and used to match all persons with stroke, heart attack, or cancer (n = 995) with four controls. Registered annual individual income development 15 years before and after the event was compared between cases and propensity score matched controls using time-to-event mixed models, stratified for sex. Results Compared to controls, a new decreasing income trend emerged among women after stroke (logarithmic income per time −0.54; 95% CI −0.88 to −0.20), whereas men getting stroke showed declining earnings already by the time of the event, further declining after stroke (−1.00, −1.37 to −0.63). Getting heart attack was associated with a new declining trend both in women (−0.68; −1.28 to −0.09) and men (−0.69, −1.05 to −0.32). Income declined also among control men (−0.24, −0.34 to −0.14), who had higher income but were less educated than control women. Conclusions Stroke and heart attack but not cancer have exogenous deleterious effects on individual economy, independently of early-life factors. The effects accelerate by time. Negative income trend in control men shows that severe health events do not explain all decrease in income.