A Healthy Economy Can Break Your Heart

"A single percentage point reduction in unemployment increases predicted deaths from heart attack by about 1.3 percent."

Sustained growth in income generally has been associated with improvements in health, but all growth may not be equally healthy. In A Healthy Economy Can Break Your Heart (NBER Working Paper No. 12102), author Christopher Ruhm shows that transitory upturns, those involving more intensive use of existing labor and changes in environmental conditions, may be associated with increased mortality from heart attacks.

To investigate this relationship, Ruhm uses a variety of measures from each of the twenty largest states, measured each year from 1970 to 1998. He calculates heart attack mortality rates using data from the Centers for Disease Control, using the number of deaths from heart attack in a state for a particular year divided by the estimated state population during that year. The rates are calculated for males, females, whites, blacks, and three age groups: 20-44, 45-64, and over 64. The annual state unemployment rate serves as a proxy for economic conditions. And, the estimates are adjusted for the fraction of state residents who are female, black, under 25 years of age, over 64, who never attended college, and who were college graduates.

In general, the results suggest that a single percentage point reduction in unemployment increases predicted deaths from heart attack by about 1.3 percent. The percentage increase in fatalities is similar for males and females, and smaller for blacks than whites. For the same reduction in unemployment, the estimate of an increase of 2.37 percent for 20-44 year olds is considerably larger than the 0.92 percent increase estimated for those 45-64, or the 1.41 percent increase estimated for those 65 and over. Although the increase in risk is largest for the 20-44 year old group, the majority of additional heart attacks are predicted to involve those over 64. Equally split between men and women, 2,220 out of the total of 2,525 additional heart attacks associated with a single percentage point drop in unemployment will affect those over 64.

Ruhm considers several reasons why heart attack deaths might rise as unemployment falls. Longer working hours could make it more difficult for individuals to take the time to exercise or eat properly. Inadequate sleep is associated with a variety of health risks, and extra hours could reduce sleep. Job stress may rise during economic expansions and may be exacerbated by production speedups and inexperienced workers. These factors would affect people of prime working age and may account for the large increase in risk observed for the 20-44 year old age group. The high number of absolute heart attacks observed among the elderly may come about as economic growth increases air pollution and traffic congestion, both of which have been associated with higher rates of heart attack.

Ruhm cautions however that, "these results obviously do not justify contractionary economic policies." Instead, they suggest that the effects of growth are not uniformly beneficial, and that "clinicians may need to make efforts to identify patients at higher risk" when the economy strengthens.

-- Linda Gorman

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