Health Disparities
The Timing of Financial Instability Matters: Midlife Income Variability and Hypertension Risk in a National Cohort Mehrnaz Siavoshi* Mehrnaz Siavoshi Walden University
Background
While socioeconomic status is a well-established determinant of cardiovascular health, less is known about how changes in income at different life stages independently affect chronic disease risk. Guided by the Life Course Theory, this study examines whether the timing of income variability, specifically early adulthood versus midlife, is associated with hypertension risk.
Methods
Using longitudinal data from 4,844 participants in the Panel Study of Income Dynamics with at least 30 years of follow-up, income variability was measured as the coefficient of variation of inflation-adjusted annual income. Participants were classified into four groups based on high or low variability during early adulthood (ages 20–35) and midlife (ages 36–50). Cox proportional hazards models adjusted for age, race, sex, marital status, employment, and birth decade estimated the hazard of self-reported hypertension diagnosis.
Results
Hypertension prevalence differed significantly across timing groups. Individuals whose income variability decreased from early adulthood to midlife had the lowest hypertension risk (HR 0.75, 95% CI 0.66-0.85) while those with newly emergent variability in midlife had the highest risk (HR 1.19, 95% CI 1.07-1.32). Persistent high variability was not significant after covariate adjustment. These associations remained directionally consistent after controlling for demographic and cohort effects.
Conclusion
These findings suggest that the timing of income instability matters for cardiovascular health. Resolving financial instability by midlife is protective, whereas new midlife volatility elevates hypertension risk. Economic interventions promoting stability during midlife may help mitigate cumulative cardiovascular risk across the life course.