Health Disparities
Beyond Average Income: Distinct Life Course Economic Trajectories and Hypertension Risk Mehrnaz Siavoshi* Mehrnaz Siavoshi Walden University
Background
Most research treats income as a static variable, yet economic circumstances fluctuate throughout life. We examined whether distinct patterns of income change over 30+ years differentially impact hypertension risk beyond absolute income level.
Methods
We classified 8,021 PSID participants into five rule-based trajectory groups: stable high income (12.9%), stable low income (19.2%), upward mobility (11.5%), downward mobility (2.3%), and fluctuating income (54.1%). Cox models estimated hypertension hazard ratios adjusted for demographics and time-varying covariates, with additional models controlling for lifetime mean income and volatility.
Results
Unadjusted models showed elevated hypertension risk for stable low income (HR 1.38, 95% CI 1.23-1.54) and downward mobility (HR 1.45, 95% CI 1.17-1.78) compared to stable high income. After demographic adjustment, all trajectory groups showed increased risk, including upward mobility (HR 1.25, 95% CI 1.21-1.29), suggesting lasting effects of early-life disadvantage. However, when lifetime mean income and volatility were included, trajectory groups became protective (stable low HR 0.75, upward mobility HR 0.77), indicating that predictability itself, independent of income level, confers health benefits, potentially through reduced chronic stress.
Conclusion
Economic trajectories have health implications beyond income level alone. The predictability and direction of change matter: early disadvantage leaves biological traces even after economic improvement, while stability appears protective. These findings support life course theory’s concept of biological embedding and suggest that policies promoting income stability may benefit cardiovascular health independent of income supplementation.