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Consumer credit, chronic disease and risk behaviours
  1. Lorraine T Dean1,2,
  2. Emily A Knapp1,
  3. Sevly Snguon1,
  4. Yusuf Ransome3,
  5. Dima M Qato4,
  6. Kala Visvanathan1,2
  1. 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
  2. 2 Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  3. 3 Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
  4. 4 Department of Pharmacy Systems, Outcomes and Policy, University of Illinois College of Pharmacy, Chicago, Illinois, USA
  1. Correspondence to Dr Lorraine T Dean, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; lori.dean{at}


Background Credit scores have been identified as a marker of disease burden. This study investigated credit scores’ association with chronic diseases and health behaviours that are associated with chronic diseases.

Methods This cross-sectional analysis included data on 2083 residents of Philadelphia, Pennsylvania, USA in 2015. Nine-digit ZIP code level FICO credit scores were appended to individual self-reported chronic diseases (obesity, diabetes, hypertension) and related health behaviours (smoking, exercise, and salt intake and medication adherence among those with hypertension). Models adjusted for individual-level and area-level demographics and retail pharmacy accessibility.

Results Median ZIP code credit score was 665 (SD=58). In adjusted models, each 50-point increase in ZIP code credit score was significantly associated with: 8% lower chronic disease risk; 6% lower overweight/obesity risk, 19% lower diabetes risk; 9% lower hypertension risk and 14% lower smoking risk. Other health behaviours were not significantly associated. Compared with high prime credit, subprime credit score was significantly associated with a 15%–70% increased risk of chronic disease, following a dose–response pattern with a prime rating.

Conclusion Lower area level credit scores may be associated with greater chronic disease prevalence but not necessarily with related health behaviours. Area-level consumer credit may make a novel contribution to identifying chronic disease patterns.

  • consumer credit
  • chronic disease
  • obesity
  • diabetes
  • hypertension
  • United States

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  • Contributors LTD and KV: contributed to the conception, writing and approval of the final manuscript. LTD: led the analysis, supported by DMQ and YR who provided data and guided analysis, with contributing analyses for specific health outcomes from EAK and SS. All authors contributed to the drafting and final approval of the manuscript.

  • Funding This work was supported by the National Cancer Institute grant K01CA184288; National Institute of Mental Health R25MH083620 (Lorraine T Dean); the Johns Hopkins University Center for AIDS Research grant P30AI094189 (Lorraine T Dean, Sevly Snguon); and the Sidney Kimmel Cancer Center grant P30CA006973 (Lorraine T Dean, Kala Visvanathan, Sevly Snguon). Emily Knapp was supported by the Clinical Research and Epidemiology in Diabetes and Endocrinology Training Grant (T32DK062707). Statistical consultation was provided by the National Center for Research Resources and the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health through Grant Number 1UL1TR001079.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been corrected since it first published online. An error in the Abstract has been corrected.

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