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Leveraging naturally occurring variation in financial stress to examine associations with inflammatory burden among older adults
  1. Laura Samuel1,
  2. Sarah L Szanton1,
  3. Neal S Fedarko2,
  4. Eleanor M Simonsick3
  1. 1Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
  2. 2Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  3. 3National Institute on Aging, Baltimore, Maryland, USA
  1. Correspondence to Laura Samuel, 525 North Wolfe Street, Rm 426, Baltimore, MD 21205, USA; lsamuel{at}


Background Financial strain is associated with earlier disability and mortality, but causal links are underexplored, partly because it is unethical to randomise people to financial stress. This study leverages naturally occurring random variation in days since monthly Social Security payment arrival among older adults to test associations with inflammatory biomarkers.

Methods Biomarker data, including tumour necrosis factor (TNF)-α, interleukin (IL)-6 and C reactive protein (CRP), was collected from 2155 non-working healthy adults aged 70–79 years, participating in the Health, Aging and Body Composition Study. Days since payment arrival was independent of all demographic, socioeconomic or health characteristics measured in this study. Restricted cubic spline models estimated associations separately for each week of the month, stratified by financial strain status (interaction term p value for TNF-α model <0.05).

Results Among financially strained older adults, more days since payment arrival was associated with higher TNF-α levels during the first week of the month (coefficient=0.102). Associations with IL-6 and CRP differed depending on the degree of financial strain (interaction term p values <0.05). Those with low, but not high, strain had lower levels of IL-6 (coefficient=−0.152) and CRP (coefficient=−0.179) during the first week.

Conclusions Days since monthly payments were associated with inflammatory cytokines among older adults who have difficulty making ends meet financially and associations depended on financial strain severity, suggesting that results are attributable to monthly variation in financial stress. Future research should examine whether more frequent Social Security disbursement would modify financial strain and inflammatory biomarkers.

  • Epidemiology of ageing
  • health inequalities
  • socio-economic

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  • Contributors LS conceived the research question and led analyses and preparation of the manuscript. ES contributed to the design and implementation of the parent study and data collection. LS, SLS, NSF and ES all contributed to the writing of the manuscript.

  • Funding This research was supported by National Institute of Nursing Research (NINR grant R01-NR012459) and National Institute on Aging (NIA, Contracts N01-AG-6-2101; N01-AG-6-2103; N01-AG-6-2106; NIA grant R01-AG028050 and grant K01AG054751 to LS). This research was funded in part by the Intramural Research Program of the NIH, National Institute on Aging.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement Data may be obtained from a third party and are not publicly available.