The impact of in-work tax credit for families on self-rated health in adults: a cohort study of 6900 New Zealanders

The Effect of the Earned Income Tax Credit on Physical and Mental health-Results from the Atlanta Paycheck Plus Experiment

Policy Points The Paycheck Plus randomized controlled trial tested a fourfold increase in the Earned Income Tax Credit (EITC) for single adults without dependent children over 3 years in New York and Atlanta. In New York, the intervention improved economic, mental, and physical health outcomes. In Atlanta, it had no economic benefit or impact on physical health and may have worsened mental health. In Atlanta, tax filing and bonus receipt were lower than in the New York arm of the trial, which may explain the lack of economic benefits. Lower mental health scores in the treatment group were driven by disadvantaged men, and the study sample was in good mental health.

CONTEXT

The Paycheck Plus experiment examined the effects of an enhanced Earned Income Tax Credit (EITC) for single adults on economic and health outcomes in Atlanta, GA and New York City (NYC). The NYC study was completed two years prior to the Atlanta study and found mental and physical benefits for the subgroups that responded best to the economic incentives provided. In this article, we present the findings from the Atlanta study, in which the uptake of the treatment (tax filings and EITC bonus) were lower and economic and health benefits were not observed.

METHODS

Paycheck Plus Atlanta was an unblinded randomized controlled trial that assigned n = 3,971 participants to either the standard federal EITC (control group) or an EITC supplement of up to $2,000 (treatment group) for three tax years (2017-2019). Administrative data on employment and earnings were obtained from the Georgia Department of Labor and survey data were used to examine validated measures of health and well-being.

FINDINGS

In Atlanta, the treatment group had significantly higher earnings in the first project year but did not have significantly higher cumulative earnings than the control group overall (mean difference = $1,812, 95% CI = -150, 3,774, p = 0.07). The treatment group also had significantly lower scores on two measures of mental health after the intervention was complete: the Patient Health Questionnaire 8 (mean difference = 0.19, 95% CI = 0.06, 0.32, p = 0.005) and the Kessler 6 (mean difference = 0.15, 95% CI = 0.03, 0.27, p = 0.012). Secondary analyses suggested these results were driven by disadvantaged men, but the study sample was in good mental health.

CONCLUSIONS

The EITC experiment in Atlanta was not associated with gains in earnings or improvements in physical or mental health.

The Relationship between Income and Morbidity-Longitudinal Findings from the German Ageing Survey

It is often assumed that higher income contributes to physical health. Indeed, there is a huge amount of research showing a strong significant association between income and health. However, very few studies have used longitudinal data and an objective variable for health, such as morbidity. Therefore, this study aims to examine the association between the income and morbidity of individuals over time. Data from a total of four waves (year 2008 to year 2017) of the nationally representative German Ageing Survey was analyzed by linear fixed-effects regressions. The used equivalized income was based on the respondents’ monthly net household income. To obtain a comprehensive picture of the dependent variable morbidity, self-reported diseases, current symptoms, and physician-diagnosed diseases were examined. The analyses showed no significant association between percentage changes in income and morbidity in the total sample. Even after considering selected socioeconomic groups in further subgroup analyses, there was no significant within-person association found over time. In summary, the unexpected results of this study suggest that the previously assumed link between income and health in Germany may be called into question. Further research based on longitudinal studies is, therefore, required.

Increased income over time predicts better self-perceived mental health only at a population level but not for individual changes: An analysis of a longitudinal cohort using cross-lagged models

BACKGROUND

The literature identifies a strong relationship between mental health and income, but there is little research that clarifies the directional association between household income and self-perceived mental health (SPMH) overtime either at between-perso+n or within-person levels. This study investigates whether higher income predicts better SPMH overtime and poor SPMH predicts lower income overtime both at between-person or within-person levels.

METHODS

Data analyzed was from the Montreal Southwest Social and Psychiatric Epidemiology Catchment Area study (ZEPSOM), a longitudinal community-based cohort. The baseline survey was conducted in 2007/8 with follow-up every two years. We traced a total of 3464 participants over a period of 8 years. To examine the associations between income and SPMH at both between-person or within-person levels, cross-lagged panel models (CLPMs) and random intercept cross-lagged panel models (RI-CLPMs) were used. Gender and age effects were examined using multiple group analyses. Complete case analyses evaluated the findings' robustness.

RESULTS

At between-person levels, higher household income predicted higher SPMH, but not vice versa. These associations were stronger among men and older adults. At within-person levels, higher income did not predict higher SPMH. No significant gender- or age- group differences were observed. Complete case analyses supported the findings.

LIMITATIONS

Loss to follow-up may affect the generalizability of the research findings.

CONCLUSIONS

This study suggests that higher household income predicts higher SPMH at between-person levels. Policy and programs aiming at promoting mental health should focus on low-income individuals, especially men and older adults.

Income, Self-Rated Health, and Morbidity. A Systematic Review of Longitudinal Studies

If people were asked whether income changes influence self-rated health and morbidity, they would probably answer yes. Indeed, previous studies validated this assumption, but most of them used cross-sectional data and only considered self-rated health as the decisive factor. On the other hand, there are a few studies using longitudinal data, which found a much smaller association between income and self-rated health. In order to give a conclusive overview of the current study situation, this review summarizes and examines studies which use only longitudinal data. In addition to self-rated health, the effects of income on the objective factor of morbidity were also investigated. The review includes a total of 14 papers that use data from seven different countries. It concludes that there is a small, statistically significant, positive impact of increased income on self-rated health, but a negative association between income growth and morbidity. Taking the limitations of confounders, attrition, and selection bias into account, the results may even be insignificant.

Relationship between the shift of socioeconomic status and cardiovascular mortality

BACKGROUND

The aim of this study is to investigate whether upward or downward shifts in socioeconomic status have an effect on cardiovascular mortality.

DESIGN

A retrospective cohort study.

METHODS

Among the Korean National Health Insurance Service National Sample Cohort, 178,812 subjects were selected who were over 20 years of age as of 2002, with available data on routine health check and free of a diagnosis of ischaemic heart disease, stroke, heart failure or cancer at baseline. Cause of death was identified by the death certificate. Stratification of socioeconomic status was done by income as low (lower 30th percentile), high (higher 30th percentile) and middle, which was reclassified annually. Shift in socioeconomic status was defined as any change in the income class from baseline.

RESULTS

During the follow-up of a median 10 years, cardiovascular mortality was significantly higher among middle and low socioeconomic status groups (hazard ratio and 95% confidence interval for middle 1.92 (1.68-2.19) and low 1.73 (1.50-2.00)) compared to the high socioeconomic status group after adjustment for age, gender, residence, blood pressure, fasting glucose, smoking and medications (statins and antiplatelet agents). In the same regression model, an upward shift of socioeconomic status was associated with a lower risk of cardiovascular death (hazard ratio 0.46, 95% confidence interval 0.40-0.52), while a downward shift was not a significant predictor.

CONCLUSION

An upward shift of socioeconomic status was associated with a lower risk of cardiovascular mortality after adjustment for baseline socioeconomic status, conventional risk factors and risk-reducing pharmacological treatments.

Conditional Cash Transfers And Health Of Low-Income Families In The US: Evaluating The Family Rewards Experiment

Opportunity NYC-Family Rewards was the first conditional cash transfer, randomized controlled trial for low-income families in the United States. From 2007 to 2010, Family Rewards offered 2,377 New York City families cash transfers that were conditional upon their investments in education, preventive health care, and parental employment. Their health and other outcomes were compared to those of a control group of 2,372 families. The experiment led to a modest improvement in health insurance coverage and a large increase in the use of preventive dental care. It improved parents' perception of their own health and levels of hope, mainly through improvements in reported financial well-being. While the program's impacts on physical health were weaker, our study might not have captured effects on chronic disease risk that take longer to accrue. In the context of New York City's operating social-safety-net programs, conditional cash transfers may have led to positive, albeit modest, improvements in the health of poor families.

Using Marginal Structural Modeling to Estimate the Cumulative Impact of an Unconditional Tax Credit on Self-Rated Health

In previous studies, researchers estimated short-term relationships between financial credits and health outcomes using conventional regression analyses, but they did not account for time-varying confounders affected by prior treatment (CAPTs) or the credits' cumulative impacts over time. In this study, we examined the association between total number of years of receiving New Zealand's Family Tax Credit (FTC) and self-rated health (SRH) in 6,900 working-age parents using 7 waves of New Zealand longitudinal data (2002-2009). We conducted conventional linear regression analyses, both unadjusted and adjusted for time-invariant and time-varying confounders measured at baseline, and fitted marginal structural models (MSMs) that more fully adjusted for confounders, including CAPTs. Of all participants, 5.1%-6.8% received the FTC for 1-3 years and 1.8%-3.6% for 4-7 years. In unadjusted and adjusted conventional regression analyses, each additional year of receiving the FTC was associated with 0.033 (95% confidence interval (CI): -0.047, -0.019) and 0.026 (95% CI: -0.041, -0.010) units worse SRH (on a 5-unit scale). In the MSMs, the average causal treatment effect also reflected a small decrease in SRH (unstabilized weights: β = -0.039 unit, 95% CI: -0.058, -0.020; stabilized weights: β = -0.031 unit, 95% CI: -0.050, -0.007). Cumulatively receiving the FTC marginally reduced SRH. Conventional regression analyses and MSMs produced similar estimates, suggesting little bias from CAPTs.

Poverty, Pregnancy, and Birth Outcomes: A Study of the Earned Income Tax Credit

BACKGROUND

Economic interventions are increasingly recognised as a mechanism to address perinatal health outcomes among disadvantaged groups. In the US, the earned income tax credit (EITC) is the largest poverty alleviation programme. Little is known about its effects on perinatal health among recipients and their children. We exploit quasi-random variation in the size of EITC payments to examine the effects of income on perinatal health.

METHODS

The study sample includes women surveyed in the 1979 National Longitudinal Survey of Youth (n = 2985) and their children born during 1986-2000 (n = 4683). Outcome variables include utilisation of prenatal and postnatal care, use of alcohol and tobacco during pregnancy, term birth, birthweight, and breast-feeding status. We first examine the health effects of both household income and EITC payment size using multivariable linear regressions. We then employ instrumental variables analysis to estimate the causal effect of income on perinatal health, using EITC payment size as an instrument for household income.

RESULTS

We find that EITC payment size is associated with better levels of several indicators of perinatal health. Instrumental variables analysis, however, does not reveal a causal association between household income and these health measures.

CONCLUSIONS

Our findings suggest that associations between income and perinatal health may be confounded by unobserved characteristics, but that EITC income improves perinatal health. Future studies should continue to explore the impacts of economic interventions on perinatal health outcomes, and investigate how different forms of income transfers may have different impacts.

The short-term impacts of Earned Income Tax Credit disbursement on health

BACKGROUND

There are conflicting findings regarding long- and short-term effects of income on health. Whereas higher average income is associated with better health, there is evidence that health behaviours worsen in the short-term following income receipt.Prior studies revealing such negative short-term effects of income receipt focus on specific subpopulations and examine a limited set of health outcomes.

METHODS

The United States Earned Income Tax Credit (EITC) is an income supplement tied to work, and is the largest poverty reduction programme in the USA. We utilize the fact that EITC recipients typically receive large cash transfers in the months of February,March and April, in order to examine associated changes in health outcomes that can fluctuate on a monthly basis. We examine associations with 30 outcomes in the categories of diet, food security, health behaviours, cardiovascular biomarkers, metabolic biomarkers and infection and immunity among 6925 individuals from the U.S. National Health and Nutrition Survey. Our research design approximates a natural experiment,since whether individuals were sampled during treatment or non-treatment months is independent of social, demographic and health characteristics that do not vary with time.

RESULTS

There are both beneficial and detrimental short-term impacts of income receipt.Although there are detrimental impacts on metabolic factors among women, most other impacts are beneficial, including those for food security, smoking and trying to lose weight.

CONCLUSIONS

The short-term impacts of EITC income receipt are not universally health promoting, but on balance there are more health benefits than detriments.