Positive income shocks and accidental deaths among Cherokee Indians: a natural experiment
Open accessAbstract
BACKGROUND: Several studies in low-income populations report the somewhat counterintuitive finding that positive income gains adversely affect adult health. The literature posits that receipt of a large portion of annual income increases, in the short term, risk-taking behaviour and/or the consumption of health-damaging goods. This work implies the hypothesis that persons with an unexpected gain in income will exhibit an elevated risk of accidental death-the fifth leading cause of death in the USA. We test this hypothesis directly by capitalizing on a natural experiment in which Cherokee Indians in rural North Carolina received discrete lump sum payments from a new casino. METHODS: We applied Poisson regression to the monthly count of accidental deaths among Cherokee Indians over 204 months spanning 1990-2006. We controlled for temporal patterns in accidental deaths (e.g. seasonality and trend) as well as changes in population size. RESULTS: As hypothesized, the risk of accidental death rises above expected levels during months of the large casino payments (relative risk = 2.62; 95% confidence interval = 1.54-4.47). Exploratory analyses of ethnographic interviews and behavioural surveys support that increased vehicular travel and consumption of health-damaging goods may account for the rise in accident proneness. CONCLUSIONS: Although long-term income gains may improve health in this population, our findings indicate that acute responses to large income gains, in the short term, increase risk-taking and accident proneness. We encourage further investigation of natural experiments to identify causal economic antecedents of population health.
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Eliminating racial and ethnic disparities would cut medical care costs by $230 billion and indirect costs of excess illness and death by over $1 trillion over three years.
“Furthermore, research suggests that eliminating racial and ethnic disparities would reduce medical care costs by $230 billion and indirect costs of excess morbidity and mortality by more than $1 trillion over three years.(54)”
From Evaluating strategies for reducing health disparities by addressing the social determinants of health. (2016) · cites this paper as [54]
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- Authors
- Bruckner, T. A., Brown, R. A., & Margerison-Zilko, C.
- Affiliations
- University of California, Irvine (US)
- RAND Corporation (US)
- Corresponding author
- Bruckner, Tim A
- Venue
- International Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-04-28
- Volume
- 40
- Issue
- 4
- Pages
- 1083-1090
- ISSN
- 0300-5771 (ISSN-L)
- 1464-3685
- PMC
- PMC3156370
- OpenAlex
- W2111357476
- Cited by
- 38
- References
- 47
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 1 · 2023: 5 · 2022: 3 · 2021: 2 · 2020: 3 · 2019: 1 · 2016: 5 · 2015: 2 · 2014: 3 · 2013: 4 · 2012: 2
- FWCI
- 3.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Epidemiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institute of Mental Health (F31MH064253)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R21HD056581)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Injury Epidemiology and Prevention
- Health Sciences › Health Professions › General Health Professions › Employment and Welfare Studies
- Keywords
- accidental death, Cherokee Indians, risk-taking, accident proneness, low-income populations, population health, rural North Carolina
- MeSH terms
- Accidents, Adolescent, Adult, Anthropology, Cultural, Cause of Death, Child, Female, Gambling, Humans, Income, Indians, North American, Male, Middle Aged, North Carolina, Rural Population, Poisson Distribution, Young Adult
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