Abstract HUP1: Asset Poverty, Negative Wealth Shock, and Incident Stroke in the Health and Retirement Study

Economic instability, including a sudden loss of wealth, has been previously associated with increased risk of mortality, but associations with stroke are understudied. We hypothesized that experiencing a negative wealth shock in late-middle age would increase subsequent risk of stroke, more so than experiencing baseline asset poverty without significant changes to wealth. To answer this question, we used the Health and Retirement Study (HRS), a longitudinal nationally representative study of aging based in the United States. We defined the exposure period from 1992-1998 and quantified negative wealth shock during this period as a 75% or greater decrease in total wealth across 2 consecutive survey waves. Participants were classified into one of three groups based on their financial status during this period: (1) asset poor at baseline (i.e., zero or negative net wealth), (2) experienced at least one negative wealth shock, or (3) maintained positive wealth without experiencing a shock through this exposure period. Participants were then followed for 24 years for incident stroke. We used discrete-time hazard models adjusted for age, sex/gender, self-reported race and ethnicity, marital status, years of education, household income, occupational status, hypertension, and diabetes, weighted for survey design. Among 13,572 HRS participants, 874 participants had asset poverty at baseline and 1727 experienced at least 1 negative wealth shock during the exposure period. The sample had a mean age of 67 years (SD 10 years) and consisted of 59% women, and 14% Black and 8% Hispanic participants. Compared to those with positive wealth without shock, those with asset poverty at baseline or experienced at least 1 negative health shock had about 36% and 26% greater risk of stroke, respectively (HR [95% CI] for asset poverty: 1.36 [1.04, 1.77]; for negative wealth shock: 1.26 [1.06, 1.50]). Overall, we found that both experiencing asset poverty and negative wealth shock were deleterious for stroke risk, and while confidence intervals overlapped, the magnitude of association was larger for asset poverty. These findings suggest that interventions to prevent economic instability in midlife may help reduce stroke burden later in life.