Hypertension and Low Wages

If workers earning low wages didn’t have enough stressors in their lives, they can now add hypertension to the list.  Our new research finds that low wages are a risk factor for hypertension among working people.  The research was recently published in the European Journal of Public Health, “Are Low Wages Risk Factors for Hypertension?”, and was partially funded by NIOSH.

Whereas low Socio-economic status (SES) has been linked to hypertension, the reasons why are unclear.  This is the first study to examine wages, the largest component of income (one part of SES), as a risk factor for hypertension.  Why is this important?  Wages are an indicator of job quality and may be linked to feelings of self worth.  Low wages can also create financial stress for families that find themselves short of funds to pay for rent, electricity, heat, and gas for their cars.  Additionally, there are steps policy makers can take to adjust wages.   For example, governments can raise minimum wages, make it easier for unions to organize,  and increase  the pay of low-wage government workers. 

Reducing hypertension could have a significant impact on the health of Americans and the associated costs to deal with the condition.  Hypertension, or high blood pressure, was listed as a primary or contributing cause of death for about 348,000 Americans in 2008.[i]  Hypertension raises the risk for heart disease and stroke and affects about 1 in 3 U.S. adults— an estimated 68 million people.[ii]  Costs directly attributable to high blood pressure for the nation total almost $131 billion annually in direct medical expenses and $25 billion in lost productivity.[iii]

Hypertension is often associated with older males so it was somewhat surprising when the research revealed strong correlations between hypertension and women and hypertension and younger workers between the ages of 25 to 44.  We found that doubling the inflation-adjusted wage was associated with a 16 percent decrease in a hypertension diagnosis over the course of the study (1999-2005).  This means that if there were 110 million people employed in the U.S. between the ages of 25 and 65 each year during the six years of the study, then a 5 percent increase in everyone’s inflation-adjusted wages would have resulted in 66,000 fewer cases of hypertension each year.  Doubling the wages of younger workers was associated with a 25 to 30 percent decrease in the risk of a hypertension diagnosis, and doubling the wages of women was associated with a 30 to 35 percent decrease in the risk of a hypertension diagnosis.

We used records from the Panel Study of Income Dynamics, a highly regarded database that includes information on employment, income, and hypertension status.  The study included longitudinal, nationally representative U.S. data from four time periods (1999, 2001, 2003 and 2005). The sample was limited to 5,651 employed participants aged 25 to 65 years with a wage of $2.78 to $77 (1999 dollars) an hour.   Hypertension was self-reported based on physician diagnosis.

If additional research using different national data sets finds the same relationship between low wages and hypertension we could have identified a way to help reduce the costs and personal impact of a major health crisis.  We encourage researchers to conduct additional studies to further this area of research.

J. Paul Leigh, Ph.D. and Juan Du, Ph.D.

Dr. Leigh is the lead author of this study and a professor in the Department of Public Health Sciences and Center for Healthcare Policy and Research at the  University of California Davis School of Medicine.

Dr.  Du is co-author and a professor of economics at Old Dominion University, Norfolk, Virginia.

[i] Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation. 2012;125(1):e2–220.

[ii] CDC. Vital signs: prevalence, treatment, and control of hypertension—United States, 1999-2002 and 2005-2008. MMWR. 2011;60(4):103-8.

[iii] Heidenreich PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123(8):933-44. Epub 2011 Jan 24.