Advertisement

The Cognitive Burden of Poverty: A Mechanism of Socioeconomic Health Disparities

  • Bradley M. Appelhans
    Correspondence
    Address correspondence to: Bradley M. Appelhans, PhD, Department of Family and Preventive Medicine, Rush University Medical Center, 1700 West Van Buren Street, Suite 470, Chicago IL 60612.
    Affiliations
    From the Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, Illinois

    and the Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
    Search for articles by this author
Published:September 27, 2022DOI:https://doi.org/10.1016/j.amepre.2022.08.012
      Living in poverty is strongly linked to poor health and premature death, a reality that manifests in a roughly 10-year difference in lifespan between those at the top and bottom of the U.S. income distribution.
      • Chetty R
      • Stepner M
      • Abraham S
      • et al.
      The association between income and life expectancy in the United States, 2001-2014.
      Socioeconomic disparities in morbidity and mortality at least partially stem from flaws and structural inequities both internal and external to the healthcare system, but a significant portion is also attributable to a greater burden of modifiable risk factors among the poor, including excess weight, smoking, poor diet, physical inactivity, and other behavioral risk factors.
      • Petrovic D
      • de Mestral C
      • Bochud M
      • et al.
      The contribution of health behaviors to socioeconomic inequalities in health: a systematic review.
      • Stringhini S
      • Carmeli C
      • Jokela M
      • et al.
      Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1.7 million men and women.
      • Zhang YB
      • Chen C
      • Pan XF
      • et al.
      Associations of healthy lifestyle and socioeconomic status with mortality and incident cardiovascular disease: two prospective cohort studies.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Chetty R
        • Stepner M
        • Abraham S
        • et al.
        The association between income and life expectancy in the United States, 2001-2014.
        JAMA. 2016; 315: 1750-1766https://doi.org/10.1001/jama.2016.4226
        • Petrovic D
        • de Mestral C
        • Bochud M
        • et al.
        The contribution of health behaviors to socioeconomic inequalities in health: a systematic review.
        Prev Med. 2018; 113: 15-31https://doi.org/10.1016/j.ypmed.2018.05.003
        • Stringhini S
        • Carmeli C
        • Jokela M
        • et al.
        Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1.7 million men and women.
        Lancet. 2017; 389: 1229-1237https://doi.org/10.1016/S0140-6736(16)32380-7
        • Zhang YB
        • Chen C
        • Pan XF
        • et al.
        Associations of healthy lifestyle and socioeconomic status with mortality and incident cardiovascular disease: two prospective cohort studies.
        BMJ. 2021; 373: n604https://doi.org/10.1136/bmj.n604
        • Tseng E
        • Zhang A
        • Shogbesan O
        • et al.
        Effectiveness of policies and programs to combat adult obesity: a systematic review.
        J Gen Intern Med. 2018; 33: 1990-2001https://doi.org/10.1007/s11606-018-4619-z
        • Dixon BN
        • Ugwoaba UA
        • Brockmann AN
        • Ross KM.
        Associations between the built environment and dietary intake, physical activity, and obesity: a scoping review of reviews.
        Obes Rev. 2021; 22: e13171https://doi.org/10.1111/obr.13171
        • Abeykoon AH
        • Engler-Stringer R
        • Muhajarine N.
        Health-related outcomes of new grocery store interventions: a systematic review.
        Public Health Nutr. 2017; 20: 2236-2248https://doi.org/10.1017/S1368980017000933
        • Rummo P
        • Sze J
        • Elbel B.
        Association between a policy to subsidize supermarkets in underserved areas and childhood obesity risk.
        JAMA Pediatr. 2022; 176: 646-653https://doi.org/10.1001/jamapediatrics.2022.1153
        • Deemer SE
        • Owora AH
        • DB Allison
        Taking a hard look at the empirical evidence for popular community-based interventions in obesity.
        JAMA Pediatr. 2022; 176: 639-641https://doi.org/10.1001/jamapediatrics.2022.1150
        • Crielaard L
        • Nicolaou M
        • Sawyer A
        • Quax R
        • Stronks K.
        Understanding the impact of exposure to adverse socioeconomic conditions on chronic stress from a complexity science perspective.
        BMC Med. 2021; 19: 242https://doi.org/10.1186/s12916-021-02106-1
        • Scott SB
        • Munoz E
        • Mogle JA
        • et al.
        Perceived neighborhood characteristics predict severity and emotional response to daily stressors.
        Soc Sci Med. 2018; 200: 262-270https://doi.org/10.1016/j.socscimed.2017.11.010
        • Shields GS
        • Sazma MA
        • Yonelinas AP.
        The effects of acute stress on core executive functions: a meta-analysis and comparison with cortisol.
        Neurosci Biobehav Rev. 2016; 68: 651-668https://doi.org/10.1016/j.neubiorev.2016.06.038
        • Mani A
        • Mullainathan S
        • Shafir E
        • Zhao J.
        Poverty impedes cognitive function.
        Science. 2013; 341: 976-980https://doi.org/10.1126/science.1238041
        • Ward A
        • Mann T.
        Control yourself: broad implications of narrowed attention.
        Perspect Psychol Sci. 2022; (In press. Online July 13)https://doi.org/10.1177/17456916221077093
        • Allan JL
        • McMinn D
        • Daly M.
        A Bidirectional relationship between executive function and health behavior: evidence, implications, and future directions.
        Front Neurosci. 2016; 10: 386https://doi.org/10.3389/fnins.2016.00386
        • Ruggeri K
        • Panin A
        • Vdovic M
        • et al.
        The globalizability of temporal discounting.
        Nat Hum Behav. 2022https://doi.org/10.1038/s41562-022-01392-w (In press. Online July 11)
        • Bickel WK
        • Jarmolowicz DP
        • Mueller ET
        • Koffarnus MN
        • Gatchalian KM.
        Excessive discounting of delayed reinforcers as a trans-disease process contributing to addiction and other disease-related vulnerabilities: emerging evidence.
        Pharmacol Ther. 2012; 134: 287-297https://doi.org/10.1016/j.pharmthera.2012.02.004
        • Amlung M
        • Petker T
        • Jackson J
        • Balodis I
        • MacKillop J.
        Steep discounting of delayed monetary and food rewards in obesity: a meta-analysis.
        Psychol Med. 2016; 46: 2423-2434https://doi.org/10.1017/S0033291716000866
        • Amlung M
        • Vedelago L
        • Acker J
        • Balodis I
        • MacKillop J.
        Steep delay discounting and addictive behavior: a meta-analysis of continuous associations.
        Addiction. 2017; 112: 51-62https://doi.org/10.1111/add.13535
        • Sweeney AM
        • Culcea I.
        IDoes a future-oriented temporal perspective relate to body mass index, eating, and exercise? A meta-analysis.
        Appetite. 2017; 112: 272-285https://doi.org/10.1016/j.appet.2017.02.006
        • Bickel WK
        • Moody L
        • Quisenberry AJ
        • Ramey CT
        • Sheffer CE.
        A Competing Neurobehavioral Decision Systems model of SES-related health and behavioral disparities.
        Prev Med. 2014; 68: 37-43https://doi.org/10.1016/j.ypmed.2014.06.032
        • Appelhans BM
        • Tangney CC
        • French SA
        • Crane MM
        • Wang Y.
        Delay discounting and household food purchasing decisions: the SHoPPER study.
        Health Psychol. 2019; 38: 334-342https://doi.org/10.1037/hea0000727
        • Appelhans BM
        • French SA
        • Pagoto SL
        • Sherwood NE.
        Managing temptation in obesity treatment: a neurobehavioral model of intervention strategies.
        Appetite. 2016; 96: 268-279https://doi.org/10.1016/j.appet.2015.09.035
        • Schwartz J
        • Mochon D
        • Wyper L
        • Maroba J
        • Patel D
        • Ariely D.
        Healthier by precommitment.
        Psychol Sci. 2014; 25: 538-546https://doi.org/10.1177/0956797613510950
        • Stoffel ST
        • Hirst Y
        • Ghanouni A
        • Waller J
        • von Wagner C
        Offering disinclined people the choice between different screening appointments: a randomised online survey.
        Psychol Health. 2021; 36: 1135-1146https://doi.org/10.1080/08870446.2020.1834559
        • Szrek H
        • Bundorf MK.
        Enrollment in prescription drug insurance: the interaction of numeracy and choice set size.
        Health Psychol. 2014; 33: 340-348https://doi.org/10.1037/a0032738
        • Day R
        • Nadash P.
        New state insurance exchanges should follow the example of Massachusetts by simplifying choices among health plans.
        Health Aff (Millwood). 2012; 31: 982-989https://doi.org/10.1377/hlthaff.2011.0691
        • Sliwinski MJ
        • Mogle JA
        • Hyun J
        • Munoz E
        • Smyth JM
        • Lipton RB.
        Reliability and validity of ambulatory cognitive assessments.
        Assessment. 2018; 25: 14-30https://doi.org/10.1177/1073191116643164
        • Lamont M
        • Adler L
        • Park BY
        • Xiang X.
        Bridging cultural sociology and cognitive psychology in three contemporary research programmes.
        Nat Hum Behav. 2017; 1: 866-872https://doi.org/10.1038/s41562-017-0242-y
        • Iceland J.
        Racial and ethnic inequality in poverty and affluence, 1959-2015.
        Popul Res Policy Rev. 2019; 38: 615-654https://doi.org/10.1007/s11113-019-09512-7
        • Intrator J
        • Tannen J
        • Massey DS.
        Segregation by race and income in the United States 1970-2010.
        Soc Sci Res. 2016; 60: 45-60https://doi.org/10.1016/j.ssresearch.2016.08.003
        • McKinney TL
        • Euler MJ
        • Butner JE.
        It's about time: the role of temporal variability in improving assessment of executive functioning.
        Clin Neuropsychol. 2020; 34: 619-642https://doi.org/10.1080/13854046.2019.1704434