Primary Submission Category: Socioeconomic status
Associations between a novel measure of census tract-level credit insecurity and frequent mental distress in U.S. urban areas, 2020
Authors: Andrea Titus Yuruo Li Claire Kramer Mills Benjamin Spoer Taylor Lampe Byoungjun Kim Marc Gourevitch Lorna Thorpe
Presenting Author: Andrea Titus*
Background: Access to and utilization of consumer credit remains an understudied social determinant of health. We examined associations between a novel, small-area, multi-dimensional credit insecurity index (CII), and the prevalence of self-reported frequent mental distress across U.S. cities in 2020.
Methods: The census tract-level CII was developed by the Federal Reserve Bank of New York using Census population information and a nationally representative sample of anonymized Equifax credit report data. The CII was calculated for tracts in 766 cities displayed on the City Health Dashboard at the time of analysis, predominantly representing cities with over 50,000 population. The CII combined data on tract-level participation in the formal credit economy with information on the percent of individuals without revolving credit, percent with high credit utilization (≥100%), and percent with deep subprime credit scores. Tracts were classified as credit-assured, credit-likely, mid-tier, at-risk, or credit-insecure. We used linear regression to examine associations between the CII and a modeled tract-level measure of frequent mental distress, obtained from the CDC PLACES project. Regression models were adjusted for neighborhood economic and demographic characteristics. We examined effect modification by U.S. region by including two-way interaction terms in regression models.
Results: In adjusted models, credit-insecure tracts had a modestly higher prevalence of frequent mental distress (prevalence difference = 0.37 percentage points; 95% CI = 0.32,0.43), compared to credit-assured tracts. Associations were most pronounced in the Midwest.
Conclusions: Local factors impacting credit access and utilization are often modifiable. The CII, a novel indicator of community financial wellbeing, may be an independent predictor of neighborhood health in U.S. cities and could illuminate policy targets to improve access to desirable credit products and downstream health outcomes.