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J Epidemiol Community Health. 2019 Jan;73(1):73-78. doi: 10.1136/jech-2018-211160. Epub 2018 Oct 15.

Consumer credit, chronic disease and risk behaviours.

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Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA.
Department of Pharmacy Systems, Outcomes and Policy, University of Illinois College of Pharmacy, Chicago, Illinois, USA.



Credit scores have been identified as a marker of disease burden. This study investigated credit scores' association with chronic diseases and health behaviours that are associated with chronic diseases.


This cross-sectional analysis included data on 2083 residents of Philadelphia, Pennsylvania, USA in 2015. Nine-digit ZIP code level FICO credit scores were appended to individual self-reported chronic diseases (obesity, diabetes, hypertension) and related health behaviours (smoking, exercise, and salt intake and medication adherence among those with hypertension). Models adjusted for individual-level and area-level demographics and retail pharmacy accessibility.


Median ZIP code credit score was 665 (SD=58). In adjusted models, each 50-point increase in ZIP code credit score was significantly associated with: 8% lower chronic disease risk; 6% lower overweight/obesity risk, 19% lower diabetes risk; 9% lower hypertension risk and 14% lower smoking risk. Other health behaviours were not significantly associated. Compared with high prime credit, subprime credit score was significantly associated with a 15%-70% increased risk of chronic disease, following a dose-response pattern with a prime rating.


Lower area level credit scores may be associated with greater chronic disease prevalence but not necessarily with related health behaviours. Area-level consumer credit may make a novel contribution to identifying chronic disease patterns.


United States; chronic disease; consumer credit; diabetes; hypertension; obesity

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