@article{ref1,
title="Positive income shocks and accidental deaths among Cherokee Indians: a natural experiment",
journal="International journal of epidemiology",
year="2011",
author="Bruckner, Tim A. and Brown, Ryan A. and Margerison-Zilko, Claire",
volume="40",
number="4",
pages="1083-1090",
abstract="BACKGROUND: Several studies in low-income populations report the somewhat counterintuitive finding that positive income gains adversely affect adult health. The literature posits that receipt of a large portion of annual income increases, in the short term, risk-taking behaviour and/or the consumption of health-damaging goods. This work implies the hypothesis that persons with an unexpected gain in income will exhibit an elevated risk of accidental death-the fifth leading cause of death in the USA. We test this hypothesis directly by capitalizing on a natural experiment in which Cherokee Indians in rural North Carolina received discrete lump sum payments from a new casino. METHODS: We applied Poisson regression to the monthly count of accidental deaths among Cherokee Indians over 204 months spanning 1990-2006. We controlled for temporal patterns in accidental deaths (e.g. seasonality and trend) as well as changes in population size. RESULTS: As hypothesized, the risk of accidental death rises above expected levels during months of the large casino payments (relative risk = 2.62; 95% confidence interval = 1.54-4.47). Exploratory analyses of ethnographic interviews and behavioural surveys support that increased vehicular travel and consumption of health-damaging goods may account for the rise in accident proneness. CONCLUSIONS: Although long-term income gains may improve health in this population, our findings indicate that acute responses to large income gains, in the short term, increase risk-taking and accident proneness. We encourage further investigation of natural experiments to identify causal economic antecedents of population health.<p /> <p>Language: en</p>",
language="en",
issn="0300-5771",
doi="10.1093/ije/dyr073",
url="http://dx.doi.org/10.1093/ije/dyr073"
}