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Open Access Research article

Financial stress in late adulthood and diverse risks of incident cardiovascular disease and all-cause mortality in women and men

Axel C Carlsson12*, Bengt Starrin3, Bruna Gigante4, Karin Leander4, Mai-Lis Hellenius5 and Ulf de Faire46

Author Affiliations

1 Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden

2 Department of Medical Sciences, Molecular Epidemiology and Science for Life, Laboratory, Uppsala University, Uppsala, Sweden

3 Department for Social Studies, Faculty of Social and Life Sciences, Karlstad University, Karlstad, Sweden

4 Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

5 Department of Medicine, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden

6 Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden

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BMC Public Health 2014, 14:17  doi:10.1186/1471-2458-14-17

Published: 9 January 2014



Financial stress may have adverse health effects. The main aim of this study was to investigate whether having a cash margin and living alone or cohabiting is associated with incident cardiovascular disease (CVD) and all-cause mortality.


Representative population-based prospective cohort study of 60-year-old women (n = 2065) and men (n = 1939) in Stockholm County, Sweden. National registers were used to identify cases of incident CVD (n = 375) and all-cause mortality (n = 385). The presence of a cash margin was determined in the questionnaire with the following question: Would you, if an unexpected situation occurred, be able to raise 10 000 SEK within a week? (This was equivalent to US$ 1250 in 1998).


Compared with cohabiting women with a cash margin, the risk of all-cause mortality was higher among cohabiting women without a cash margin, with hazard ratios (HRs) of 1.97 (95% confidence interval (CI) 1.06–3.66). Using cohabiting men with cash margin as referent, single men without a cash margin were at an increased risk of both incident CVD and all-cause mortality: HR 2.84 (95% CI 1.61–4.99) and 2.78 (95% CI 1.69–4.56), respectively. Single men with cash margins still had an increased risk of all-cause mortality when compared with cohabiting men with a cash margin: HR 1.67 (95% CI 1.22–2.28).


Financial stress may increase the risks of incident CVD and all-cause mortality, especially among men. Furthermore these risks are likely to be greater in men living in single households and in women without cash margins. Living with a partner seems to protect men, but not women, from ill-health associated with financial stress due to the lack of a cash margin.

Cash margin; Financial stress; Cohort study; All-cause mortality; Cardiovascular disease