Work

Is consumer credit a social determinant of health for older adults? An investigation in the advanced cognitive training for independent and vital elderly (ACTIVE) trial

Year: 2026

Type: article

Abstract: Purpose: Few empirical studies have focused on how consumer credit relates to social determinants of health (SDoH). We examined consumer credit as a measurable aspect of SDoH, which is distinct from existing indicators for SDoH domains. Methods: We linked data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study with credit data provided by TransUnionR. Our analysis entailed convergent construct validation against five SDoH domains; and criterion validation against physical and mental/cognitive health outcomes. Finally, we assessed consumer credit as a mediator on the association between SDoH domains with physical and mental/cognitive health outcomes. Results: Consumer credit most strongly reflected the Economic Stability SDoH domain; consumer credit measures pertaining to debt (e.g. percent of credit used, collections in past 12 months) inversely reflected one’s Economic Stability. Adding consumer credit measures to SDoH factors helped explain significantly more variance in physical and mental health. Consumer credit mediated pathways between SDoH domains and physical health, and between SDoH domains and memory. Conclusions: Consumer credit contributes unique information not captured by other SDoH domains. Future studies requiring quantifying latent SDoH constructs should consider incorporating consumer credit in their measurement models.

Source: Acta Psychologica

DOI: 10.1016/j.actpsy.2026.108099