![]() 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). ![]() seasonality and trend) as well as changes in population size. We controlled for temporal patterns in accidental deaths (e.g. Methods We applied Poisson regression to the monthly count of accidental deaths among Cherokee Indians over 204 months spanning 1990–2006. 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. 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. 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. Background Several studies in low-income populations report the somewhat counterintuitive finding that positive income gains adversely affect adult health.
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