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Abstract
Previous research has suggested that incarceration has negative implications for individuals' well-being, health, and mortality. Most of these studies, however, have not followed former prisoners over an extended period and into older adult ages, when the risk of health deterioration and mortality is the greatest. Contributing to this literature, this study is the first to employ the Panel Study of Income Dynamics (PSID) to estimate the long-run association between individual incarceration and mortality over nearly 40 years. We also supplement those analyses with data from the National Longitudinal Survey of Youth 1979 (NLSY79). We then use these estimates to investigate the implications of the U.S. incarceration regime and the post-1980 incarceration boom for the U.S. health and mortality disadvantage relative to industrialized peer countries (the United Kingdom).
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Affiliation(s)
- Sebastian Daza
- Center for Demography and Ecology, University of Wisconsin-Madison, 1180 Observatory Drive, Madison, WI, 53706, USA.
| | - Alberto Palloni
- Center for Demography of Health of Aging, University of Wisconsin-Madison, 1180 Observatory Drive, Madison, WI, 53706, USA
| | - Jerrett Jones
- Center for Demography and Ecology, University of Wisconsin-Madison, 1180 Observatory Drive, Madison, WI, 53706, USA
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102
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Meyer AC, Drefahl S, Ahlbom A, Lambe M, Modig K. Trends in life expectancy: did the gap between the healthy and the ill widen or close? BMC Med 2020; 18:41. [PMID: 32192480 PMCID: PMC7082956 DOI: 10.1186/s12916-020-01514-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/06/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND During the past decades, life expectancy has continued to increase in most high-income countries. Previous research suggests that improvements in life expectancy have primarily been driven by advances at the upper end of the health distribution, while parts of the population have lagged behind. Using data from the entire Swedish population, this study aims to examine the life expectancy development among subgroups of individuals with a history of common diseases relative to that of the general population. METHODS The remaining life expectancy at age 65 was estimated for each year in 1998-2017 among individuals with a history of disease, and for the total Swedish population. We defined population subgroups as individuals with a history of myocardial infarction, ischemic or hemorrhagic stroke, hip fracture, or colon, breast, or lung cancer. We further distinguished between different educational levels and Charlson comorbidity index scores. RESULTS Life expectancy gains have been larger for men and women with a history of myocardial infarction, ischemic or hemorrhagic stroke, and colon or breast cancer than for the general population. The life expectancy gap between individuals with a history of hip fracture or lung cancer and the general population has, however, been growing. Education and comorbidity have affected mortality levels, but have not altered the rate of increase in life expectancy among individuals with disease history. The female advantage in life expectancy was less pronounced among individuals with disease history than among the general population. CONCLUSIONS Life expectancy has increased faster in many subpopulations with a history of disease than in the general population, while still remaining at lower levels. Improvements in life expectancy have been observed regardless of comorbidity or educational level. These findings suggest that the rise in overall life expectancy reflects more than just improved survival among the healthy or the delayed onset of disease.
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Affiliation(s)
- Anna C Meyer
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, PO Box 210, SE-171 77, Stockholm, Sweden.
| | - Sven Drefahl
- Demography Unit, Stockholm University, SE-10691, Stockholm, Sweden
| | - Anders Ahlbom
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, PO Box 210, SE-171 77, Stockholm, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, SE-17177, Stockholm, Sweden.,Regional Cancer Centre, University Hospital, SE-751 85, Uppsala, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, PO Box 210, SE-171 77, Stockholm, Sweden
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103
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Kim J, Choi EA, Han YE, Lee JW, Kim YS, Kim Y, You HS, Hyun HJ, Kang HT. Association between statin use and all-cause mortality in cancer survivors, based on the Korean health insurance service between 2002 and 2015. Nutr Metab Cardiovasc Dis 2020; 30:434-440. [PMID: 31831365 DOI: 10.1016/j.numecd.2019.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Cancer is the number one cause of death in Korea. This study aimed to investigate if statin use in cancer survivors was inversely associated with all-cause mortality. METHODS AND RESULTS Data from the 2002 to 2015 National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) were used. The Kaplan-Meier estimator was used to estimate the survival function according to statin usage. Cox proportional hazards regression models were adopted after stepwise adjustment for potential confounders to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality. The median follow-up duration was 10.0 years. Statin users had a higher percentage of diabetes and hypertension in both sexes. Survival rates of statin users were higher than non-users (p-values <0.001 in men and 0.021 in women). Compared to non-users, the HRs (95% CIs) of statin users for all-cause mortality were 0.327 (0.194-0.553) in men and 0.287 (0.148-0.560) in women after adjustment for potential confounding factors. CONCLUSIONS Statin users in cancer survivors had higher survival rate than non-users in both sexes.
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Affiliation(s)
- Joungyoun Kim
- Department of Information & Statistics, Chungbuk National University, 1 Chungdae-ro, Seowon-gu, Cheongju, Chungbuk, 28644, Republic of Korea
| | - Eun-A Choi
- Department of Information & Statistics, Chungbuk National University, 1 Chungdae-ro, Seowon-gu, Cheongju, Chungbuk, 28644, Republic of Korea
| | - Ye-Eun Han
- Department of Information & Statistics, Chungbuk National University, 1 Chungdae-ro, Seowon-gu, Cheongju, Chungbuk, 28644, Republic of Korea
| | - Jae-Woo Lee
- Department of Family Medicine, Chungbuk National University Hospital, 776 1-Soonwhan-ro, Seowon-gu, Cheongju, Chungbuk, 28644, Republic of Korea
| | - Ye-Seul Kim
- Department of Family Medicine, Chungbuk National University Hospital, 776 1-Soonwhan-ro, Seowon-gu, Cheongju, Chungbuk, 28644, Republic of Korea
| | - Yonghwan Kim
- Department of Family Medicine, Chungbuk National University Hospital, 776 1-Soonwhan-ro, Seowon-gu, Cheongju, Chungbuk, 28644, Republic of Korea
| | - Hyo-Sun You
- Department of Family Medicine, Chungbuk National University Hospital, 776 1-Soonwhan-ro, Seowon-gu, Cheongju, Chungbuk, 28644, Republic of Korea
| | - Hyeong-Jin Hyun
- Department of Statistics, Seoul National University, Seoul, 08826, Republic of Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Chungbuk National University Hospital, 776 1-Soonwhan-ro, Seowon-gu, Cheongju, Chungbuk, 28644, Republic of Korea; Department of Family Medicine, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, Cheongju, Chungbuk, 28644, Republic of Korea.
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104
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Fiori KL, Windsor TD, Huxhold O. The Increasing Importance of Friendship in Late Life: Understanding the Role of Sociohistorical Context in Social Development. Gerontology 2020; 66:286-294. [PMID: 32088720 DOI: 10.1159/000505547] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/19/2019] [Indexed: 11/19/2022] Open
Abstract
Historically, family ties have been understood as the primary source of support for aging adults, and past empirical and theoretical work has highlighted the tendency of older adults to focus on close family. However, in line with demographic changes and historical increases in the diversity of social structures, friendships are increasing in importance in recent generations of older adults. Given the powerful role of context in shaping these changes, this paper offers a conceptual analysis linking individual agency to sociohistorical context as a way to understand this increasing diversity of social ties. More specifically, we propose that the individual invests time and energy to form and maintain social ties, and that each individual has a specific social opportunity structure (all potential ties that are available to invest in, as well as the costs of those investments). Furthermore, this investment of time and energy is determined in part by individual differences in capacities and motivations. We argue that sociohistorical context influences this process in three important ways: (1) in its effect on the social opportunity structure; (2) in its direct effect on time and energy; and (3) in its effect on individuals' capacities and motivations. We believe that these mechanisms can account for the increasing diversity of social ties across adulthood, as well as the potential for future historical changes.
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Affiliation(s)
| | - Tim D Windsor
- Flinders University, Adelaide, South Australia, Australia
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105
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Abstract
Homicide is a leading cause of death for young people in the United States aged 15-34, but it has a disproportionate impact on one subset of the population: African American males. The national decline in homicide mortality that occurred from 1991 to 2014 thus provides an opportunity to generate evidence on a unique question-How do population health and health inequality change when the prevalence of one of the leading causes of death is cut in half? In this article, we estimate the impact of the decline in homicide mortality on life expectancy at birth as well as years of potential life lost for African American and white males and females, respectively. Estimates are generated using national mortality data by age, gender, race, and education level. Counterfactual estimates are constructed under the assumption of no change in mortality due to homicide from 1991 (the year when the national homicide rate reached its latest peak) to 2014 (the year when the homicide rate reached its trough). We estimate that the decline in homicides led to a 0.80-year increase in life expectancy at birth for African American males, and reduced years of potential life lost by 1,156 years for every 100,000 African American males. Results suggest that the drop in homicide represents a public health breakthrough for African American males, accounting for 17 % of the reduction in the life expectancy gap between white and African American males.
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106
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Brown CM, Samaan ZM, Mansour ME, Glance A, Morehous JF, Taylor S, Hawke J, Kahn RS. A Framework to Measure and Improve Well-Being in Primary Care. Pediatrics 2020; 145:peds.2019-1531. [PMID: 31852736 DOI: 10.1542/peds.2019-1531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2019] [Indexed: 11/24/2022] Open
Abstract
Pediatricians aspire to optimize overall health and development, but there are no comprehensive measures of well-being to guide pediatric primary care redesign. The objective of this article is to describe the Cincinnati Kids Thrive at 5 outcome measure, along with a set of more proximal outcome and process measures, designed to drive system improvement over several years. In this article, we describe a composite measure of "thriving" at age 66 months, using primary care data from the electronic health record. Thriving is defined as immunizations up-to-date, healthy BMI, free of dental pain, normal or corrected vision, normal or corrected hearing, and on track for communication, literacy, and social-emotional milestones. We discuss key considerations and tradeoffs in developing the measure. We then summarize insights from applying this measure to 9544 patients over 3 years. Baseline rates of thriving were 13% when including all patients and 31% when including only patients with complete data available. Interpretation of results was complicated by missing data in 50% of patients and nonindependent success rates among bundle components. There was considerable enthusiasm among other practices and sectors to learn with us and to measure system performance using time-linked trajectories. We learned to present our data in ways that balanced aspirational long-term or multidisciplinary goal-setting with more easily attainable short-term aims. On the basis of our experience with the Thrive at 5 measure, we discuss future directions and place a broader call to action for pediatricians, researchers, policy makers, and communities.
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Affiliation(s)
- Courtney M Brown
- Division of General and Community Pediatrics and .,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and.,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Zeina M Samaan
- Division of General and Community Pediatrics and.,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Mona E Mansour
- Division of General and Community Pediatrics and.,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Allison Glance
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | | | - Stuart Taylor
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Jesse Hawke
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Robert S Kahn
- Division of General and Community Pediatrics and.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and.,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
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107
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Warren JR, Muller C, Hummer RA, Grodsky E, Humphries M. Which Aspects of Education Matter for Early Adult Mortality? Evidence from the High School and Beyond Cohort. SOCIUS : SOCIOLOGICAL RESEARCH FOR A DYNAMIC WORLD 2020; 6:10.1177/2378023120918082. [PMID: 33094163 PMCID: PMC7575125 DOI: 10.1177/2378023120918082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
What dimensions of education matter for people's chances of surviving young adulthood? Do cognitive skills, non-cognitive skills, course taking patterns, and school social contexts matter for young adult mortality, even net of educational attainment? We analyze data from High School & Beyond-a nationally representative cohort of ~25,000 high school students first interviewed in 1980. Many dimensions of education are associated with young adult mortality, and high school students' math course taking retain their associations with mortality net of educational attainment. Our work draws on theories and measures from sociological and educational research and enriches public health, economic, and demographic research on educational gradients in mortality that has almost exclusively relied on ideas of human capital accumulation and measures of degree attainment. Our findings also call on social and education researchers to engage together in research on the life-long consequences of educational processes, school structures, and inequalities in opportunities to learn.
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Affiliation(s)
- John Robert Warren
- Department of Sociology ~ Minnesota Population Center, University of Minnesota
| | - Chandra Muller
- Department of Sociology ~ Population Research Center, University of Texas
| | - Robert A Hummer
- Department of Sociology ~ Carolina Population Center, University of North Carolina
| | - Eric Grodsky
- Department of Sociology ~ Center for Demography and Ecology, University of Wisconsin
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108
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Rehder K, Lusk J, Chen JI. Deaths of Despair: Conceptual and Clinical Implications. COGNITIVE AND BEHAVIORAL PRACTICE 2019; 28:40-52. [PMID: 34168422 DOI: 10.1016/j.cbpra.2019.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Since the late 1990s, mortality rates for middle-aged (45-55), White non-Hispanic (WNH) Americans began to rise while rates declined for all other demographic and age groups. Coinciding with the rise in mortality, rates of death due to suicide, drug- and alcohol-related overdoses, and alcohol-related liver diseases increased as well for this demographic. Research suggests these causes of death (i.e., suicide, poisoning, alcohol-related liver disease) are driving the overall mortality rate for middle-aged WNHs and have been described as "deaths of despair" in the literature. In the current paper, we describe the social and clinical features of "deaths of despair," explore theoretical models of psychopathology (e.g., depression, posttraumatic stress disorder) that may inform our understanding of mechanisms of risk for negative mental health outcomes, and propose an initial conceptual model of "deaths of despair" to identify intervention targets. We then review an applied case example demonstrating how this model could be used for clinical application. We conclude our paper by describing how current cognitive-behavioral interventions may address these mechanisms of "despair."
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Affiliation(s)
- Kristoffer Rehder
- Pacific University, Salem Vet Center Information, HSR&D Center to Improve Veteran Involvement in Care and Oregon Health & Science University
| | - Jaimie Lusk
- Pacific University, Salem Vet Center Information, HSR&D Center to Improve Veteran Involvement in Care and Oregon Health & Science University
| | - Jason I Chen
- Pacific University, Salem Vet Center Information, HSR&D Center to Improve Veteran Involvement in Care and Oregon Health & Science University
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109
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Roth AR, Denney JT, Amiri S, Amram O. Characteristics of place and the rural disadvantage in deaths from highly preventable causes. Soc Sci Med 2019; 245:112689. [PMID: 31783226 DOI: 10.1016/j.socscimed.2019.112689] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 11/18/2022]
Abstract
Extensive research has documented higher mortality in rural parts of the United States compared to urban areas. Much of this work focuses on aggregate rates, documenting a rural mortality penalty that has been increasing over the last three decades. Advances in place-based analyses suggest the importance of community resources for individual mortality but have largely focused on urban spaces. We advance knowledge on rural-urban mortality disparities by focusing on differences for highly preventable causes of death. Using unique geocoded mortality records from Washington state, we match individual-level attributes with area-level measures of socioeconomic conditions to examine whether characteristics of place elucidate the rural mortality penalty. We find that rural decedents have greater odds of dying from highly preventable causes compared to their urban counterparts. Place-based socioeconomic measures, meanwhile, independently associate with the odds of dying from highly preventable causes. However, we find no evidence that the relationship between socioeconomic conditions and highly preventable death varies across geographic contexts.
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Affiliation(s)
- Adam R Roth
- Department of Sociology, Washington State University, Pullman, WA, 99164, USA.
| | - Justin T Denney
- Department of Sociology, Washington State University, Pullman, WA, 99164, USA
| | - Solmaz Amiri
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, 99210, USA
| | - Ofer Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, 99210, USA; Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, 99164, USA
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110
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A "Swiss paradox" in the United States? Level of spatial aggregation changes the association between income inequality and morbidity for older Americans. Int J Health Geogr 2019; 18:28. [PMID: 31775750 PMCID: PMC6880635 DOI: 10.1186/s12942-019-0192-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/19/2019] [Indexed: 12/29/2022] Open
Abstract
Although a preponderance of research indicates that increased income inequality negatively impacts population health, several international studies found that a greater income inequality was associated with better population health when measured on a fine geographic level of aggregation. This finding is known as a “Swiss paradox”. To date, no studies have examined variability in the associations between income inequality and health outcomes by spatial aggregation level in the US. Therefore, this study examined associations between income inequality (Gini index, GI) and population health by geographic level using a large, nationally representative dataset of older adults. We geographically linked respondents’ county data from the 2012 Behavioral Risk Factor Surveillance System to 2012 American Community Survey data. Using generalized linear models, we estimated the association between GI decile on the state and county levels and five population health outcomes (diabetes, obesity, smoking, sedentary lifestyle and self-rated health), accounting for confounders and complex sampling. Although state-level GI was not significantly associated with obesity rates (b = − 0.245, 95% CI − 0.497, 0.008), there was a significant, negative association between county-level GI and obesity rates (b = − 0.416, 95% CI − 0.629, − 0.202). State-level GI also associated with an increased diabetes rate (b = 0.304, 95% CI 0.063, 0.546), but the association was not significant for county-level GI and diabetes rate (b = − 0.101, 95% CI − 0.305, 0.104). Associations between both county-level GI and state-level GI and current smoking status were also not significant. These findings show the associations between income inequality and health vary by spatial aggregation level and challenge the preponderance of evidence suggesting that income inequality is consistently associated with worse health. Further research is needed to understand the nuances behind these observed associations to design informed policies and programs designed to reduce socioeconomic health inequities among older adults.
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111
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Abstract
Importance US life expectancy has not kept pace with that of other wealthy countries and is now decreasing. Objective To examine vital statistics and review the history of changes in US life expectancy and increasing mortality rates; and to identify potential contributing factors, drawing insights from current literature and an analysis of state-level trends. Evidence Life expectancy data for 1959-2016 and cause-specific mortality rates for 1999-2017 were obtained from the US Mortality Database and CDC WONDER, respectively. The analysis focused on midlife deaths (ages 25-64 years), stratified by sex, race/ethnicity, socioeconomic status, and geography (including the 50 states). Published research from January 1990 through August 2019 that examined relevant mortality trends and potential contributory factors was examined. Findings Between 1959 and 2016, US life expectancy increased from 69.9 years to 78.9 years but declined for 3 consecutive years after 2014. The recent decrease in US life expectancy culminated a period of increasing cause-specific mortality among adults aged 25 to 64 years that began in the 1990s, ultimately producing an increase in all-cause mortality that began in 2010. During 2010-2017, midlife all-cause mortality rates increased from 328.5 deaths/100 000 to 348.2 deaths/100 000. By 2014, midlife mortality was increasing across all racial groups, caused by drug overdoses, alcohol abuse, suicides, and a diverse list of organ system diseases. The largest relative increases in midlife mortality rates occurred in New England (New Hampshire, 23.3%; Maine, 20.7%; Vermont, 19.9%) and the Ohio Valley (West Virginia, 23.0%; Ohio, 21.6%; Indiana, 14.8%; Kentucky, 14.7%). The increase in midlife mortality during 2010-2017 was associated with an estimated 33 307 excess US deaths, 32.8% of which occurred in 4 Ohio Valley states. Conclusions and Relevance US life expectancy increased for most of the past 60 years, but the rate of increase slowed over time and life expectancy decreased after 2014. A major contributor has been an increase in mortality from specific causes (eg, drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups, with an onset as early as the 1990s and with the largest relative increases occurring in the Ohio Valley and New England. The implications for public health and the economy are substantial, making it vital to understand the underlying causes.
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Affiliation(s)
- Steven H Woolf
- Center on Society and Health, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond
| | - Heidi Schoomaker
- Center on Society and Health, Virginia Commonwealth University School of Medicine, Richmond
- Now with Eastern Virginia Medical School, Norfolk
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112
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Child ST, Kaczynski AT, Walsemann KM, Fleischer N, McLain A, Moore S. Socioeconomic Differences in Access to Neighborhood and Network Social Capital and Associations With Body Mass Index Among Black Americans. Am J Health Promot 2019; 34:150-160. [PMID: 31665895 DOI: 10.1177/0890117119883583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To examine associations between socioeconomic status and two forms of social capital, namely, neighborhood and network measures, and how these distinct forms of capital are associated with body mass index (BMI) among Black residents of low-income communities. DESIGN Respondent-driven sampling was used to engage residents in a household survey to collect data on the respondents' personal network, perceptions about their neighborhood environment, and health. SETTING Eight special emphasis neighborhoods in Greenville, South Carolina. PARTICIPANTS N = 337 black/African American older adults, nearly half of whom have a household income of less than $15 000 and a high school education, were included. MEASURES Neighborhood capital was assessed via three scales on social cohesion, collective efficacy, and social support from neighbors. Network capital was calculated via a position generator, common in egocentric network surveys. Body mass index was calculated with self-reported height and weight. ANALYSIS Multilevel linear regression models were used to examine the association between neighborhood and network capital and obesity among respondents within sampling chains. RESULTS Higher household income was associated with greater neighborhood capital, whereas higher educational attainment was associated with greater network capital. Social cohesion was negatively associated with BMI (b = -1.25, 95% confidence interval [CI]: -2.39 to -0.11); network diversity was positively associated with BMI (b = 0.31, 95% CI: 0.08 to 0.55). CONCLUSION The findings shed light on how social capital may be patterned by socioeconomic status and, further, how distinct forms of capital may be differentially associated with health among black Americans.
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Affiliation(s)
- Stephanie T Child
- Berkeley Population Center, University of California, Berkeley, CA, USA
| | - Andrew T Kaczynski
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Katrina M Walsemann
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Nancy Fleischer
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Alexander McLain
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Spencer Moore
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
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113
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Wright J, Hayward A, West J, Pickett K, McEachan RM, Mon-Williams M, Christie N, Vaughan L, Sheringham J, Haklay M, Sheard L, Dickerson J, Barber S, Small N, Cookson R, Garnett P, Bywater T, Pleace N, Brunner EJ, Cameron C, Ucci M, Cummins S, Fancourt D, Kandt J, Longley P, Morris S, Ploubidis G, Savage R, Aldridge R, Hopewell D, Yang T, Mason D, Santorelli G, Romano R, Bryant M, Crosby L, Sheldon T. ActEarly: a City Collaboratory approach to early promotion of good health and wellbeing. Wellcome Open Res 2019; 4:156. [PMID: 31840089 PMCID: PMC6904987 DOI: 10.12688/wellcomeopenres.15443.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2019] [Indexed: 11/20/2022] Open
Abstract
Economic, physical, built, cultural, learning, social and service environments have a profound effect on lifelong health. However, policy thinking about health research is dominated by the ‘biomedical model’ which promotes medicalisation and an emphasis on diagnosis and treatment at the expense of prevention. Prevention research has tended to focus on ‘downstream’ interventions that rely on individual behaviour change, frequently increasing inequalities. Preventive strategies often focus on isolated leverage points and are scattered across different settings. This paper describes a major new prevention research programme that aims to create City Collaboratory testbeds to support the identification, implementation and evaluation of upstream interventions within a whole system city setting. Prevention of physical and mental ill-health will come from the cumulative effect of multiple system-wide interventions. Rather than scatter these interventions across many settings and evaluate single outcomes, we will test their collective impact across multiple outcomes with the goal of achieving a tipping point for better health. Our focus is on early life (ActEarly) in recognition of childhood and adolescence being such critical periods for influencing lifelong health and wellbeing.
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Affiliation(s)
- John Wright
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, UCL, London, WC1E 6BT, UK
| | - Jane West
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Kate Pickett
- Department of Health Sciences, University of York, UK, York, YO10 5DD, UK
| | | | | | - Nicola Christie
- Centre for Transport Studies, Department of Civil, Environmental and Geomatic Engineering, UCL, London, WC1E 6BT, UK
| | - Laura Vaughan
- Space Syntax Laboratory, Bartlett School of Architecture, UCL, London, WC1E 6BT, UK
| | - Jess Sheringham
- Institute of Epidemiology and Health Care, UCL, London, WC1E 6BT, UK
| | - Muki Haklay
- Extreme Citizen Science Group, Department of Geography, UCL, London, WC1E 6BT, UK
| | - Laura Sheard
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Josie Dickerson
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Sally Barber
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Neil Small
- University of Bradford, Bradford, BD7 1DP, UK
| | - Richard Cookson
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Philip Garnett
- York Cross-disciplinary Centre for Systems Analysis and School of Management, University of York, York, YO10 5GD, UK
| | - Tracey Bywater
- Department of Health Sciences, University of York, UK, York, YO10 5DD, UK
| | - Nicholas Pleace
- Centre for Housing Policy, University of York, UK, York, YO10 5DD, UK
| | - Eric J Brunner
- Institute of Epidemiology and Health Care, UCL, London, WC1E 6BT, UK
| | - Claire Cameron
- Department of Social Science, UCL Institute of Education, UCL, London, WC1H 0AA, UK
| | - Marcella Ucci
- UCL Institute for Environmental Design and Engineering, The Bartlett Faculty of the Built Environment, UCL, London, WC1H 0NN, UK
| | - Steve Cummins
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Daisy Fancourt
- Institute of Epidemiology and Health Care, UCL, London, WC1E 6BT, UK
| | - Jens Kandt
- Space Syntax Laboratory, Bartlett School of Architecture, UCL, London, WC1E 6BT, UK
| | - Paul Longley
- Consumer Data Research Centre Department of Geography, UCL, London, WC1E 6BT, UK
| | - Steve Morris
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | | | | | | | | | - Tiffany Yang
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Dan Mason
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | | | - Richard Romano
- Institute for Transport Studies, University of Leeds, Leeds, LS2 9JT, UK
| | - Maria Bryant
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Liam Crosby
- Institute of Epidemiology and Health Care, UCL, London, WC1E 6BT, UK
| | - Trevor Sheldon
- Department of Health Sciences, University of York, UK, York, YO10 5DD, UK
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Carmel S. Health and Well-Being in Late Life: Gender Differences Worldwide. Front Med (Lausanne) 2019; 6:218. [PMID: 31649931 PMCID: PMC6795677 DOI: 10.3389/fmed.2019.00218] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/23/2019] [Indexed: 11/13/2022] Open
Abstract
Maintaining health and quality of life and decreasing the number of years lived with disabilities in old age are among the main challenges of aging societies worldwide. This paper aims to present current worldwide health-related gender inequalities throughout life, and especially in late life, as well as gender gaps in social and personal resources which affect health, functioning and well-being. This paper also addresses the question of whether gender gaps at younger ages tend to narrow in late life, due to the many biological and social changes that occur in old age. Based on international data regarding these gender gaps and the trends of change in personal resources and health-related lifestyles in the more and less developed nations, conclusions regarding future changes in gender gaps are presented, along with practical implications for future improvements in women's health and well-being.
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Affiliation(s)
- Sara Carmel
- Department of Public Health, Faculty of Health Sciences, Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Beer Sheva, Israel
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115
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The Uniqueness and Importance of Children in Addressing Health Disparities Across the Life Course: Implications for Research. Epidemiology 2019; 30 Suppl 2:S60-S64. [PMID: 31569154 DOI: 10.1097/ede.0000000000001069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Division of Intramural Population Health Research celebrates its 50th Anniversary, it is appropriate to recognize great achievements in reducing child morbidity and mortality and increasing life expectancy. Unfortunately large racial/ethnic and socioeconomic health and healthcare disparities persist. This commentary suggests a framework to clarify the research and interventions needed to eliminate health disparities starting early in the life course.
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116
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Polyakova M, Hua LM. Local Area Variation in Morbidity Among Low-Income, Older Adults in the United States: A Cross-sectional Study. Ann Intern Med 2019; 171:464-473. [PMID: 31499522 PMCID: PMC7062581 DOI: 10.7326/m18-2800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Recent studies have reported that low-income adults living in more affluent areas of the United States have longer life expectancies. Less is known about the relationship between the affluence of a geographic area and morbidity of the low-income population. Objective To evaluate the association between the prevalence of chronic conditions among low-income, older adults and the economic affluence of a local area. Design Cross-sectional association study. Setting Medicare in 2015. Participants 6 363 097 Medicare beneficiaries aged 66 to 100 years with a history of low-income support under Medicare Part D. Measurements Adjusted prevalence of 48 chronic conditions was computed for 736 commuting zones (CZs). Factor analysis was used to assess spatial covariation of condition prevalence and to construct a composite condition prevalence index for each CZ. The association between morbidity and area affluence was measured by comparing the average of condition prevalence index across deciles of median CZ house values. Results The mean age of study participants was 77.7 years (SD, 8.2); 67% were women, and 61% were white. The crude prevalence of 48 chronic conditions ranged from 72.5 per 100 for hypertension to 0.6 per 100 for posttraumatic stress disorder. The prevalence of these 48 chronic conditions was highly spatially correlated. Composite condition prevalence was on average substantially lower in more affluent CZs. Limitation Low-income status measured on the basis of receipt of Medicare Part D low-income subsidies and not capturing persons not enrolled in Medicare Part D. Conclusion Low-income, older adults living in more affluent areas of the country are healthier, and areas with poor health in the low-income, older adult population tend to have a high prevalence of most chronic conditions. Primary Funding Source National Institute on Aging.
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Affiliation(s)
- Maria Polyakova
- Maria Polyakova is an assistant professor of health research and policy at Stanford University School of Medicine, Stanford, CA and a faculty research fellow at the National Bureau of Economic Research, Cambridge, MA
| | - Lynn M. Hua
- Lynn M. Hua is a doctoral student in the Department of Health Care Management at the University of Pennsylvania, Philadelphia, PA
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117
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Differences in Patient Experience Between Hispanic and Non-Hispanic White Patients Across U.S. Hospitals. J Healthc Qual 2019; 40:292-300. [PMID: 29252871 DOI: 10.1097/jhq.0000000000000113] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Despite the increased emphasis on patient experience, little is known about whether there are meaningful differences in hospital satisfaction between Hispanic and non-Hispanic whites. METHODS To determine if satisfaction differs, we used Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data (2009-2010) reported by hospitals to compare responses between Hispanic and non-Hispanic white patients. Clustered logistic regression models identified within-hospital and between-hospital differences in satisfaction. RESULTS Of the 3,864,938 respondents, 6.2% were Hispanics, who were more often younger and females and less likely to have graduated from high school. Hispanics were overall more likely to recommend their hospital (74.1% vs. 70.9%, p < .001) and to rate it 9 or 10 (72.5% vs. 65.9%, p < .001) than whites. Increased satisfaction among Hispanics was more pronounced when compared with whites within the same hospitals, with significantly higher ratings on all HCAHPS measures. However, hospitals serving a higher percentage of Hispanics had lower satisfaction scores for both Hispanic and white patients than other hospitals. CONCLUSION There were significant but only modest-sized differences in patient experience between Hispanic and white patients across U.S. hospitals. Hispanics tended to be more satisfied with their care but received care at lower-performing hospitals.
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118
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A matter of life and longer life. J Aging Stud 2019; 50:100800. [PMID: 31526498 DOI: 10.1016/j.jaging.2019.100800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/03/2019] [Accepted: 07/06/2019] [Indexed: 10/26/2022]
Abstract
While the major scientific discoveries that would extend the length and health of human lives are not yet here, the research that could create them is already underway. As prospects for a world in which extended and improved lives inches closer into reality, the discourse about what to consider as we move forward grows richer, with corporate executives, ideologues, scientists, theologians, ethicists, investigative journalists, and philosophers taking part in imagining and anticipating the rich array of humanity's possible futures. Drawing from in-depth interviews with key stakeholders (n = 22), we offer empirical insights into key values and beliefs animating the "longevity movement," including what constitutes an ideal human state, the imperative to intervene, and the role of individual liberty and concerns for equality. Emerging from these interviews are common concerns about reducing suffering, preserving diversity in visions of successful aging and how best to promote access to a future that may not remain hypothetical for long.
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119
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Spencer JC, Gertner AK, Silberman PJ. Health Status and Access to Care for the North Carolina Medicaid Gap Population. N C Med J 2019; 80:269-275. [PMID: 31471506 PMCID: PMC6744939 DOI: 10.18043/ncm.80.5.269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND North Carolina remains one of several states that has not expanded Medicaid eligibility criteria to cover all low-income adults, leading to the so-called Medicaid gap, a population ineligible for Medicaid and too poor for premium subsidies through the federal Health Insurance Marketplace. Our objective was to characterize the health care access and health status of the Medicaid gap population in North Carolina.METHODS We combined annual data from the Behavioral Risk Factor Surveillance Survey (2013-2016). Respondents who were uninsured and earning below 100% of the federal poverty guidelines (FPG) were classified as falling within the Medicaid gap and were compared to insured populations below FPG, representing the traditional Medicaid population, and to individuals above the FPG, regardless of insurance status. We reported health care access, receipt of preventive care, and current health status in unadjusted and demographically adjusted models.RESULTS Compared to either traditional Medicaid or above FPG groups, those in the Medicaid gap were 3 times as likely to have no regular source of care and twice as likely to report delaying needed care due to cost. Individuals in the Medicaid gap were more likely than individuals above FPG to report multiple chronic conditions (22% versus 16%) or a functional disability (35% versus 15%), but less likely than the traditional Medicaid population to do so.CONCLUSION While less likely than the traditional Medicaid population to have complex health needs, we found that individuals in the North Carolina Medicaid gap report numerous health care access barriers and lower use of preventive care.
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Affiliation(s)
- Jennifer C Spencer
- affiliate, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alex K Gertner
- MD/PhD candidate, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Pam J Silberman
- professor and director, Executive Doctoral Program in Health Leadership Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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120
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Gutin I. Essential(ist) medicine: promoting social explanations for racial variation in biomedical research. MEDICAL HUMANITIES 2019; 45:224-234. [PMID: 29941665 DOI: 10.1136/medhum-2017-011432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 06/08/2023]
Abstract
Biomedical research has a long and complicated history as a tool of oppression, exemplary of the racial science used to legitimise and maintain racial hierarchies in the USA and abroad. While the explicit racism and racial inferiority supported by this research has dissipated and modern methods of inquiry have increased in sophistication and rigor, contemporary biomedical research continues to essentialise race by distilling racial differences and disparities in health to an underlying, biogenetic source. Focusing on the persistence of essentialism in an era of genomic medicine, this paper examines the deep social origins and social implications of the essentialist viewpoint in biomedicine and how it relates to the broader construction of social and scientific knowledge. Invoking Hacking's 'looping effects' as a useful conceptual tool, I then demonstrate how sociohistorical forces influence scientific and medical research in producing evidence that favours and legitimises a biological construction of race. I extend the looping framework to consider a parallel 'louping' process whereby applying a socially rooted meaning to race in biomedical research results becomes magnified to influence social norms and ideas about race. As many biomedical researchers are motivated by a desire to eliminate racial disparities in outcomes, I argue that greater social acuity allows scientists to avoid individualising and racialising health, challenge preconceived assumptions about the meaning of racial variation in health and medicine and thus promote and strengthen a socioenvironmental focus on how to best improve individuals' and population health. Concluding with a call for structural competency in biomedical research, I suggest that empowering scientists to more freely discuss sociostructural factors in their work allows for the continued use of race in biological and medical research, while social scientists and medical humanities scholars stand to benefit from seeing their work imbued with the cultural authority currently granted to biomedicine.
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Affiliation(s)
- Iliya Gutin
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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121
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Sasson I, Hayward MD. Association Between Educational Attainment and Causes of Death Among White and Black US Adults, 2010-2017. JAMA 2019; 322:756-763. [PMID: 31454044 PMCID: PMC6714034 DOI: 10.1001/jama.2019.11330] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE There are substantial and increasing educational differences in US adult life expectancy. To reduce social inequalities in mortality, it is important to understand how specific causes of death have contributed to increasing educational differences in adult life expectancy in recent years. OBJECTIVE To estimate the relationship of specific causes of death with increasing educational differences in adult life expectancy from 2010 to 2017. DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional study of 4 690 729 deaths recorded in the US National Vital Statistics System in 2010 and 2017. EXPOSURES Sex, race/ethnicity, and educational attainment. MAIN OUTCOMES AND MEASURES Life expectancy at age 25 years and years of life lost between ages 25 and 84 years by cause of death. RESULTS The analysis included a total of 2 211 633 deaths in 2010 and 2 479 096 deaths in 2017. Between 2010 and 2017, life expectancy at age 25 significantly declined among white and black non-Hispanic US residents from an expected age at death of 79.34 to 79.15 years (difference, -0.18 [95% CI, -0.23 to -0.14]). Greater decreases were observed among persons with a high school degree or less (white men: -1.05 years [95% CI, -1.15 to -0.94], white women: -1.14 years [95% CI, -1.24 to -1.04], and black men: -0.30 years [95% CI, -0.56 to -0.04]). White adults with some college education but no 4-year college degree experienced similar declines in life expectancy (men: -0.89 years [95% CI, -1.07 to -0.73], women: -0.59 years [95% CI, -0.77 to -0.42]). In contrast, life expectancy at age 25 significantly increased among the college-educated (white men: 0.58 years [95% CI, 0.42 to 0.73], white women: 0.78 years [95% CI, 0.57 to 1.00], and black women: 1.70 years [95% CI, 0.91 to 2.53]). The difference between high- and low-education groups increased from 2010 to 2017, largely because life-years lost to drug use increased among those with a high school degree or less (white men: 0.93 years [95% CI, 0.90 to 0.96], white women: 0.50 years [95% CI, 0.47 to 0.52], black men: 0.75 years [95% CI, 0.71 to 0.79], and black women: 0.28 years [95% CI, 0.25 to 0.31]). CONCLUSIONS AND RELEVANCE In this serial cross-sectional study, estimated life expectancy at age 25 years declined overall between 2010 and 2017; however, it declined among persons without a 4-year college degree and increased among college-educated persons. Much of the increasing educational differences in years of life lost may be related to deaths attributed to drug use.
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Affiliation(s)
- Isaac Sasson
- Department of Sociology and Anthropology and the Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel
| | - Mark D. Hayward
- Department of Sociology and Population Research Center, University of Texas at Austin
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122
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Roberts MT, Reither EN, Lim S. Contributors to Wisconsin's persistent black-white gap in life expectancy. BMC Public Health 2019; 19:891. [PMID: 31277617 PMCID: PMC6612087 DOI: 10.1186/s12889-019-7145-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 06/10/2019] [Indexed: 11/20/2022] Open
Abstract
Background Although the black-white gap in life expectancy has narrowed in the U.S., there is considerable variability across states. In Wisconsin, the black-white gap exceeds 6 years, well above the national average. Reducing this disparity is an urgent public health priority, but there is limited understanding of what contributes to Wisconsin’s racial gap in longevity. Our investigation identifies causes of death that contribute most to Wisconsin’s black-white gap in life expectancy among males and females, and highlights specific ages where each cause of death contributes most to the gap. Methods Our study employs 1999–2016 restricted-use mortality data provided by the National Center for Health Statistics. After generating race- and sex-specific life tables for each 3-year period of observation (e.g., 1999–2001), we trace recent trends in the black-white life expectancy gap in Wisconsin. We subsequently conduct a series of analyses to decompose the black-white gap in three time periods into 13 separate causes and 19 different age groups. Results In 2014–16, Wisconsin’s black-white gap in life expectancy was 7.34 years for males (67% larger than the national gap), and 5.61 years for females (115% larger than the national gap). Among males, homicide was the single largest contributor, accounting for 1.56 years of the total gap. Heart disease and cancer followed, contributing 1.43 and 1.42 years, respectively. Among females, heart disease and cancer were the two leading contributors to the gap, accounting for 1.12 and 1.00 years, respectively. Whereas homicide contributed most to the racial gap in male longevity during late adolescence and early adulthood, heart disease and cancer exerted most of their influence between ages 50–70 for both males and females. Other notable contributors were unintentional injuries (males), diabetes and cerebrovascular disease (females), and perinatal conditions (males and females). Conclusions Our study identifies targets for future policy interventions that could substantially reduce Wisconsin’s racial gap in life expectancy. Concerted efforts to eliminate racial disparities in perinatal mortality and homicide early in the life course, and chronic conditions such as cancer and heart disease in later life, promise to help Wisconsin achieve the public health objective of racial parity in longevity. Electronic supplementary material The online version of this article (10.1186/s12889-019-7145-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Max T Roberts
- Utah State University, 0730 Old Main Hill, Logan, UT, 84322, USA.
| | - Eric N Reither
- Utah State University, 0730 Old Main Hill, Logan, UT, 84322, USA
| | - Sojung Lim
- Utah State University, 0730 Old Main Hill, Logan, UT, 84322, USA
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123
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Abstract
Objectives: We evaluate the extent to which subjective and objective measures of economic distress account for differences in substance abuse between the mid-1990s and early-2010s. Methods: We use cross-sectional survey data for national samples of Americans aged 25-74 in 1995-96 (N = 3034) and 2011-14 (N = 2598). Using a logit model, we regress dichotomous indicators of drug and alcohol abuse on economic distress. Results: After adjusting for sociodemographic characteristics, the odds of drug abuse in the early-2010s among older individuals (aged 50+) were 2.9 times (95%CI 1.9-4.2) those of the mid-1990s, but there was no statistically significant period difference in drug abuse among younger individuals. Measures of model performance demonstrate that subjective measures of economic distress are better predictors of drug abuse than objective measures. The subjective measures also account for a larger share (26%) of the increase in drug abuse at ages 50+ than the objective measures (6%). We cannot draw clear conclusions regarding alcohol abuse because results are sensitive to specification. Conclusions: The rise in drug abuse among midlife Americans may relate to perceived economic distress that is not captured by standard economic measures.
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Affiliation(s)
- Dana A Glei
- Senior Research Investigator, Georgetown University, Center for Population and Health, Washington, DC;,
| | - Maxine Weinstein
- Distinguished Professor, Georgetown University, Center for Population and Health, Washington, DC
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124
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Havranek EP. Epidemiology of heart disease: The influence of socioeconomic position. Trends Cardiovasc Med 2019; 29:298-303. [DOI: 10.1016/j.tcm.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 08/31/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
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125
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Thomas MD, Michaels EK, Reeves AN, Okoye U, Price MM, Hasson RE, Chae DH, Allen AM. Differential associations between everyday versus institution-specific racial discrimination, self-reported health, and allostatic load among black women: implications for clinical assessment and epidemiologic studies. Ann Epidemiol 2019; 35:20-28.e3. [PMID: 31235363 PMCID: PMC7179332 DOI: 10.1016/j.annepidem.2019.05.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 04/06/2019] [Accepted: 05/08/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE Black women have the highest estimated allostatic load (AL). AL and self-perceived health are strong health predictors and have been linked to racial discrimination. Research suggests that everyday and institution-specific racial discrimination may predict different AL and self-reported health (SRH) outcomes. Furthermore, discrepancies between AL and self-perceived health could widen disparities. We estimated associations between everyday versus institution-specific racial discrimination with AL and SRH. METHODS Data are from a San Francisco Bay Area community sample of 208 black women aged 30-50 years. Participation involved a questionnaire, self-interview, blood draw, and anthropometric measurements. Adjusted generalized linear regression models estimated associations of racial discrimination with AL and SRH. RESULTS After adjusting for age, socioeconomic position, and medication use, institution-specific discrimination was negatively associated with AL (i.e., better health), whereas everyday experiences showed no association. Those reporting very-high (vs. moderate) institution-specific discrimination had lower AL (β = -1.31 [95% CI: -2.41, -0.20]; AL range: 0-15). No racial discrimination-SRH association was found. CONCLUSIONS For black women, (1) institution-specific racial discrimination may be differentially embodied compared with everyday experiences and (2) institutional racism may contribute to physiologic stress-regulation regardless of self-perceived health status. Potential factors that may contribute to an inverse racial discrimination-AL association, and future research, are discussed.
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Affiliation(s)
- Marilyn D Thomas
- Division of Epidemiology, School of Public Health, University of California, Berkeley.
| | - Elizabeth K Michaels
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Alexis N Reeves
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Uche Okoye
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Melisa M Price
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Rebecca E Hasson
- Schools of Kinesiology and Public Health, University of Michigan, Ann Arbor
| | - David H Chae
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, Auburn, AL
| | - Amani M Allen
- Division of Epidemiology, School of Public Health, University of California, Berkeley
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126
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Beltrán-Sánchez H, Subramanian SV. Period and cohort-specific trends in life expectancy at different ages: Analysis of survival in high-income countries. SSM Popul Health 2019; 8:100422. [PMID: 31245527 PMCID: PMC6582062 DOI: 10.1016/j.ssmph.2019.100422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/30/2019] [Accepted: 06/01/2019] [Indexed: 11/26/2022] Open
Abstract
The number of older adults is increasing in high-income countries as survival chances continue to improve. We investigate changes in survival at older ages in high-income countries and show that although survival chances have improved, these improvements are concentrated at the top of the survival distribution where there is a small share of the population. Among females who survive to age 85 in the most recently birth cohort (1925), for example, about half die within 8 years while those in the top 25% of the survival distribution live at least 50% longer (12 years or more). Importantly, these results indicate that having some individuals reach exceptionally old age does not imply that the majority of the population is living longer. In addition, estimates of lifespan inequality at older ages suggests that years of life lost because of death have increased in recent times and among recently born cohorts leading to an increase uncertainty in the age at death at older ages. Thus, slow survival improvements at ages 65+ suggest that most of the population is unlikely to reach long life expectancies in the near future, which may lead to lower than expected fraction of adults reaching older ages. There has been an increasing number of older adults in high-income countries as survival chances continue to improve. We document large survival inequalities over time and across birth cohorts particularly at older ages. The age at death in the top 10% of the distribution increased faster than in the bottom 25% over time and across cohorts. Slow survival improvements at older ages suggest most people are not reaching life expectancy of 100 years in the near future. Survival inequalities highlight persistent disparities by socioeconomic status and health behaviors across the life course.
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Affiliation(s)
- Hiram Beltrán-Sánchez
- Department of Community Health Sciences at the Fielding School of Public Health and California Center for Population Research, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - S V Subramanian
- Professor of Population Health and Geography, Department of Social and Behavioral Sciences at the T.H. Chan School of Public Health and the Harvard Center for Population and Development Studies, Harvard University, Boston, MA, USA
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127
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Fan W, Qian Y. Rising educational gradients in mortality among U.S. whites: What are the roles of marital status and educational homogamy? Soc Sci Med 2019; 235:112365. [PMID: 31229359 DOI: 10.1016/j.socscimed.2019.112365] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/11/2019] [Accepted: 06/11/2019] [Indexed: 12/16/2022]
Abstract
The educational gradient in U.S. mortality has been rising among non-Hispanic whites. A common intuition sees the growing educational divide in marital status and increases in educational homogamy as potential explanations. To empirically assess this possibility, we analyze mortality from 1986 to 2015 using the National Health Interview Survey Linked Mortality Files (562,584 persons; 204,756 deaths). At the individual level, being unmarried and spouse's lower educational attainment are associated with higher mortality. Counterfactual analyses, however, reveal that the growing educational divide in marital status and increases in educational homogamy contribute little (8%-15%) to the widening educational gradient in mortality. Our simulation analyses further show that extreme educational divide in marital status could substantially drive up mortality inequality, whereas educational homogamy, even when pushed to the maximum level, would play a limited role in increasing mortality inequality. Combined, the results suggest that changes in the educational divide in marital status have the potential to affect mortality inequality, but the actual changes over the past decades were not strong enough to have a major impact; increases in education homogamy, in contrast, barely affect mortality inequality by education. Along with other research showing small effects of educational homogamy on income inequality, our research suggests that the consequences of changing marriage patterns for social inequalities in general and health inequalities in particular may be more limited than commonly assumed.
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Affiliation(s)
- Wen Fan
- Department of Sociology, Boston College, United States.
| | - Yue Qian
- Department of Sociology, University of British Columbia, Canada
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128
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Geronimus AT, Bound J, Waidmann TA, Rodriguez JM, Timpe B. Weathering, Drugs, and Whack-a-Mole: Fundamental and Proximate Causes of Widening Educational Inequity in U.S. Life Expectancy by Sex and Race, 1990-2015. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2019; 60:222-239. [PMID: 31190569 PMCID: PMC6684959 DOI: 10.1177/0022146519849932] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Discussion of growing inequity in U.S. life expectancy increasingly focuses on the popularized narrative that it is driven by a surge of "deaths of despair." Does this narrative fit the empirical evidence? Using census and Vital Statistics data, we apply life-table methods to calculate cause-specific years of life lost between ages 25 and 84 by sex and educational rank for non-Hispanic blacks and whites in 1990 and 2015. Drug overdoses do contribute importantly to widening inequity for whites, especially men, but trivially for blacks. The contribution of suicide to growing inequity is unremarkable. Cardiovascular disease, non-lung cancers, and other internal causes are key to explaining growing life expectancy inequity. Results underline the speculative nature of attempts to attribute trends in life-expectancy inequity to an epidemic of despair. They call for continued investigation of the possible weathering effects of tenacious high-effort coping with chronic stressors on the health of marginalized populations.
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Affiliation(s)
| | - John Bound
- 1 University of Michigan, Ann Arbor, MI, USA
- 2 National Bureau of Economic Research, Cambridge, MA, USA
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129
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Abstract
This review focuses on the widening disparities in death rates by socioeconomic class. In recent years, there has been a major increase in the availability of data linking mortality risk and measures of socioeconomic status. The result has been a virtual explosion of new empirical research showing not only the existence of large inequities in the risk of death between those at the top and those at the bottom of the socioeconomic distribution, but also that the gaps have been growing. This assessment of the empirical research finds a consistent pattern of growing disparities within the United States. However, this widening gap in death rates does appear to be a uniquely American phenomenon, as the disparities by socioeconomic class appear to be stable or even declining in Europe and Canada.
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Affiliation(s)
- Barry Bosworth
- Economics Studies Program, The Brookings Institution, Washington, DC 20036, USA;
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130
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Barcelos Winchester S. Social Determinants of Health Assessment Tool: Implications for Healthcare Practice. SOCIAL WORK IN PUBLIC HEALTH 2019; 34:395-408. [PMID: 31088227 DOI: 10.1080/19371918.2019.1614507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Underserved populations are at risk for chronic health conditions due to social determinants. There is a gap in instrument availability in identifying individuals at risk of, or experiencing, cumulative social, environmental, economic, and cultural factors impacting health. The Social Determinants of Health Assessment Tool is a brief, cost-effective semistructured interview allowing healthcare professionals to engage in appropriate service prioritization. Phase I of this instrument development reported adequate face validity by Delphi panel consensus with experts in social work, nursing, public health, and psychology. This instrument identifies individuals at risk of social determinants to improve healthcare and social service delivery.
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131
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Stewart KA, Ristvedt S, Brown KM, Waters EA, Trinkaus K, McCray N, James AS. Giving Voice to Black Men: Guidance for Increasing the Likelihood of Having a Usual Source of Care. Am J Mens Health 2019; 13:1557988319856738. [PMID: 31170862 PMCID: PMC6557027 DOI: 10.1177/1557988319856738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Black men suffer inequalities in health and health-care outcomes relative to other racial/ethnic groups, requiring well-informed efforts for health promotion. Fewer Black men have a usual source of health care, which may be a contributor to these disparities. Increasing access to and the likelihood of a usual source of care among Black men are important to address health and health-care disparities. In this focus group study, we sought to better understand how Black men think about primary care and usual sources of care. A total of six focus groups were conducted with N = 25 men. Groups were a mix of men with and without a usual source of care. Several themes were identified through analysis of the data regarding factors that contribute to Black men going to the doctor. Themes identified in the data analysis included Lack of Health Insurance as a Barrier to Establishing Usual Source of Care; Family Promoting Health Care Use; Relationship With Doctor, Trust, and Empowerment; Age and Maturity in Health Promotion; and Positive Tone of Messaging. Future research should explore if similar findings are obtained among men in different regions of the United States or between Black men of different backgrounds. Taking a step beyond this research, specifically, future research can also examine the impact of particular health messages/messaging on Black men's health-care-seeking behaviors.
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Affiliation(s)
- Karyn A Stewart
- 1 Department of Sociology, DePaul University, Chicago, IL, USA
| | - Stephen Ristvedt
- 2 Department of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Katherine M Brown
- 3 Division of Public Health Sciences, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Erika A Waters
- 3 Division of Public Health Sciences, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Kathryn Trinkaus
- 4 Biostatistics Shared Resource, Siteman Cancer Center, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Natasan McCray
- 3 Division of Public Health Sciences, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Aimee S James
- 3 Division of Public Health Sciences, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
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132
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Abrams LR, Mehta NK. Changes in depressive symptoms over age among older Americans: Differences by gender, race/ethnicity, education, and birth cohort. SSM Popul Health 2019; 7:100399. [PMID: 31024986 PMCID: PMC6476127 DOI: 10.1016/j.ssmph.2019.100399] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/25/2019] [Accepted: 04/07/2019] [Indexed: 01/17/2023] Open
Abstract
Despite concerns about recent trends in the health and functioning of older Americans, little is known about dynamics of depression among recent cohorts of U.S. older adults and how these dynamics differ across sociodemographic groups. This study examined sociodemographic differences in mid- and late-life depressive symptoms over age, as well as changes over time. Using nationally representative data from the Health and Retirement Study (1994–2014), we estimated mixed effects models to generate depressive symptoms over age by gender, race/ethnicity, education, and birth cohort in 33,280 adults ages 51–90 years. Depressive symptoms were measured using the 8-item Center for Epidemiological Studies Depression scale. Women compared to men, low compared to high education groups, and racial/ethnic minorities compared to whites exhibited higher depressive symptoms. The largest disparity resulted from education, with those without high school degrees exhibiting over two more predicted depressive symptoms in midlife compared to those with college degrees. Importantly, war babies and baby boomers (born 1942–1959) exhibited slightly higher depressive symptoms with more decreasing symptoms over age than their predecessors (born 1931–1941) at ages 51–65. We additionally observed an age-as-leveler pattern by gender, whereby females compared to males had higher depressive symptomology from ages 51–85, but not at ages 86–90. Our findings have implication for gauging the aging population's overall well-being, for public health policies aimed at reducing health disparities, and for anticipating demand on an array of health and social services. Depressive symptoms in mid- and late-life are higher among socially disadvantaged groups. Education levels generated the largest sociodemographic disparity, especially in mid-life. Recent birth cohorts had higher symptoms with more declining curves than predecessors ages 51-65. Trajectories of depressive symptoms in sociodemographic subgroups converged at higher ages. Depressed mood and somatic complaints both rose in late life but men reported lower depressed mood.
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Affiliation(s)
- Leah R Abrams
- University of Michigan School of Public Health, Department of Health Management and Policy, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - Neil K Mehta
- University of Michigan School of Public Health, Department of Health Management and Policy, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
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133
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Montez JK, Zajacova A, Hayward MD, Woolf SH, Chapman D, Beckfield J. Educational Disparities in Adult Mortality Across U.S. States: How Do They Differ, and Have They Changed Since the Mid-1980s? Demography 2019; 56:621-644. [PMID: 30607779 PMCID: PMC6450761 DOI: 10.1007/s13524-018-0750-z] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Adult mortality varies greatly by educational attainment. Explanations have focused on actions and choices made by individuals, neglecting contextual factors such as economic and policy environments. This study takes an important step toward explaining educational disparities in U.S. adult mortality and their growth since the mid-1980s by examining them across U.S. states. We analyzed data on adults aged 45-89 in the 1985-2011 National Health Interview Survey Linked Mortality File (721,448 adults; 225,592 deaths). We compared educational disparities in mortality in the early twenty-first century (1999-2011) with those of the late twentieth century (1985-1998) for 36 large-sample states, accounting for demographic covariates and birth state. We found that disparities vary considerably by state: in the early twenty-first century, the greater risk of death associated with lacking a high school credential, compared with having completed at least one year of college, ranged from 40 % in Arizona to 104 % in Maryland. The size of the disparities varies across states primarily because mortality associated with low education varies. Between the two periods, higher-educated adult mortality declined to similar levels across most states, but lower-educated adult mortality decreased, increased, or changed little, depending on the state. Consequently, educational disparities in mortality grew over time in many, but not all, states, with growth most common in the South and Midwest. The findings provide new insights into the troubling trends and disparities in U.S. adult mortality.
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Affiliation(s)
- Jennifer Karas Montez
- Department of Sociology and Aging Studies Institute, Syracuse University, 314 Lyman Hall, Syracuse, NY, 13244, USA.
| | - Anna Zajacova
- Department of Sociology, Western University, London, Ontario, Canada
| | - Mark D Hayward
- Department of Sociology and Population Research Center, University of Texas at Austin, Austin, TX, USA
| | - Steven H Woolf
- Department of Family Medicine and Population Health and the Center on Society and Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Derek Chapman
- Department of Family Medicine and Population Health and the Center on Society and Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Jason Beckfield
- Department of Sociology, Harvard University, Cambridge, MA, USA
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134
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Sheehan CM. Education and Health Conditions among the Currently Incarcerated and the Non-Incarcerated Populations. POPULATION RESEARCH AND POLICY REVIEW 2019; 38:73-93. [PMID: 36860891 PMCID: PMC9974178 DOI: 10.1007/s11113-018-9496-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Previous research has found a strong link between educational attainment and health, where the highly educated live longer and healthier lives than those with lower levels of education. Because such research has relied on samples of the non-institutionalized population, previous research has not explored the association between education and specific chronic and infectious health conditions among the currently incarcerated. Analyzing the relationship between education and health conditions among the incarcerated, whom tend to be less healthy and for whom many of the intermediate mechanisms between education and health are held relatively constant in prison, may yield new insights. Using the 2002-2004 National Health Interview Study (N=74,881), the 2004 Survey of Inmates in State and Federal Correctional Facilities (N=17,553), and interaction terms from logistic regression models, I compared the strength of the association between educational attainment and the presence of chronic and infectious health conditions among the incarcerated and non-incarcerated populations. These models indicated generally stronger negative associations between educational attainment and chronic conditions among the non-incarcerated, while the negative relationship between education and hepatitis was stronger for the incarcerated. These results suggest that while education may play a lesser role for chronic conditions for the incarcerated, it can still important for avoiding risky health behaviors.
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Affiliation(s)
- Connor M Sheehan
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University
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135
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Theeke L, Carpenter RD, Mallow J, Theeke E. Gender differences in loneliness, anger, depression, self-management ability and biomarkers of chronic illness in chronically ill mid-life adults in Appalachia. Appl Nurs Res 2019; 45:55-62. [DOI: 10.1016/j.apnr.2018.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/04/2018] [Indexed: 12/20/2022]
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136
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Unique contribution of education to behavioral and psychosocial antecedents of health in a national sample of African Americans. J Behav Med 2019; 42:860-872. [PMID: 30607656 DOI: 10.1007/s10865-018-00009-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/22/2018] [Indexed: 01/01/2023]
Abstract
Education has demonstrated consistent links with many aspects of physical health and is theorized to relate to a variety of behavioral and psychosocial antecedents of health that may ultimately account for these associations. However, many of these associations and the extent to which they manifest specifically for African Americans have not been thoroughly tested. We examined associations of education-distinct from income-with established behavioral and psychosocial antecedents of health in a national sample of African Americans. Education favorably related to many behavioral (e.g., fruit/vegetable intake, lifetime smoking) and psychosocial (e.g., self-efficacy, personality traits, self-esteem, psychological well-being) antecedents of health, but not to all. Some evidence of stronger salutary relations of education for women was found. Results suggest that, for African Americans, education is generally favorably associated with an array of behavioral and psychosocial antecedents of physical health, partially explaining health disparities and providing a point of intervention moving forward.
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137
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138
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Bostwick WB, Hughes TL, Steffen A, Veldhuis CB, Wilsnack SC. Depression and Victimization in a Community Sample of Bisexual and Lesbian Women: An Intersectional Approach. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:131-141. [PMID: 29968037 PMCID: PMC6314920 DOI: 10.1007/s10508-018-1247-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 05/02/2018] [Accepted: 05/26/2018] [Indexed: 05/06/2023]
Abstract
Mental health inequities among bisexual and lesbian women are well-documented. Compared to heterosexual women, both bisexual and lesbian women are more likely to report lifetime depressive disorders, with bisexual women often faring the worst on mental health outcomes. Risk factors for depression, such as victimization in childhood and adulthood, are also more prevalent among bisexual women. Less is known about the intersection of racial/ethnic and sexual minority identities, and how depression and victimization may differ across these multiple, co-occurring identities. Data were from Wave 3 of the Chicago Health and Life Experiences of Women study, an 18-year, community-based longitudinal study of sexual minority women's health. We constructed a six-category "intersection" variable based on sexual identity and race/ethnicity to examine group differences in lifetime depression and victimization. We tested childhood and adult victimization as moderators of lifetime depression (n = 600). A majority (58.2%) of the total sample met criteria for lifetime depression. When considering the intersection of race/ethnicity and sexual identity, Black bisexual and Black lesbian women had significantly lower odds of depression than White lesbian women, despite their higher reports of victimization. Latina bisexual and lesbian women did not differ from White lesbians on depression. Victimization did not moderate the association between the intersection variable and depression. More research is needed to better understand risk and protective factors for depression among racially/ethnically diverse sexual minority women (SWM). We highlight the need to deliberately oversample SWM of color to accomplish this goal.
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Affiliation(s)
- Wendy B. Bostwick
- Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, IL 60612;
| | | | - Alana Steffen
- Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, IL 60612;
| | | | - Sharon C. Wilsnack
- Department of Psychiatry and Behavioral Science, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND
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139
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Tipirneni R, Ganguli I, Ayanian JZ, Langa KM. Reducing Disparities in Healthy Aging Through an Enhanced Medicare Annual Wellness Visit. THE PUBLIC POLICY AND AGING REPORT 2019; 29:26-32. [PMID: 31156322 PMCID: PMC6529776 DOI: 10.1093/ppar/pry048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Renuka Tipirneni
- Division of General Medicine, University of Michigan Medical School, Ann Arbor
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor
| | - Ishani Ganguli
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
| | - John Z Ayanian
- Division of General Medicine, University of Michigan Medical School, Ann Arbor
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
- Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor
| | - Kenneth M Langa
- Division of General Medicine, University of Michigan Medical School, Ann Arbor
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
- Institute for Social Research, University of Michigan, Ann Arbor
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
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140
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Glei DA, Goldman N, Weinstein M. Perception has its Own Reality: Subjective versus Objective Measures of Economic Distress. POPULATION AND DEVELOPMENT REVIEW 2018; 44:695-722. [PMID: 30828111 PMCID: PMC6395043 DOI: 10.1111/padr.12183] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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141
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Aşkın B, Wagner A, Tübek M, Rieger MA. [The role of migrant organizations in health care: An integrative review]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2018; 139:37-45. [PMID: 30477974 DOI: 10.1016/j.zefq.2018.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND QUESTION People with a migration background are exposed to greater health risks and burdens due to their often less favorable social situation. At the same time, conventional health services and programs do not sufficiently reach them. Migrant organizations (MOs) are said to have the potential to reach this otherwise difficult target group. This review examines whether there are any indications in the scientific literature that MOs could improve target group attainment. METHODS A broad-based systematic literature search was carried out in German and English databases with predefined search terms for the period from 2005 to 2015 (inclusive). RESULTS Out of 3,236 hits, 8 studies fulfilled the inclusion and exclusion criteria. These studies provide indications that MOs are effectively reaching and addressing the target group. Due to a lack of comparability of the MOs involved and different study populations, the interpretation of the results is difficult, though. CONCLUSION MOs, as protected social spaces in everyday life, provide an opportunity to offer healthcare services to organizationally affine people with a migration background. However, the research process (e.g., selection of MOs, field access, recruitment of participants) does not seem to be methodologically stringent. Above all, it is still unclear which principles are effective when MOs are integrated into health services. This is where future projects should be started.
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Affiliation(s)
- Basri Aşkın
- Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Deutschland.
| | - Anke Wagner
- Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Mesut Tübek
- Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Monika A Rieger
- Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Deutschland
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142
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Bennett JM, Reeves G, Billman GE, Sturmberg JP. Inflammation-Nature's Way to Efficiently Respond to All Types of Challenges: Implications for Understanding and Managing "the Epidemic" of Chronic Diseases. Front Med (Lausanne) 2018; 5:316. [PMID: 30538987 PMCID: PMC6277637 DOI: 10.3389/fmed.2018.00316] [Citation(s) in RCA: 211] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/23/2018] [Indexed: 01/06/2023] Open
Abstract
Siloed or singular system approach to disease management is common practice, developing out of traditional medical school education. Textbooks of medicine describe a huge number of discrete diseases, usually in a systematic fashion following headings like etiology, pathology, investigations, differential diagnoses, and management. This approach suggests that the body has a multitude of ways to respond to harmful incidences. However, physiology and systems biology provide evidence that there is a simple mechanism behind this phenotypical variability. Regardless if an injury or change was caused by trauma, infection, non-communicable disease, autoimmune disorders, or stress, the typical physiological response is: an increase in blood supply to the area, an increase in white cells into the affected tissue, an increase in phagocytic activity to remove the offending agent, followed by a down-regulation of these mechanisms resulting in healing. The cascade of inflammation is the body's unique mechanism to maintain its integrity in response to macroscopic as well as microscopic injuries. We hypothesize that chronic disease development and progression are linked to uncontrolled or dysfunctional inflammation to injuries regardless of their nature, physical, environmental, or psychological. Thus, we aim to reframe the prevailing approach of management of individual diseases into a more integrated systemic approach of treating the "person as a whole," enhancing the patient experience, ability to a make necessary changes, and maximize overall health and well-being. The first part of the paper reviews the local immune cascades of pro- and anti-inflammatory regulation and the interconnected feedback loops with neural and psychological pathways. The second part emphasizes one of nature's principles at work-system design and efficiency. Continually overwhelming this finely tuned system will result in systemic inflammation allowing chronic diseases to emerge; the pathways of several common conditions are described in detail. The final part of the paper considers the implications of these understandings for clinical care and explore how this lens could shape the physician-patient encounter and health system redesign. We conclude that healthcare professionals must advocate for an anti-inflammatory lifestyle at the patient level as well as at the local and national levels to enhance population health and well-being.
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Affiliation(s)
- Jeanette M. Bennett
- Department of Psychological Science, StressWAVES Biobehavioral Research Lab, The University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Glenn Reeves
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - George E. Billman
- Department of Physiology and Cell Biology, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, United States
| | - Joachim P. Sturmberg
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
- Foundation President, International Society for Systems and Complexity Sciences for Health, Delaware, United States
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143
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Finkel D, Ernsth Bravell M. Cohort by Education Interactions in Longitudinal Changes in Functional Abilities. J Aging Health 2018; 32:208-215. [PMID: 30466342 DOI: 10.1177/0898264318814108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Investigations of cohort differences in relationships between education and health tend to focus on mortality or self-reported health. We report one of the first analyses of cohort differences in relationships between education and objective measures of functional abilities across the lifespan. Method: Up to 26 years of follow-up data were available from 859 adults from the Swedish Adoption/Twin Study of Aging. The sample was divided into two cohorts by birth year: 1900-1924 and 1925-1948. Latent growth curve models (LGCM) were compared across cohort and educational levels. Results: LGCM indicated divergence between adults with lower and higher educational attainment in longitudinal trajectories of change with age in the Balance and Flexibility factors for the later born cohort only. Discussion: Results support the cumulative advantage theory and suggest that education-health disparities are increasing in recent cohorts, even in counties with national health care systems and strong support of education.
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Affiliation(s)
- Deborah Finkel
- Indiana University Southeast, New Albany, USA.,Jönköping University, Sweden
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144
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Noel-London K, Breitbach A, Belue R. Filling the Gaps in Adolescent Care and School Health Policy-Tackling Health Disparities through Sports Medicine Integration. Healthcare (Basel) 2018; 6:healthcare6040132. [PMID: 30428510 PMCID: PMC6316866 DOI: 10.3390/healthcare6040132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/06/2018] [Accepted: 11/10/2018] [Indexed: 12/29/2022] Open
Abstract
The School-Based Health Centre (SBHC) model of healthcare delivery in community health is designed to address the unique needs of adolescents. Through a collaborative interprofessional approach, they aim to provide comprehensive care with the goal of reducing health disparities in underserved, at-risk adolescents. Integration of sports medicine health professionals is a novel approach to increasing available services, as well as patient utilization, while addressing multiple public health issues, including lack of athletic training services for youth athletes.
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Affiliation(s)
- Kemba Noel-London
- College for Public Health and Social Justice Department of Health Management and Policy, Saint Louis University, St. Louis, MO 63104, USA.
| | - Anthony Breitbach
- Doisy College of Health Sciences, Department of Physical Therapy and Athletic Training, Saint Louis University, St. Louis, MO 63104, USA.
| | - Rhonda Belue
- College for Public Health and Social Justice Department of Health Management and Policy, Saint Louis University, St. Louis, MO 63104, USA.
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145
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Shaked D, Katzel LI, Seliger SL, Gullapalli RP, Davatzikos C, Erus G, Evans MK, Zonderman AB, Waldstein SR. Dorsolateral prefrontal cortex volume as a mediator between socioeconomic status and executive function. Neuropsychology 2018; 32:985-995. [PMID: 30211609 PMCID: PMC6234054 DOI: 10.1037/neu0000484] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Lower socioeconomic status (SES) is related to poorer cognitive performance, but the neural underpinnings of this relation are not fully understood. This study examined whether SES-linked decrements in executive function were mediated by smaller dorsolateral prefrontal cortex (DLPFC) volumes. Given the literature demonstrating that SES-brain relations differ by race, we examined whether race moderated these mediations. METHOD Participants were 190 socioeconomically diverse, self-identified African American (AA) and White adults from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) SCAN study. Regional brain volumes were derived using T1-weighted MP-RAGE images. Adjusting for age and sex, moderated mediation analyses examined if the DLPFC mediated SES-executive function relations differently across racial groups. Executive function was measured using Trail Making Test part B (Trails B), Digit Span Backwards (DSB), and verbal fluency. RESULTS Moderated mediation demonstrated that DLPFC volume significantly mediated the association between SES and Trails B in Whites (lower confidence interval [CI] = 0.01; upper CI = 0.07), but not in AAs (lower CI = -0.05; upper CI = 0.01). No mediations were found for DSB or verbal fluency, although SES was related to all tests. CONCLUSION The DLPFC may be important in the association of SES and mental flexibility for White, but not AA adults. It is possible that the well-replicated advantages of high SES among Whites do not readily translate, on average, to AAs. These findings highlight the importance of brain volume for cognitive functioning, while adding to the literature on sociodemographic health disparities. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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146
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Greenfield EA. Age-Friendly Initiatives, Social Inequalities, and Spatial Justice. Hastings Cent Rep 2018; 48 Suppl 3:S41-S45. [DOI: 10.1002/hast.912] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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147
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Corbi G, Ambrosino I, Massari M, De Lucia O, Simplicio S, Dragone M, Paolisso G, Piccioni M, Ferrara N, Campobasso CP. The potential impact of multidimesional geriatric assessment in the social security system. Aging Clin Exp Res 2018; 30:1225-1232. [PMID: 29330838 DOI: 10.1007/s40520-017-0889-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 12/30/2017] [Indexed: 10/18/2022]
Abstract
AIM To evaluate the efficacy of multidimensional geriatric assessment (MGA/CGA) in patients over 65 years old in predicting the release of the accompaniment allowance (AA) indemnity by a Local Medico-Legal Committee (MLC-NHS) and by the National Institute of Social Security Committee (MLC-INPS). METHODS In a longitudinal observational study, 200 Italian elder citizens requesting AA were first evaluated by MLC-NHS and later by MLC-INPS. Only MLC-INPS performed a MGA/CGA (including SPMSQ, Barthel Index, GDS-SF, and CIRS). This report was written according to the STROBE guidelines. RESULTS The data analysis was performed on January 2016. The evaluation by the MLC-NHS and by the MLC-INPS was in agreement in 66% of cases. In the 28%, the AA benefit was recognized by the MLC-NHS, but not by the MLC-INPS. By the multivariate analysis, the best predictors of the AA release, by the MLC-NHS, were represented by gender and the Barthel Index score. The presence of carcinoma, the Barthel Index score, and the SPMQ score were the best predictors for the AA release by MLC-INPS. CONCLUSIONS MGA/CGA could be useful in saving financial resources reducing the risk of incorrect indemnity release. It can improve the accuracy of the impairment assessment in social security system.
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Blacksher E. Shrinking Poor White Life Spans: Class, Race, and Health Justice. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:3-14. [PMID: 30339069 DOI: 10.1080/15265161.2018.1513585] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
An absolute decline in US life expectancy in low education whites has alarmed policy makers and attracted media attention. Depending on which studies are correct, low education white women have lost between 3 and 5 years of lifespan; men, between 6 months and 3 years. Although absolute declines in life expectancy are relatively rare, some commentators see the public alarm as reflecting a racist concern for white lives over black ones. How ought we ethically to evaluate this lifespan contraction in low education whites? Should we care, or is it racist to care? Does it constitute an injustice or reflect justice being done? I argue that the lifespan contraction in low education whites violates key normative criteria used to make determinations of health justice, and that these judgments do not vitiate concerns about racism. I conclude with reflections on US population health policy and building an inclusive health equity movement.
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149
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Hamidi S, Alzouebi K, Akinci F, Zengul FD. Examining the association between educational attainment and life expectancy in MENA region: A panel data analysis. Int J Health Plann Manage 2018; 33:e1124-e1136. [PMID: 30091478 DOI: 10.1002/hpm.2598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 07/04/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The purpose of this study is to investigate the association between educational attainment and life expectancy in 18 countries in MENA region. METHODS We used World Bank database for a panel of 18 MENA countries during the years 1995 to 2009. We used Life Expectancy at Birth, as the key health care output measure. Additionally, we used six health care input independent variables. All variables were transformed into natural logarithms. We estimated the production function using Cobb-Douglas function. RESULTS Results indicate that 1% increase in educational attainment of males 25 to 34 years old, males 25 years and older, females 25 to 34 years old, females 25 years and older, and females aged 15 to 44 years old will increase life expectancy by 0.14%, 0.07%, 0.04%, 0.03%, and 0.04%, respectively, while everything else remains constant. CONCLUSION Our results suggest that for MENA region countries investing in education to broaden access would improve health outcomes and life expectancy. Boosting educational attainment for both male and female population may close the life expectancy gaps between the MENA region and other developed countries, and males and females within the same country. Education attainment has the potential to be a social remedy for better health outcomes in MENA countries.
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Affiliation(s)
- Samer Hamidi
- School of Health and Environmental Studies, Hamdan Bin Mohammad Smart University, Dubai, United Arab Emirates
| | - Khadeegha Alzouebi
- School of e-Education, Hamdan Bin Mohammad Smart University, Dubai, United Arab Emirates
| | - Fevzi Akinci
- Dean, John G. Rangos, Sr. School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Ferhat D Zengul
- Department of Healthcare Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
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150
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Chin MH, King PT, Jones RG, Jones B, Ameratunga SN, Muramatsu N, Derrett S. Lessons for achieving health equity comparing Aotearoa/New Zealand and the United States. Health Policy 2018; 122:837-853. [PMID: 29961558 PMCID: PMC6561487 DOI: 10.1016/j.healthpol.2018.05.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 04/30/2018] [Accepted: 05/05/2018] [Indexed: 11/21/2022]
Abstract
Aotearoa/New Zealand (Aotearoa/NZ) and the United States (U.S.) suffer inequities in health outcomes by race/ethnicity and socioeconomic status. This paper compares both countries' approaches to health equity to inform policy efforts. We developed a conceptual model that highlights how government and private policies influence health equity by impacting the healthcare system (access to care, structure and quality of care, payment of care), and integration of healthcare system with social services. These policies are shaped by each country's culture, history, and values. Aotearoa/NZ and U.S. share strong aspirational goals for health equity in their national health strategy documents. Unfortunately, implemented policies are frequently not explicit in how they address health inequities, and often do not align with evidence-based approaches known to improve equity. To authentically commit to achieving health equity, nations should: 1) Explicitly design quality of care and payment policies to achieve equity, holding the healthcare system accountable through public monitoring and evaluation, and supporting with adequate resources; 2) Address all determinants of health for individuals and communities with coordinated approaches, integrated funding streams, and shared accountability metrics across health and social sectors; 3) Share power authentically with racial/ethnic minorities and promote indigenous peoples' self-determination; 4) Have free, frank, and fearless discussions about impacts of structural racism, colonialism, and white privilege, ensuring that policies and programs explicitly address root causes.
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Affiliation(s)
- Marshall H Chin
- Section of General Internal Medicine, University of Chicago, 5841 S. Maryland Ave., MC2007, Chicago, IL 60637, USA.
| | - Paula T King
- Te Rōpū Rangahau Hauora A Eru Pōmare (Eru Pōmare Māori Health Research Unit), University of Otago, Wellington, New Zealand.
| | - Rhys G Jones
- Te Kupenga Hauora Māori (Department of Māori Health), School of Population Health, University of Auckland, New Zealand.
| | | | - Shanthi N Ameratunga
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1141, New Zealand.
| | - Naoko Muramatsu
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, 1603 W. Taylor Street (MC 923), Chicago, IL 60612-4394, USA.
| | - Sarah Derrett
- Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
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