All-cause and cause-specific mortality of immigrants and native born in the United States

Assessment of mortality after long-term follow-up of patients with community-acquired pneumonia

Although studies have assessed short-term mortality among patients with community-acquired pneumonia, there is limited data on prognosis and risk factors that affect long-term mortality. The mortality among patients enrolled at 4 sites of the Pneumonia Patient Outcome Research Team cohort study who survived at least 90 days after presentation to the hospital was compared with that among age-matched control subjects. Overall, 1419 of 1555 patients survived for >90 days, with a mean follow-up period of 5.9 years. There was significantly higher long-term mortality among patients with pneumonia than among age-matched controls. Factors significantly associated with long-term mortality were age (stratified by decade), do-not-resuscitate status, poor nutritional status, pleural effusion, glucocorticoid use, nursing home residence, high school graduation level or less, male sex, preexisting comorbid illnesses, and the lack of feverishness. This study demonstrates that there is significantly higher long-term mortality among patients with pneumonia than among age-matched controls and that long-term mortality largely is not affected by acute physiologic derangements.

Acculturation stress, social support, and self-rated health among Latinos in California

This study looks at the effect of social support mechanisms as potential moderators and mediators of the relationship between stressful acculturation experiences and self-ratings of physical health. Data are from a sample of 3012 Mexican-origin adults aged 18-59 sampled under a probabilistic, stratified, cluster sampling design in Fresno County, California. While acculturation stressors (i.e., discrimination, legal status, and language conflict) all had a gross positive effect on the likelihood of rating oneself in fair/poor health, only legal status stress had a net effect. In addition, greater numbers of peers and family members in the United States, and a higher reliance on religious support mechanisms decreased the likelihood of reporting fair/poor health. However, levels of both instrumental social support and religious support seeking moderated the (nonsignificant, main) effects of discrimination on physical health. This study indicates that physical health is negatively associated with acculturation stressors and positively associated with social support; discrimination is only associated with poorer physical health among those for whom social support is lacking.

Health status, health insurance, and health care utilization patterns of immigrant Black men

OBJECTIVES

This study sought to describe the health status, health insurance, and health care utilization patterns of the growing population of immigrant Black men.

METHODS

We used data from the 1997-2000 National Health Interview Survey to examine and then compare health variables of foreign-born Black men with those of US-born Black and White men. Logistic regression analyses were used to examine health outcomes.

RESULTS

Foreign-born Black men were in better overall health than their US-born Black counterparts and were much less likely than either US-born Black or White men to report adverse health behaviors. Despite these health advantages, foreign-born Black men were more likely than either US-born Black or White men to be uninsured.

CONCLUSIONS

In the long term, immigrant Black men who are in poor health may be adversely affected by lack of health care coverage.

Area deprivation and widening inequalities in US mortality, 1969-1998

OBJECTIVES

This study examined age-, sex-, and race-specific gradients in US mortality by area deprivation between 1969 and 1998.

METHODS

A census-based area deprivation index was linked to county mortality data.

RESULTS

Area deprivation gradients in US mortality increased substantially during 1969 through 1998. The gradients were steepest for men and women aged 25 to 44 years and those younger than 25 years, with higher mortality rates observed in more deprived areas. Although area gradients were less pronounced for women in each age group, they rose sharply for women aged 25 to 44 and 45 to 64 years.

CONCLUSIONS

Areal inequalities in mortality widened because of slower mortality declines in more deprived areas. Future research needs to examine population-level social, behavioral, and medical care factors that may account for the increasing gradient.

Sociodemographics, self-rated health, and mortality in the US

Using data from the 1987 National Medical Expenditure Survey, a representative sample of US civilians, and their 5-year mortality, we examined the adjusted relationships among baseline self-reported health, derived from SF-20 subscales (health perceptions, physical function, role function and mental health) and sociodemographics (age, sex, race/ethnicity, income and education) and subsequent mortality. Included were 21,363 persons aged 21 and over, with complete follow-up on 19,812. Physical function showed the greatest decline with age, whereas mental health increased slightly. Women reported lower health for all scales except role function. Greater income was associated with better health, least marked for mental health. Greater education was associated with better health, most marked for health perceptions. Compared with whites, blacks reported lower health, whereas Latinos reported higher health. Lower self-reported health predicted increased adjusted mortality. After adjustment for baseline self-rated health, the relationships between income and education and mortality were greatly attenuated, whereas the relationships between age, gender, race/ethnicity and mortality were not. Self-rated health exhibited more profound relationships with mortality in younger persons, those with more education, and whites. In conclusion, lower socioeconomic status (SES), and being black are associated with lower reported health status and higher mortality; women report lower health status but exhibit lower mortality; and Latinos report higher health status and exhibit lower mortality. The effects of SES on mortality are largely explained by their associations with self-rated health, whereas, the effects of gender and race/ethnicity on mortality appear to act through independent pathways. Because of these differential sociodemographic relationships caution is urged when using self-rated health measures in research, clinical, and policy settings.

Sociodemographic indicators and risk of brain tumours

BACKGROUND

To better understand patterns of occurrence or diagnosis of brain tumours in different segments of the population, we evaluated associations between sociodemographic variables and the relative incidence of brain tumours as part of a multi-faceted case-control study.

METHODS

The study was conducted at hospitals in three US cities between 1994 and 1998. In all, 489 glioma cases (354 high-grade, 135 low-grade), 197 meningioma cases, 96 acoustic neuroma cases, and 799 controls admitted to the same hospitals for any of a variety of non-neoplastic diseases or conditions were enrolled and interviewed. Logistic regression was used to estimate odds ratios (OR), calculate 95% CI, and test for trends.

RESULTS

The OR showed significant positive associations with household income for low-grade glioma, meningioma, and acoustic neuroma, but not for high-grade glioma. Positive associations were observed with level of education for low-grade glioma and acoustic neuroma, but not for high-grade glioma or meningioma. Jewish religion was associated with a significantly elevated risk for meningioma (OR = 4.3; 95% CI: 2.0-9.0). Being single at the time of tumour diagnosis or enrolment was associated with significantly reduced risks for meningioma (OR = 0.4; 95% CI: 0.3-0.6) and low- or high-grade glioma (OR = 0.6; 95% CI: 0.5-0.8), but not for acoustic neuroma.

CONCLUSIONS

Associations with sociodemographic variables varied considerably among the different subtypes of brain tumour, including between low-grade and high-grade glioma. The general pattern was for associations with indicators of affluence and education to be stronger for tumours that tend to grow more slowly and have less catastrophic effects, although the evidence was mixed for meningioma. We cannot isolate the specific factors underlying the observed associations, but intrapopulation differences in the completeness or timing of diagnosis may have played a role. There is less opportunity for such influences to operate for the rapidly progressing, high-grade gliomas than for more slowly growing tumours.

Disability status differentials across fifteen Asian and Pacific Islander groups and the effect of nativity and duration of residence in the U.S

This study examines disparities in disability status across 15 Asian and Pacific Islander American (API) subpopulations and how nativity and duration in the U.S. influence these differences. Employing three disability questions (work limitations, mobility limitations, and self-care limitations) from the 1990 PUMS, the authors find substantial heterogeneity in disability status across API subgroups: while Japanese American adults have the most favorable outcomes, Other Southeast Asian adults (Laotians, Hmong, and Cambodians), followed by Vietnamese and Pacific Islander adults, suffer from a high risk of disabilities. Many of the disparities in disability status across API subpopulation adults are attributable to differentials in demographic characteristics and SES. The inclusion of an interaction term of age and nativity/duration of residence in the U.S. in multivariate regression analyses demonstrates that the effect of nativity/duration plays a different role across age, net of demographic, and SES risk factors. The overall findings are also consistent with previous studies on the relationship between immigrant health and nativity/duration. That is, immigrants with short duration in the U.S. have superior health status, measured by risk of disability, than longer-term immigrants and their U.S.-born counterparts.

HIV prevalence among foreign- and US-born clients of public STD clinics

OBJECTIVES

We examined differences in HIV seroprevalence and the likely timing of HIV infection by birth region.

METHODS

We analyzed unlinked HIV antibody data on 61 120 specimens from 7 public health centers in Los Angeles County from 1993 to 1999.

RESULTS

Most (87%) immigrant clients were Central American/Mexican-born. HIV prevalence was similar for US- and foreign-born clients (1.8% [95% confidence interval (CI) = 1.7%, 1.9%] and 1.6% [95% CI = 1.5%, 1.8%], respectively). Seroprevalence was high among sub-Saharan African females and low among Asian/Pacific Islander males and females. For HIV-positive immigrants, the average age at and time since immigration were 20.6 years and 12.3 years, respectively.

CONCLUSIONS

The relatively young age at arrival and long time since arrival for HIV-positive foreign-born clients suggest that most were infected after immigration.

Suicide amongst Irish migrants in Britain: a review of the identity and integration hypothesis

BACKGROUND

Studies have consistently reported higher rates of suicide amongst Irish migrants in Britain than in the population as a whole. Leavey offers a hypothetical model to explain such rates that incorporates lack of social cohesion and integration meshed with the inability to establish an authentic identity and other contributory factors.

MATERIAL

Systematic review methodologies are used to examine the central tenets of this explanatory framework. Some of the macro-level ecological associations in the model are critically evaluated in the context of findings from the 1991 Census and government social and household panel surveys.

DISCUSSION

The evidence base suggests that statements on social isolation and reluctance to use health care services are questionable and Irish migration is shown to be much more heterogeneous than the model suggests. Only small positive, and as yet unreplicated, associations have been established between identity and health behaviour in a non-representative sample and evidence is lacking of Irish stoicism and anti-Irish racism as putative risk factors. Epidemiological studies show that adjusting suicide rates for social class explains virtually none of the excess in Irish migrants, although higher risks for unmarried persons are reported. Explanations in the literature for higher rates of migrant suicide are discussed.

CONCLUSIONS

Studies based on individual-level analysis and record linkage are urgently needed to explain the high rates.

Increasing inequalities in all-cause and cardiovascular mortality among US adults aged 25-64 years by area socioeconomic status, 1969-1998

BACKGROUND

This study examined the extent to which areal socio-economic gradients in all-cause and cardiovascular disease (CVD) mortality among US men and women aged 25-64 years increased between 1969 and 1998.

METHODS

Using factor analysis 17 census tract variables were used to develop an areal index of socio-economic status that was used to stratify all US counties into five socio-economic categories. By linking the index to county-level mortality data from 1969 to 1998, we calculated annual age-adjusted mortality rates for each area socio-economic group. Poisson regression models were fitted to estimate areal socio-economic gradients in mortality over time.

RESULTS

Areal socio-economic gradients in all-cause and cardiovascular mortality have increased substantially over the past three decades. Compared to men in the highest area socio-economic group, rates of all-cause and CVD mortality among men in the lowest area socio-economic group were 42% and 30% greater in 1969-1970 and 73% and 79% greater in 1997-1998, respectively. The gradients in mortality among women were steeper for CVD than for all causes. Compared to women in the highest area socio-economic group, rates of all-cause and CVD mortality among women in the lowest area socio-economic group were 29% and 49% greater in 1969-1970 and 53% and 94% greater in 1997-1998, respectively.

CONCLUSIONS

Although US all-cause and cardiovascular mortality declined for all area socio-economic groups during 1969-1998, the gradient increased because of significantly larger mortality declines in the higher socio-economic groups. Increasing areal inequalities in mortality shown here may be related to increasing temporal differences in the material and social living conditions between areas.

Association of language spoken at home with health and school issues among Asian American adolescents

The study examined the association of language spoken at home with the school and health risks and behaviors of Asian American adolescents. Using the United States component of the 1997-1998 World Health Organization Study of Health Behavior in School Children, bivariate and multiple logistic regression analyses were conducted of records for Asian children to explore the relationship between language spoken at home and outcome variables regarding health behaviors, psychosocial and school risk factors, and parental factors. Compared to those who usually speak English at home, adolescents who usually speak another language, or who speak two languages equally, face a greater risk for health risk factors, psychosocial and school risk factors, and parental risk factors. Not speaking English at home was associated with higher health risks, including not wearing seat belts and bicycle helmets; higher psychosocial and school risk factors, including feeling that they do not belong at school, difficulty making new friends, and lacking confidence; and higher parental risks, including reporting that parents were not ready to help them or willing to talk to teachers. Adolescents less acculturated to the United States experience a variety of physical and psychosocial risks. School-based interventions such as early identification and outreach, needs assessment, and counseling and support services should be provided to immigrant students and their families.

Validity of self-rated health among Latino(a)s

The authors investigated whether self-rated health (SRH) had differential mortality risks for Latino(a) adults of various acculturation statuses living in the United States. They used cumulative National Health Interview Survey data from 1989 to 1994 (n = 37,713) linked with the National Health Interview Survey Multiple Cause of Death data files (1,364 deaths) that match records from the National Death Index through 1997. The authors specified survival models to estimate the effect of SRH on mortality and further stratified their model by birth and duration in the United States as proxies for acculturation. These estimates were compared across strata. Poor SRH was found to be a weaker predictor of subsequent mortality risk among the less acculturated, although the overall risk among the aggregated sample is similar to the risk reported in previous studies. The relation between poor SRH and mortality risk increases with United States acculturation among Latinos. While poor SRH was significantly associated with short-term mortality among the least acculturated, this association did not persist beyond 2-year mortality risk. Health researchers wishing to use SRH to assess the physical health of multiethnic populations should at least control for levels of acculturation among respondents.

Increased risk of heart disease and stroke among foreign-born females residing in the United States

BACKGROUND

Although the number of foreign-born people residing in the United States is at its highest point in 80 years, a mortality analysis of the foreign born has not been conducted since 1989. This article provides an update of mortality rates among the foreign born in the United States and, in particular, examines mortality rates from heart disease among foreign-born females.

METHODS

We calculated mortality rates for U.S.-born and foreign-born people for all causes-ischemic heart disease, stroke, neoplastic disease, hypertensive diseases, diabetes, accidents, infectious disease, and chronic obstructive pulmonary disease-for 1997. Death data were obtained from the 1997 Multiple Cause of Death data file, and population data were obtained from the 1997 Current Population Survey.

RESULTS

While all-cause, age-adjusted mortality rates for foreign-born people are significantly lower than for native-born people, deaths due to ischemic heart disease and stroke are significantly higher among foreign-born females than native-born females (161.63 and 58.24 deaths, respectively, per 100,000 foreign-born females vs 122.01 and 49.39 deaths per 100,000 native-born females).

CONCLUSIONS

Foreign-born females appear to be at greater risk of death from ischemic heart disease and stroke than native-born females. Future research efforts are needed to determine which foreign-born groups are most at risk for heart disease and stroke so that targeted prevention efforts can be initiated.