What do we know about the impact of economic recessions on mortality inequalities? A critical review

The Role of Race in Deaths of Despair in Brazil: Is it a White People Problem?

BACKGROUND

A new paradigm has been discussed regarding the impact of economic cycles on the mortality pattern from specific causes. These causes are called deaths of despair, and they selectively impact specific demographic groups. Also, low- and middle-income countries are most affected due to their economic and social instability. In this sense, the objective of study was to compare the magnitude of disparity in deaths from despair according to sex, age, and race in Brazil.

METHODS

We performed Poisson regression modeling to estimate the magnitude of the association between sex, age group, race, and deaths from despair. Also, we estimated the relationship of time as a proxy of economic crisis phase and deaths of despair.

RESULTS

We found an association between mortality from despair and male sex (PR = 6.15, 95%CI 6.09-6.22); emphasis on the age groups from 40 to 49 years old (PR = 2.45, 95% CI 2.41-2.48) and 50 to 59 years old (PR = 2.39, 95% CI 2.36-2.43); and brown (PR = 1.21, 95% CI 1.20-1.22) and black race (PR = 1.36, 95% CI 1.34-1.37).

CONCLUSIONS

The present study preliminarily presents the effect of the economic crisis and mortality in the population, with demographic differences. Association with race was opposite to that verified in the original study in the USA, which suggests that this variable should be analyzed in the light of structural context.

Economic fluctuations and educational inequalities in premature ischemic heart disease mortality in Argentina

Although mortality from ischemic heart disease has declined over the past decades in Argentina, ischemic heart disease remains one of the most frequent causes of death. This study aimed to describe the role of individual and contextual factors on premature ischemic heart disease mortality and to analyze how educational differentials in premature ischemic heart disease mortality changed during economic fluctuations in two provinces of Argentina from 1990 to 2018. To test the relationship between individual (age, sex, and educational level) and contextual (urbanization, poverty, and macroeconomic variations) factors, a multilevel Poisson model was estimated. When controlling for the level of poverty at the departmental level, we observed inequalities in premature ischemic heart disease mortality according to the educational level of individuals, affecting population of low educational level. Moreover, economic expansion was related to an increase in ischemic heart disease mortality, however, expansion years were not associated with increasing educational inequalities in ischemic heart disease mortality. At the departmental level, we found no contextual association beween area-related socioeconomic level and the risk of ischemic heart disease mortality. Despite the continuing decline in ischemic heart disease mortality in Argentina, this study highlighted that social inequalities in mortality risk increased over time. Therefore, prevention policies should be more focused on populations of lower socioeconomic status in Argentina.

Long-term trends in urban-neighbourhood inequalities in cause-specific mortality and hospitalisation - multilevel analyses among individuals nested in Finnish post-code areas, 1991-2018

Background

High-income countries yield mixed evidence concerning the long-term trends of neighbourhood inequalities in health outcomes. The reasons why these inequalities persist and the factors driving any changes over time remain unclear. We analysed trends in general neighbourhood differences in mortality and hospitalisation, compared specific area-level and individual-level income effects, and assessed whether area-level effects were attributable to the neighbourhood population composition.

Methods

This prospective cohort study used individual-level register-linked information on sociodemographic factors covering the total population of 20-64-year-olds living in Finnish cities at the beginning of seven four-year periods in 1991-2018 (N = 952,493-1,200,431). We used random-effects Poisson models to assess all-cause and external mortality and hospitalisations among individuals nested in postal-code areas.

Results

The general contextual effect of the neighbourhood on all-cause mortality and hospitalisation was stable across time, with a median incidence-rate ratio of around 1.20-1.30, and it was mainly attributable to the population's composition. The association between area-level income and both mortality and hospitalisation was also robust and increased slightly even after accounting for population composition. The lowest neighbourhood income quintile in 2015-2018 had 15% (95% CI:5-26%) and 30% (95% CI:15-47%) excess mortality among men and women, respectively. These differentials were particularly large for external causes, but all area-level income associations were much smaller than the corresponding individual-level associations.

Conclusion

The overall relevance of the neighbourhood context to mortality and hospitalisation was stable across time, and generally attributable to population composition. However, there were substantial relative area-level income disparities between neighbourhoods, which had grown over time.

COVID-19 and changes in college student educational expectations and health by disability status

This study examines the implications of the coronavirus pandemic for college students' health and education, with special attention to variation by disability status. Disaster research supports the hypothesis that students with disabilities will experience higher-than-usual levels of pandemic-related stress, which could lead to re-evaluations of their educational expectations and declines in health. We evaluate this hypothesis by modeling changes in students' (1) mental and physical health and (2) educational expectations during the first year (spring of 2020 to spring of 2021) of the pandemic, using survey data collected from a population-based sample of college students in the state of Indiana. Although we observe across-the-board declines in both domains, students with disabilities were especially vulnerable. Mediation analyses suggest that differential exposure to financial and illness-related stressors is partially to blame, explaining a significant portion of the group differences between students with and without disabilities. We interpret these results as evidence of the unique vulnerabilities associated with disability status and its wide-ranging importance as a dimension of social stratification.