1
|
Fowle M, Chang J, Saxton K. "Racial mortality inversion": Black-white disparities in mortality among people experiencing homelessness in the United States. SSM Popul Health 2024; 27:101688. [PMID: 39055644 PMCID: PMC11269784 DOI: 10.1016/j.ssmph.2024.101688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 07/27/2024] Open
Abstract
Disparities in mortality between Black and White people have long been observed. These disparities persist at all income levels. However, similar patterns in racial mortality disparities are not observed among people experiencing homelessness. Instead, studies in a handful of cities show a reversal in the Black-White mortality disparity in the United States: Black people experiencing homelessness are less likely to die compared to White people experiencing homelessness. We propose a theory of "racial mortality inversion" and test whether inverted Black-White mortality patterns are observable in homeless populations throughout the United States. Using a novel dataset of 18,618 homeless decedents in 20 localities across 10 states and the District of Columbia, we find consistent evidence for "racial mortality inversion" across time and place. Between 2015 and 2020, the aggregate White homeless mortality rate was 67.8%-138.4% higher than the rate for the Black homeless population. Inverted racial mortality rates were observed in all 20 localities and in nearly every year. Across the entire sample, higher average ages of death were also observed for Black people compared to White people experiencing homelessness in 5 of 6 years, though racial inversion in age was not consistent across localities. These findings offer novel insight into racial health disparities among people experiencing homelessness and may inform policies and programs that seek to prevent homelessness and homeless mortality across racial groups.
Collapse
Affiliation(s)
- Matthew Fowle
- Weitzman School of Design, University of Pennsylvania, United States
| | - Jamie Chang
- School of Social Welfare, University of California Berkeley, United States
| | - Katherine Saxton
- Department of Public Health Santa Clara University, United States
| |
Collapse
|
2
|
Bergeron-Boucher MP, Callaway J, Strozza C, Oeppen J. Inequalities in lifespan and mortality risk in the US, 2015-2019: a cross-sectional analysis of subpopulations by social determinants of health. BMJ Open 2024; 14:e079534. [PMID: 39106997 DOI: 10.1136/bmjopen-2023-079534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVE To quantify inequalities in lifespan across multiple social determinants of health, how they act in tandem with one another, and to create a scoring system that can accurately identify subgroups of the population at high risk of mortality. DESIGN Comparison of life tables across 54 subpopulations defined by combinations of four social determinants of health: sex, marital status, education and race, using data from the Multiple Cause of Death dataset and the American Community Survey. SETTING United States, 2015-2019. MAIN OUTCOME MEASURES We compared the partial life expectancies (PLEs) between age 30 and 90 years of all subpopulations. We also developed a scoring system to identify subgroups at high risk of mortality. RESULTS There is an 18.0-year difference between the subpopulations with the lowest and highest PLE. Differences in PLE between subpopulations are not significant in most pairwise comparisons. We visually illustrate how the PLE changes across social determinants of health. There is a complex interaction among social determinants of health, with no single determinant fully explaining the observed variation in lifespan. The proposed scoring system adds clarification to this interaction by yielding a single score that can be used to identify subgroups that might be at high risk of mortality. A similar scoring system by cause of death was also created to identify which subgroups could be considered at high risk of mortality from specific causes. Even if subgroups have similar mortality levels, they are often subject to different cause-specific mortality risks. CONCLUSIONS Having one characteristic associated with higher mortality is often not sufficient to be considered at high risk of mortality, but the risk increases with the number of such characteristics. Reducing inequalities is vital for societies, and better identifying individuals and subgroups at high risk of mortality is necessary for public health policy.
Collapse
Affiliation(s)
| | - Julia Callaway
- Interdisciplinary Centre on Population Dynamics, Syddansk Universitet, Odense, Denmark
| | - Cosmo Strozza
- Interdisciplinary Centre on Population Dynamics, Syddansk Universitet, Odense, Denmark
| | - Jim Oeppen
- Interdisciplinary Centre on Population Dynamics, Syddansk Universitet, Odense, Denmark
| |
Collapse
|
3
|
Ueyama H, Yamamura M, Koyanagi J, Fukunaga K, Takemura S, Nakamura S. Early Postoperative Functional Recovery in Older Patients With Periprosthetic Femoral Fractures: Comparison Between Cemented and Cementless Stem Revisions. Arthroplast Today 2024; 28:101467. [PMID: 39100417 PMCID: PMC11295462 DOI: 10.1016/j.artd.2024.101467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/18/2024] [Accepted: 06/10/2024] [Indexed: 08/06/2024] Open
Abstract
Background Early postoperative functional recovery is important in older patients with lower-extremity fractures to prevent disuse, and periprosthetic femoral fractures (PFFs) are no exception. This study aimed to compare the postoperative functional recovery in the early phase after revision for PFF with loose stems between cemented and cementless stems. Methods Eighteen patients with Unified Classification System type B2 PFF were included in this retrospective cohort study with a follow-up period of about 2 years. All patients underwent stem revision and were divided into 2 groups: the cemented stem group (n = 9) and the cementless stem group (n = 9). In postrevision, functional independence measure score, independent walk rate, activities of daily living recovery rate to the original level at 2 weeks postoperatively, the Beals and Tower classification for radiological status, and survival rate for readmission as endpoints were compared between the 2 groups. Results Patients in the cemented group recovered functional mobility earlier than in the cementless group, with higher postoperative functional independence measure functional subscale values (73 vs 50 points, P = .02), higher independent walk rate (89 vs 11%, P < .01), and more postoperative activities of daily living recovery (100% vs 44%, P = .03) at 2 weeks postoperatively. The Beals and Tower classification and survival rates were similar in both groups. Conclusions Revision using a cemented stem for PFF in older patients was a useful surgical procedure in terms of early postoperative functional recovery. Cemented stem revision was comparable with cementless in bone union and safety at 2 years postoperatively.
Collapse
Affiliation(s)
- Hideki Ueyama
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Mitsuyoshi Yamamura
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Junichiro Koyanagi
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Kenji Fukunaga
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Susumu Takemura
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Suguru Nakamura
- Department of Orthopedic Surgery, Sano Memorial Hospital, Izumisanoshi, Osaka, Japan
| |
Collapse
|
4
|
Xu J, Liao J, Yan Q, Jiao J, Hu N, Zhang W, Shi L, Deng M, Huang S, Tang X. Trends analysis of cancer incidence, mortality, and survival for the elderly in the United States, 1975-2020. Cancer Med 2024; 13:e70062. [PMID: 39082934 PMCID: PMC11289898 DOI: 10.1002/cam4.70062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 07/02/2024] [Accepted: 07/20/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Cancer burden from the elderly has been rising largely due to the aging population. However, research on the long-term epidemiological trends in cancer of the elderly is lacking. METHODS Registry data of this population-based cross-sectional study were from the Surveillance, Epidemiology, and End Results (SEER) database. The study population aged 65 years or more, from geographically distinct regions. Joinpoint regression and JP Surv method were used to analyze cancer trends and survival. RESULTS Mortality rate during 1975-2020 decreased from 995.20 to 824.99 per 100,000 elderly persons, with an average annual decrease of 0.421% (95% CI, 0.378-0.464). While overall incidence increased with no significance. Prostate (29%) and breast (26%) cancer were the most common malignancies, respectively, in elderly males and females, and the mortality for both of the two (prostate 15%, breast 14%) ranked just behind lung and bronchus cancer, which had the highest mortality rates in males (29%) and females (23%). Many cancers showed adverse trends in the latest follow-up periods (the last period calculated by the Joinpoint method). For intrahepatic cholangiocarcinoma, incidence (male Annual Percentage Change [APC] = 7.4*; female APC = 6.7*) and mortality (male APC = 3.0*; female APC = 3.3*) increased relatively fast, and its survival was also terrible (3-year survival only 10%). Other cancers with recent increasing mortality included cancer of anus, anal canal and anorectum, retroperitoneum, pleura, peritoneum, etc. Most cancers had favorable trends of survival during the nearest follow-up period. CONCLUSION Against the background of overall improvement, many cancers showed adverse trends. Further research for the underlying mechanisms and targeted implements towards adverse trends is also urgent.
Collapse
Affiliation(s)
- Jia Xu
- Department of GastroenterologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan ProvinceLuzhouChina
| | - Jingyuan Liao
- Department of GastroenterologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan ProvinceLuzhouChina
| | - Qiong Yan
- Department of GastroenterologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan ProvinceLuzhouChina
| | - Jiang Jiao
- Department of GastroenterologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan ProvinceLuzhouChina
| | - Nan Hu
- Department of GastroenterologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan ProvinceLuzhouChina
| | - Wei Zhang
- Department of GastroenterologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan ProvinceLuzhouChina
| | - Lei Shi
- Department of GastroenterologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan ProvinceLuzhouChina
| | - Mingming Deng
- Department of GastroenterologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan ProvinceLuzhouChina
| | - Shu Huang
- Department of GastroenterologyLianshui County People' HospitalHuaianChina
- Department of GastroenterologyLianshui People' Hospital of Kangda College Affiliated to Nanjing Medical UniversityHuaianChina
| | - Xiaowei Tang
- Department of GastroenterologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan ProvinceLuzhouChina
| |
Collapse
|
5
|
Kendrick P, Kelly YO, Baumann MM, Kahn E, Compton K, Schmidt C, Sylte DO, Li Z, La Motte-Kerr W, Daoud F, Ong KL, Moberg M, Hay SI, Rodriquez EJ, Strassle PD, Mensah GA, Bandiera FC, George SM, Simonsick EM, Brown C, Pérez-Stable EJ, Murray CJL, Mokdad AH, Dwyer-Lindgren L. Mortality due to falls by county, age group, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities. Lancet Public Health 2024; 9:e539-e550. [PMID: 39095132 DOI: 10.1016/s2468-2667(24)00122-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Fall-related mortality has increased rapidly over the past two decades in the USA, but the extent to which mortality varies across racial and ethnic populations, counties, and age groups is not well understood. The aim of this study was to estimate age-standardised mortality rates due to falls by racial and ethnic population, county, and age group over a 20-year period. METHODS Redistribution methods for insufficient cause of death codes and validated small-area estimation methods were applied to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate annual fall-related mortality. Estimates from 2000 to 2019 were stratified by county (n=3110) and five mutually exclusive racial and ethnic populations: American Indian or Alaska Native (AIAN), Asian or Pacific Islander (Asian), Black, Latino or Hispanic (Latino), and White. Estimates were corrected for misreporting of race and ethnicity on death certificates using published misclassification ratios. We masked (ie, did not display) estimates for county and racial and ethnic population combinations with a mean annual population of less than 1000. Age-standardised mortality is presented for all ages combined and for age groups 20-64 years (younger adults) and 65 years and older (older adults). FINDINGS Nationally, in 2019, the overall age-standardised fall-related mortality rate for the total population was 13·4 deaths per 100 000 population (95% uncertainty interval 13·3-13·6), an increase of 65·3% (61·9-68·8) from 8·1 deaths per 100 000 (8·0-8·3) in 2000, with the largest increases observed in older adults. Fall-related mortality at the national level was highest across all years in the AIAN population (in 2019, 15·9 deaths per 100 000 population [95% uncertainty interval 14·0-18·2]) and White population (14·8 deaths per 100 000 [14·6-15·0]), and was about half as high among the Latino (8·7 deaths per 100 000 [8·3-9·0]), Black (8·1 deaths per 100 000 [7·9-8·4]), and Asian (7·5 deaths per 100 000 [7·1-7·9]) populations. The disparities between racial and ethnic populations varied widely by age group, with mortality among younger adults highest for the AIAN population and mortality among older adults highest for the White population. The national-level patterns were observed broadly at the county level, although there was considerable spatial variation across ages and racial and ethnic populations. For younger adults, among almost all counties with unmasked estimates, there was higher mortality in the AIAN population than in all other racial and ethnic populations, while there were pockets of high mortality in the Latino population, particularly in the Mountain West region. For older adults, mortality was particularly high in the White population within clusters of counties across states including Florida, Minnesota, and Wisconsin. INTERPRETATION Age-standardised mortality due to falls increased over the study period for each racial and ethnic population and almost every county. Wide variation in mortality across geography, age, and race and ethnicity highlights areas and populations that might benefit most from efficacious fall prevention interventions as well as additional prevention research. FUNDING US National Institutes of Health (Intramural Research Program, National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; Intramural Research Program, National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research).
Collapse
|
6
|
Adzrago D, Williams DR, Williams F. Multiple chronic diseases and psychological distress among adults in the United States: the intersectionality of chronic diseases, race/ethnicity, immigration, sex, and insurance coverage. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02730-1. [PMID: 39017703 DOI: 10.1007/s00127-024-02730-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 07/05/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE Psychological distress significantly contributes to the burdens of morbidity and mortality in the United States (U.S.), but our understanding is limited with regards to the risk factors associated with psychological distress. We used nationally representative data to examine (1) the comorbidities of chronic diseases and their risks for psychological distress and (2) the ways in which chronic diseases combine with demographic factors such as sex, race/ethnicity, immigration status, and health insurance coverage to affect the patterning of psychological distress. METHODS We analyzed the 2005-2018 National Health Survey Interview cross-sectional data on U.S. adults aged ≥ 18 years (n = 351,457). We fitted sequential multivariable logistic regression models. RESULTS There was a dose-response relationship between the number of chronic diseases and psychological distress, with increased number of chronic diseases associated with increased psychological distress risk. Females (vs. males) and those without health insurance (vs. insured) were more likely to experience psychological distress. Immigrants (vs. non-immigrants) and racial/ethnic minorities (vs. White individuals) were less likely to experience psychological distress. There were significant interactions between chronic diseases and insurance coverage, immigration status, and race/ethnicity, but the three-way interactions were not statistically significant with psychological distress: chronic disease status vs. immigration status vs. health insurance coverage, and chronic disease vs. race/ethnicity vs. immigration status. CONCLUSION The findings suggest a critical need to consider the complex ways in which chronic diseases and psychosocial factors combine to affect psychological distress and their implications for tailoring mental health screening, initiatives to reduce distress, and prevention strategies for effectively addressing health-related disparities in the general population.
Collapse
Affiliation(s)
- David Adzrago
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
| | - David R Williams
- Department of Social and Behavioral Sciences, Department of African and African American Studies, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
7
|
Lu VM, Gurses ME, Shah KH, Chandar J, Khalafallah AM, Shah AH, Komotar RJ, Ivan ME. The Feasibility of Robot-assisted Laser Interstitial Thermal Therapy (LITT) for Brain Tumors in Octogenarians. World Neurosurg 2024:S1878-8750(24)01173-2. [PMID: 38986945 DOI: 10.1016/j.wneu.2024.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND The use of robot-assisted laser interstitial thermal therapy (LITT) is emerging as a viable treatment option for brain tumors in patients aged 80-90 years (octogenarians). Correspondingly, the aim of this study was to describe the clinical feasibility of octogenarians undergoing LITT procedure for brain tumors at our institution. METHODS A retrospective review was conducted of all robot-assisted LITT procedures performed at our institution between 2013 and 2023 for octogenarians. Comparison of continuous variables was by Student t tests, and Kaplan-Meier estimates were used to estimate survival outcomes. RESULTS A total of 20 of 311 (6%) LITT patients in the search cohort were octogenarians. Mean age was 82.6 years (range, 80.1-88.0 years) with 13 (65%) female patients. Brain tumor lesions most commonly were located on the left side (65%), and, for ablation, all were single trajectories with mean number of 2.3 ablations. No operative complications were seen during hospitalization, with mean length of stay of 1.6 days and most common disposition destination being home (95%). There were no 30- or 90-day readmissions or emergency department presentations. Mean follow-up was 12.4 months without any complications in that time. The most common pathology in our cohort was glioblastoma (55%). CONCLUSIONS Robot-assisted LITT is a safe and effective treatment option for brain tumors in octogenarians with a very low morbidity risk. Therefore, further investigation is required to understand how LITT can translate to therapeutic benefit in patients aged over 80 years old with brain tumors.
Collapse
Affiliation(s)
- Victor M Lu
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA.
| | - Muhammet E Gurses
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Khushi H Shah
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Jay Chandar
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Adham M Khalafallah
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Ashish H Shah
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| |
Collapse
|
8
|
Leung E, Yazdi H, Drayton M, Davis D, Middleton D, Senter L. Building the African American/Black Community's Capacity to Elucidate Factors for High Smoking Rates in Jackson, MS: Results from Implementing a Community-Led Needs Assessment. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02066-1. [PMID: 38969927 DOI: 10.1007/s40615-024-02066-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/14/2024] [Accepted: 06/18/2024] [Indexed: 07/07/2024]
Abstract
INTRODUCTION Although smoking has decreased dramatically over the last 50 years, reductions are uneven by race and income, specifically in the Southern United States. There is a need for intentional collaboration with communities located where large tobacco disparities exist to make lasting change. Using community-based participatory research principles, we provided intensive capacity building to a community advisory group (CAG) of 14 Jackson, MS, residents to conduct a community-led needs assessment. The aim of the community-led needs assessment was to investigate firsthand why the community smokes and the impacts of smoking-giving the CAG voice and choice to work towards reducing tobacco-related harms and inequities. METHODS From October 2020 to September 2021, CAG members conducted thirteen interviews and nine focus groups, reaching 54 residents. We analyzed the data using a thematic and in vivo approach. RESULTS Participants reported smoking is used to cope with systemic socio-economic issues (e.g., racism, poverty). Smoking is normalized in the community through continued use, ease of purchase, visibility of tobacco retailers, and lack of conversations or questioning surrounding smoking. Participants felt that peer and family use, addiction, and inaccessible smoking resources were the most influential factors driving smoking behaviors. CONCLUSION This community engagement approach empowered residents to design and implement a comprehensive needs assessment resulting in rich data-a needed approach for a community experiencing enduring health inequities. Communities need to be engaged and invested in from the beginning as equal partners to learn, investigate, and develop community-relevant and innovative solutions to address tobacco social norms.
Collapse
Affiliation(s)
- Emily Leung
- CAI (Cicatelli Associates Inc.), 505 Eighth Ave., Suite 1900, New York, NY, 10018, USA.
| | - Hanaan Yazdi
- CAI (Cicatelli Associates Inc.), 505 Eighth Ave., Suite 1900, New York, NY, 10018, USA
| | - Maisha Drayton
- CAI (Cicatelli Associates Inc.), 505 Eighth Ave., Suite 1900, New York, NY, 10018, USA
| | - David Davis
- CAI (Cicatelli Associates Inc.), 505 Eighth Ave., Suite 1900, New York, NY, 10018, USA
| | - Dawn Middleton
- CAI (Cicatelli Associates Inc.), 505 Eighth Ave., Suite 1900, New York, NY, 10018, USA
| | - Lindsay Senter
- CAI (Cicatelli Associates Inc.), 505 Eighth Ave., Suite 1900, New York, NY, 10018, USA
| |
Collapse
|
9
|
Merrill RM, Gibbons IS. Inequality in Female Breast Cancer Relative Survival Rates between White and Black Women in the United States. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02079-w. [PMID: 38961004 DOI: 10.1007/s40615-024-02079-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND This study assessed the difference in 3-, 5-, and 10-year relative survival rates (RSRs) for female breast cancer between White and Black patients across the levels of year, tumor stage, age, and marital status at diagnosis. Confounding factors and effect modifiers were considered. METHODS Analyses were based on 17 population-based tumor registries in the Surveillance, Epidemiology, and End Results (SEER) Program. Cases were diagnosed in 2000-2017 and followed through 2020. RESULTS Three-, 5-, and 10-year female breast cancer RSRs significantly improved for White and Black patients during the years 2000-2020, more so for Blacks than Whites. Three-, 5-, and 10-year estimated annual percent changes in trends were 0.09%, 0.16%, and 0.29% for Whites and 0.36%, 0.49%, and 0.86% for Blacks, respectively. However, a large difference in RSRs for White and Black patients persists, 4.2% for three-year RSRs, 5.7% for five-year RSRs, and 7.5% for 10-year RSRs, after adjusting for year, tumor stage, age, and marital status at diagnosis. The difference in RSRs between White and Black patients differs by tumor stage at diagnosis. For example, higher five-year RSRs in Whites than Blacks were 2.6% for local, 9.3% for regional, 10.4% for distant, and 6.2% for unknown/unstaged tumors at diagnosis. CONCLUSION Improvement in 3-, 5-, and 10-year female breast cancer RSRs occurred for both White and Black patients, albeit more so for Blacks. Yet the poorer RSRs for Blacks remain large and significant, increasingly so with later staged disease at diagnosis and as we move from 3- to 5- to 10-year RSRs.
Collapse
Affiliation(s)
- Ray M Merrill
- Department of Public Health, College of Life Sciences, Brigham Young University, 2063 Life Sciences Building, Provo, UT, 84602, USA.
| | - Ian S Gibbons
- Department of Public Health, College of Life Sciences, Brigham Young University, 2063 Life Sciences Building, Provo, UT, 84602, USA
| |
Collapse
|
10
|
Nalliah RP. Letters. J Am Dent Assoc 2024; 155:559-560. [PMID: 38819358 DOI: 10.1016/j.adaj.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 06/01/2024]
Affiliation(s)
- Romesh P Nalliah
- Associate Dean for Patient Services, School of Dentistry, University of Michigan, Ann Arbor, MI
| |
Collapse
|
11
|
Liu Q, Lin D. The impact of distance education on the socialization of college students in the Covid-19 era: problems in communication and impact on mental health. BMC MEDICAL EDUCATION 2024; 24:575. [PMID: 38789971 PMCID: PMC11127413 DOI: 10.1186/s12909-024-05551-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND The problems of students' social interaction and psychological well-being associated with online learning dependent on self-directed learning have become an important topic of research in recent years worldwide due to the COVID-19 pandemic, affecting their Social Emotional Learning. This paper aimed to compare the students' loneliness, social anxiety, social interaction, and general psychological well-being at different stages of online learning (at the beginning and the height of the pandemic), considering their criteria (presence/absence of a job and own family). METHODS For this, the researchers conducted an electronic survey of students (n = 320) twice, in February and May 2020, using four questionnaires: UCLA loneliness scale-3, Social Anxiety Scale for E-Learning Environments, Social Interaction Scale, and Brief Adjustment Scale. The responses at different stages of online learning were compared using Student's t-test. Differences between employed and unemployed students with or without their own families were determined using the analysis of variance (ANOVA). RESULTS The findings showed that unemployed students without their families suffered the most from loneliness. Social interaction online was rated higher by students with their own families; psychological well-being at the beginning of the distance period and social anxiety at the height of the distance period were higher among unemployed students. CONCLUSIONS This research can become a theoretical basis for a phase-by-phase study of social predictors for the psychological well-being of higher education students and is of practical value for teachers and administrators of online learning aimed at students' socialization. In addition, it provides education officials with information about how students perceive psychological well-being, anxiety, social interaction, and loneliness during distance learning, which can help officials direct their decisions and reforms to improve interaction in the online environment.
Collapse
Affiliation(s)
- Qingxia Liu
- Mental Health Education Counseling Center, Student Affairs Office, Anhui Sanlian University, Hefei, China.
| | - Douxiu Lin
- Department of Education, School of Culture and Media, Anhui Xinhua University, Hefei, China
| |
Collapse
|
12
|
Rainford M, Barbour LA, Birch D, Catalano P, Daniels E, Gremont C, Marshall NE, Wharton K, Thornburg K. Barriers to implementing good nutrition in pregnancy and early childhood: Creating equitable national solutions. Ann N Y Acad Sci 2024; 1534:94-105. [PMID: 38520393 DOI: 10.1111/nyas.15122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
Exposure to deleterious stressors in early life, such as poor nutrition, underlies most adult-onset chronic diseases. As rates of chronic disease continue to climb in the United States, a focus on good nutrition before and during pregnancy, lactation, and early childhood provides a potential opportunity to reverse this trend. This report provides an overview of nutrition investigations in pregnancy and early childhood and addresses racial disparities and health outcomes, current national guidelines, and barriers to achieving adequate nutrition in pregnant individuals and children. Current national policies and community interventions to improve nutrition, as well as the current state of nutrition education among healthcare professionals and students, are discussed. Major gaps in knowledge and implementation of nutrition practices during pregnancy and early childhood were identified and action goals were constructed. The action goals are intended to guide the development and implementation of critical nutritional strategies that bridge these gaps. Such goals create a national blueprint for improving the health of mothers and children by promoting long-term developmental outcomes that improve the overall health of the US population.
Collapse
Affiliation(s)
- Monique Rainford
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Linda A Barbour
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Darlena Birch
- Public Health Nutrition, National WIC Association, Washington, District of Columbia, USA
| | - Patrick Catalano
- Department of Obstetrics and Gynecology, Tufts University, Boston, Massachusetts, USA
| | - Ella Daniels
- Veggies Early & Often, Partnership for a Healthier America, Washington, District of Columbia, USA
| | - Caron Gremont
- Share Our Strength, Washington, District of Columbia, USA
| | - Nicole E Marshall
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Kurt Wharton
- Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Kent Thornburg
- Knight Cardiovascular Institute, Center for Developmental Health, and Moore Institute for Nutrition & Wellness, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
13
|
MacConnachie L, Zhang YS, Farina M, Gutierrez C, Hoover A, He Y, Aiello AE, Noppert GA. The association between incarceration and housing insecurity and advanced immune age during late life. Soc Sci Med 2024; 347:116698. [PMID: 38461610 PMCID: PMC11164318 DOI: 10.1016/j.socscimed.2024.116698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 03/12/2024]
Abstract
Emerging evidence suggests that psychosocial stress ages the immune system. Accordingly, immune aging may be an important potential mechanism linking psychosocial stress to aging-related decline and disease. Incarceration and housing insecurity represent severe and complex experiences of a multitude of psychosocial stressors, including discrimination, violence, and poverty. In this study, we investigated the association between incarceration and/or housing insecurity and advanced immune age in adults aged 55 and older. Our sample was derived from the Health and Retirement Survey (HRS), with n = 7003 individuals with valid housing insecurity data and n = 7523 with valid incarceration data. From 2016 Venous Blood Study data, we assessed immune aging using a comprehensive set of immune markers including inflammatory markers (IL-6, CRP, s-TNFR1), markers of viral control (CMV IgG antibodies), and ratios of T cell phenotypes (CD8+:CD4+, CD+ Memory: Naïve, CD4+ Memory: Naïve, CD8+ Memory: Naïve ratios). We found that both incarceration and housing insecurity were strongly associated with more advanced immune aging as indicated by increased inflammation, reduced viral control, and reduction in naïve T cells relative to memory T cells. Given that those who experienced incarceration, housing insecurity, and/or are racialized minorities were less likely to be included in this study, our results likely underestimated these associations. Despite these limitations, our study provided strong evidence that experiencing incarceration and/or housing insecurity may accelerate the aging of the immune system.
Collapse
Affiliation(s)
- Lauren MacConnachie
- Institute for Social Research, University of Michigan, 426 Thompson St., Ann Arbor, MI, 48103, USA.
| | - Yuan S Zhang
- Department of Sociomedical Sciences and Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Mateo Farina
- Department of Human Development and Family Sciences, Population Research Center, University of Texas at Austin, Austin, TX, USA.
| | - Carmen Gutierrez
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Andrew Hoover
- Institute for Social Research, University of Michigan, 426 Thompson St., Ann Arbor, MI, 48103, USA.
| | - Yuelin He
- Institute for Social Research, University of Michigan, 426 Thompson St., Ann Arbor, MI, 48103, USA.
| | - Allison E Aiello
- Department of Epidemiology and Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Grace A Noppert
- Institute for Social Research, University of Michigan, 426 Thompson St., Ann Arbor, MI, 48103, USA.
| |
Collapse
|
14
|
Burden of liver cancer mortality by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities. Lancet Public Health 2024; 9:e186-e198. [PMID: 38429018 PMCID: PMC10986755 DOI: 10.1016/s2468-2667(24)00002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/21/2023] [Accepted: 01/02/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Understanding how specific populations are affected by liver cancer is important for identifying priorities, policies, and interventions to mitigate health risks and reduce disparities. This study aims to provide comprehensive analysis of rates and trends in liver cancer mortality for different racial and ethnic populations in the USA nationally and at the county level from 2000 to 2019. METHODS We applied small-area estimation methods to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate liver cancer mortality rates by county, racial and ethnic population, and year (2000-19) in the USA. Race and ethnicity were categorised as non-Latino and non-Hispanic American Indian or Alaska Native (AIAN), non-Latino and non-Hispanic Asian or Pacific Islander (Asian), non-Latino and non-Hispanic Black (Black), Latino or Hispanic (Latino), and non-Latino and non-Hispanic White (White). Estimates were adjusted using published misclassification ratios to correct for inaccuracies in race or ethnicity as recorded on death certificates, and then age-standardised. Mortality rate estimates are presented for all county and racial and ethnic population combinations with a mean annual population greater than 1000. FINDINGS Nationally, the age-standardised liver cancer mortality rate increased between the years 2000 (4·2 deaths per 100 000 population [95% uncertainty interval 4·1-4·3]) and 2016 (6·0 per 100 000 [5·9-6·1]), followed by a stabilisation in rates from 2016 to 2019 (6·1 per 100 000 [6·0-6·2]). Similar trends were observed across the AIAN, Black, Latino, and White populations, whereas the Asian population showed an overall decrease across the 20-year study period. Qualitatively similar trends were observed in most counties; however, the mortality rate and the rate of change varied substantially across counties, both within and across racial and ethnic populations. For the 2016-19 period, mortality continued to increase at a substantial rate in some counties even while it stabilised nationally. Nationally, the White population had the lowest mortality rate in all years, while the racial and ethnic population with the highest rate changed from the Asian population in 2000 to the AIAN population in 2019. Racial and ethnic disparities were substantial: in 2019, mortality was highest in the AIAN population (10·5 deaths per 100 000 [9·1-12·0]), notably lower for the Asian (7·5 per 100 000 [7·1-7·9]), Black (7·6 per 100 000 [7·3-7·8]), and Latino (7·7 per 100 000 [7·5-8·0]) populations, and lowest for the White population (5·5 [5·4-5·6]). These racial and ethnic disparities in mortality were prevalent throughout the country: in 2019, mortality was higher in minoritised racial and ethnic populations than in the White population living in the same county in 408 (87·7%) of 465 counties with unmasked estimates for the AIAN population, 604 (90·6%) of 667 counties for the Asian population, 1207 (81·2%) of 1486 counties for the Black population, and 1073 (73·0%) of 1469 counties for the Latino population. INTERPRETATION Although the plateau in liver cancer mortality rates in recent years is encouraging, mortality remains too high in many locations throughout the USA, particularly for minoritised racial and ethnic populations. Addressing population-specific risk factors and differences in access to quality health care is essential for decreasing the burden and disparities in liver cancer mortality across racial and ethnic populations and locations. FUNDING US National Institutes of Health (Intramural Research Program, National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; Intramural Research Program, National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research).
Collapse
|
15
|
Cai J, Pirzada A, Baldoni PL, Heiss G, Kunz J, Rosamond WD, Youngblood ME, Aviles-Santa ML, Gallo LC, Isasi CR, Kaplan R, Lash JP, Lee DJ, Llabre MM, Schneiderman N, Wassertheil-Smoller S, Talavera GA, Daviglus ML. Cumulative All-Cause Mortality in Diverse Hispanic/Latino Adults : A Prospective, Multicenter Cohort Study. Ann Intern Med 2024; 177:303-314. [PMID: 38437694 DOI: 10.7326/m23-1990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND All-cause mortality among diverse Hispanic/Latino groups in the United States and factors underlying mortality differences have not been examined prospectively. OBJECTIVE To describe cumulative all-cause mortality (and factors underlying differences) by Hispanic/Latino background, before and during the COVID-19 pandemic. DESIGN Prospective, multicenter cohort study. SETTING Hispanic Community Health Study/Study of Latinos. PARTICIPANTS 15 568 adults aged 18 to 74 years at baseline (2008 to 2011) of Central American, Cuban, Dominican, Mexican, Puerto Rican, South American, and other backgrounds from the Bronx, New York; Chicago, Illinois; Miami, Florida; and San Diego, California. MEASUREMENTS Sociodemographic, acculturation-related, lifestyle, and clinical factors were assessed at baseline, and vital status was ascertained through December 2021 (969 deaths; 173 444 person-years of follow-up). Marginally adjusted cumulative all-cause mortality risks (11-year before the pandemic and 2-year during the pandemic) were examined using progressively adjusted Cox regression. RESULTS Before the pandemic, 11-year cumulative mortality risks adjusted for age and sex were higher in the Puerto Rican and Cuban groups (6.3% [95% CI, 5.2% to 7.6%] and 5.7% [CI, 5.0% to 6.6%], respectively) and lowest in the South American group (2.4% [CI, 1.7% to 3.5%]). Differences were attenuated with adjustment for lifestyle and clinical factors. During the pandemic, 2-year cumulative mortality risks adjusted for age and sex ranged from 1.1% (CI, 0.6% to 2.0%; South American) to 2.0% (CI, 1.4% to 3.0%; Central American); CIs overlapped across groups. With adjustment for lifestyle factors, 2-year cumulative mortality risks were highest in persons of Central American and Mexican backgrounds and lowest among those of Puerto Rican and Cuban backgrounds. LIMITATION Lack of data on race and baseline citizenship status; correlation between Hispanic/Latino background and site. CONCLUSION Differences in prepandemic mortality risks across Hispanic/Latino groups were explained by lifestyle and clinical factors. Mortality patterns changed during the pandemic, with higher risks in persons of Central American and Mexican backgrounds than in those of Puerto Rican and Cuban backgrounds. PRIMARY FUNDING SOURCE National Institutes of Health.
Collapse
Affiliation(s)
- Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.C., M.E.Y.)
| | - Amber Pirzada
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, Illinois (A.P., M.L.D.)
| | - Pedro L Baldoni
- Bioinformatics Division, Walter and Eliza Hall Institute of Medical Research, and Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia (P.L.B.)
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (G.H., W.D.R.)
| | - John Kunz
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland (J.K.)
| | - Wayne D Rosamond
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (G.H., W.D.R.)
| | - Marston E Youngblood
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.C., M.E.Y.)
| | - M Larissa Aviles-Santa
- Division of Clinical and Health Services Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland (M.L.A.)
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, California (L.C.G., G.A.T.)
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York (C.R.I., S.W.)
| | - Robert Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, and Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington (R.K.)
| | - James P Lash
- Department of Medicine, University of Illinois Chicago, Chicago, Illinois (J.P.L.)
| | - David J Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida (D.J.L.)
| | - Maria M Llabre
- Department of Psychology, University of Miami, Miami, Florida (M.M.L., N.S.)
| | - Neil Schneiderman
- Department of Psychology, University of Miami, Miami, Florida (M.M.L., N.S.)
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York (C.R.I., S.W.)
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, San Diego, California (L.C.G., G.A.T.)
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, Illinois (A.P., M.L.D.)
| |
Collapse
|
16
|
Frugé AD, Robinson LA, Strickland KP, Watts SO, Tuggle FJ, Slay JL, Sewell J, Helms K, Ellison KJ. Race and gender disparities in preventive health activity engagement of older adults in the southeastern United States. Geriatr Nurs 2024; 56:184-190. [PMID: 38359738 DOI: 10.1016/j.gerinurse.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/17/2024] [Accepted: 02/01/2024] [Indexed: 02/17/2024]
Abstract
A cross-sectional study was conducted to determine preventive-health-activity engagement in community-dwelling older adults participating in student-led health screenings in east Alabama. From 2017-2019, health professions students conducted health screenings at 23 community and independent living sites to assess medical and social needs of adults. Clients' responses to questions regarding vaccinations (flu/pneumonia/shingles), cancer screenings (colon/sex-specific), and other (dental/vision) screenings were aggregated to create a preventive health behavior (prevmed) score. Chi-square, t-tests, and regression analyses were conducted. Data from 464 adults ages 50-99 (72.9±10.1) years old were analyzed. The sample was 71.3% female, 63.1% Black/African American (BA), and 33.4% rural. Linear regression indicated BA race (p=0.001), currently unmarried (p=0.030), no primary care provider (p<0.001) or insurance (p=0.010), age <65 years (p=0.042) and assessment at a residential site (p=0.037) predicted lower prevmed scores. Social factors predict preventive health activity engagement in community-dwelling adults in east Alabama, indicating several opportunities to improve health outcomes.
Collapse
Affiliation(s)
- Andrew D Frugé
- College of Nursing, Auburn University, Auburn, AL 36849, USA.
| | - Laura A Robinson
- College of Nursing, Auburn University, Auburn, AL 36849, USA; Department of Nutritional Sciences, Auburn University, Auburn, AL 36849, USA
| | | | - Sarah O Watts
- College of Nursing, Auburn University, Auburn, AL 36849, USA
| | - Felicia J Tuggle
- Department of Sociology, Anthropology, and Social Work, Auburn University, Auburn, AL 36849, USA
| | - Jennifer L Slay
- Department of Sociology, Anthropology, and Social Work, Auburn University, Auburn, AL 36849, USA
| | - Jeanna Sewell
- Harrison College of Pharmacy, Auburn University, Auburn, AL 36849, USA
| | - Kristen Helms
- Alabama College of Osteopathic Medicine, Dothan, AL 36303, USA
| | - Kathy J Ellison
- College of Nursing, Auburn University, Auburn, AL 36849, USA
| |
Collapse
|
17
|
Bowser DM, Maurico K, Ruscitti BA, Crown WH. American clusters: using machine learning to understand health and health care disparities in the United States. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae017. [PMID: 38756919 PMCID: PMC10986293 DOI: 10.1093/haschl/qxae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/19/2023] [Accepted: 02/12/2024] [Indexed: 05/18/2024]
Abstract
Health and health care access in the United States are plagued by high inequality. While machine learning (ML) is increasingly used in clinical settings to inform health care delivery decisions and predict health care utilization, using ML as a research tool to understand health care disparities in the United States and how these are connected to health outcomes, access to health care, and health system organization is less common. We utilized over 650 variables from 24 different databases aggregated by the Agency for Healthcare Research and Quality in their Social Determinants of Health (SDOH) database. We used k-means-a non-hierarchical ML clustering method-to cluster county-level data. Principal factor analysis created county-level index values for each SDOH domain and 2 health care domains: health care infrastructure and health care access. Logistic regression classification was used to identify the primary drivers of cluster classification. The most efficient cluster classification consists of 3 distinct clusters in the United States; the cluster having the highest life expectancy comprised only 10% of counties. The most efficient ML clusters do not identify the clusters with the widest health care disparities. ML clustering, using county-level data, shows that health care infrastructure and access are the primary drivers of cluster composition.
Collapse
Affiliation(s)
- Diana M Bowser
- Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, United States
| | - Kaili Maurico
- Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, United States
| | - Brielle A Ruscitti
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454, United States
| | - William H Crown
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454, United States
| |
Collapse
|
18
|
Reitsma MB, Rose S, Reinhart A, Goldhaber-Fiebert JD, Salomon JA. Bias-Adjusted Predictions of County-Level Vaccination Coverage from the COVID-19 Trends and Impact Survey. Med Decis Making 2024; 44:175-188. [PMID: 38159263 PMCID: PMC10865746 DOI: 10.1177/0272989x231218024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 10/11/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The potential for selection bias in nonrepresentative, large-scale, low-cost survey data can limit their utility for population health measurement and public health decision making. We developed an approach to bias adjust county-level COVID-19 vaccination coverage predictions from the large-scale US COVID-19 Trends and Impact Survey. DESIGN We developed a multistep regression framework to adjust for selection bias in predicted county-level vaccination coverage plateaus. Our approach included poststratification to the American Community Survey, adjusting for differences in observed covariates, and secondary normalization to an unbiased reference indicator. As a case study, we prospectively applied this framework to predict county-level long-run vaccination coverage among children ages 5 to 11 y. We evaluated our approach against an interim observed measure of 3-mo coverage for children ages 5 to 11 y and used long-term coverage estimates to monitor equity in the pace of vaccination scale up. RESULTS Our predictions suggested a low ceiling on long-term national vaccination coverage (46%), detected substantial geographic heterogeneity (ranging from 11% to 91% across counties in the United States), and highlighted widespread disparities in the pace of scale up in the 3 mo following Emergency Use Authorization of COVID-19 vaccination for 5- to 11-y-olds. LIMITATIONS We relied on historical relationships between vaccination hesitancy and observed coverage, which may not capture rapid changes in the COVID-19 policy and epidemiologic landscape. CONCLUSIONS Our analysis demonstrates an approach to leverage differing strengths of multiple sources of information to produce estimates on the time scale and geographic scale necessary for proactive decision making. IMPLICATIONS Designing integrated health measurement systems that combine sources with different advantages across the spectrum of timeliness, spatial resolution, and representativeness can maximize the benefits of data collection relative to costs. HIGHLIGHTS The COVID-19 pandemic catalyzed massive survey data collection efforts that prioritized timeliness and sample size over population representativeness.The potential for selection bias in these large-scale, low-cost, nonrepresentative data has led to questions about their utility for population health measurement.We developed a multistep regression framework to bias adjust county-level vaccination coverage predictions from the largest public health survey conducted in the United States to date: the US COVID-19 Trends and Impact Survey.Our study demonstrates the value of leveraging differing strengths of multiple data sources to generate estimates on the time scale and geographic scale necessary for proactive public health decision making.
Collapse
Affiliation(s)
| | - Sherri Rose
- Department of Health Policy, Stanford University, Stanford, CA, USA
| | - Alex Reinhart
- Department of Statistics & Data Science, Carnegie Mellon University, Pittsburgh, PA, USA
- Delphi Group, Carnegie Mellon University, Pittsburgh, PA, USA
| | | | - Joshua A. Salomon
- Department of Health Policy, Stanford University, Stanford, CA, USA
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| |
Collapse
|
19
|
Arena R, Pronk NP, Woodard C. Predicting life expectancy in the united states: The importance of healthy living behaviors and residential geography. Prog Cardiovasc Dis 2024:S0033-0620(24)00021-5. [PMID: 38307361 DOI: 10.1016/j.pcad.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 01/27/2024] [Indexed: 02/04/2024]
Abstract
According to the World Health Organization, 30 countries currently have a life expectancy of ≥80 years: the United States (U.S.) is not among this group of countries. The current analysis assesses the ability of key lifestyle behaviors and characteristics to predict a life expectancy of ≥80 years. Only 577 (19%) of the 3066 U.S. Counties assessed had a life expectancy ≥80 years. These counties had significantly higher life expectancy (81 ± 3 vs. 76 ± 2 years) and lower percent of the population who are physically inactive (20.7 ± 3.9 vs. 27.0 ± 4.7%), actively smoke (15.9 ± 3.1 vs. 21.1 ± 3.6%), obese (31.7 ± 4.7 vs. 37.3 ± 3.9%) and have limited access to healthy food (7.1 ± 6.8 vs. 8.4 ± 6.6%) (all p < 0.001). Binary logistic regression revealed percent adults who currently smoke, percent obese, percent physically inactive, and percent with limited access to healthy food were all significant univariate predictors of ≥80 years life expectancy (p < 0.001) and retained in the multivariate regression (p < 0.05). A better understanding of the driving forces that increase healthy living behaviors should be a primary goal in the effort to increase U.S. life expectancy: an individualized approach recognizing unique regional cultures may significantly improve adoption and maintenance of desirable health behaviors and outcomes.
Collapse
Affiliation(s)
- Ross Arena
- Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, USA; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA.
| | - Nicolaas P Pronk
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA; HealthPartners Institute, Minneapolis, MN, USA; Department of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Colin Woodard
- Nationhood Lab, Pell Center for International Relations and Public Policy, Salve Regina University, Newport, RI, USA
| |
Collapse
|
20
|
Egede LE, Walker RJ, Williams JS. Addressing Structural Inequalities, Structural Racism, and Social Determinants of Health: a Vision for the Future. J Gen Intern Med 2024; 39:487-491. [PMID: 37740168 PMCID: PMC10897090 DOI: 10.1007/s11606-023-08426-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023]
Abstract
Significant national discourse has focused on the idea of structural inequalities and structural racism within a variety of societal sectors, including healthcare. This perspective provides an understanding of the historic and pervasive nature of structural inequalities and structural racism; uses well-known frameworks in health equity research for conceptualizing structural inequality and structural racism; offers a summary of the consequences of structural inequalities and structural racism on modern-day health outcomes; and concludes with strategies and suggestions for a way forward. Recommended strategies across different sectors of influence include (a) employment and economic empowerment sector: creating capacity for individuals to earn livable wages; (b) education sector: developing new funding structures to ensure equal opportunities are offered to all; (c) healthcare sector: prioritizing universal access to high-quality health care, including mental health treatment; (d) housing sector: improving access to affordable, safe housing through public-private partnerships; (e) criminal justice sector: focusing reform on restorative justice that is people-centric instead of punitive; and (f) environmental sector: creating sustainable systems that alleviate downstream consequences of climate change. The recommended strategies account for the mutually reinforcing and pervasive nature of structural inequalities/structural racism and target key sectors of influence to enhance overall health outcomes and achieve equity regardless of race, ethnicity, or socioeconomic status.
Collapse
Affiliation(s)
- Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joni S Williams
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
21
|
Jones DS, Hammonds E, Gone JP, Williams D. Explaining Health Inequities - The Enduring Legacy of Historical Biases. N Engl J Med 2024; 390:389-395. [PMID: 38284897 DOI: 10.1056/nejmp2307312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Affiliation(s)
- David S Jones
- From the Departments of the History of Science (D.S.J., E.H.), African and African American Studies (E.H., D.W.), Anthropology (J.P.G.), and Sociology (D.W.), Faculty of Arts and Sciences, Harvard University, and the Harvard University Native American Program (J.P.G.) - both in Cambridge, MA; and the Department of Global Health and Social Medicine, Harvard Medical School (D.S.J., J.P.G.), and the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (E.H., D.W.) - both in Boston
| | - Evelynn Hammonds
- From the Departments of the History of Science (D.S.J., E.H.), African and African American Studies (E.H., D.W.), Anthropology (J.P.G.), and Sociology (D.W.), Faculty of Arts and Sciences, Harvard University, and the Harvard University Native American Program (J.P.G.) - both in Cambridge, MA; and the Department of Global Health and Social Medicine, Harvard Medical School (D.S.J., J.P.G.), and the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (E.H., D.W.) - both in Boston
| | - Joseph P Gone
- From the Departments of the History of Science (D.S.J., E.H.), African and African American Studies (E.H., D.W.), Anthropology (J.P.G.), and Sociology (D.W.), Faculty of Arts and Sciences, Harvard University, and the Harvard University Native American Program (J.P.G.) - both in Cambridge, MA; and the Department of Global Health and Social Medicine, Harvard Medical School (D.S.J., J.P.G.), and the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (E.H., D.W.) - both in Boston
| | - David Williams
- From the Departments of the History of Science (D.S.J., E.H.), African and African American Studies (E.H., D.W.), Anthropology (J.P.G.), and Sociology (D.W.), Faculty of Arts and Sciences, Harvard University, and the Harvard University Native American Program (J.P.G.) - both in Cambridge, MA; and the Department of Global Health and Social Medicine, Harvard Medical School (D.S.J., J.P.G.), and the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (E.H., D.W.) - both in Boston
| |
Collapse
|
22
|
Sandoval MH, Portaccio MEA, Albala C. Ethnic differences in disability-free life expectancy and disabled life expectancy in older adults in Chile. BMC Geriatr 2024; 24:116. [PMID: 38297194 PMCID: PMC10829324 DOI: 10.1186/s12877-024-04728-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Although about 10% of the Latin American population is indigenous, ethnic differences in disability-free life expectancy (DFLE) and life expectancy with disability (DLE) are unknown. OBJECTIVE To estimate disability-free life expectancy and disabled life expectancy among Mapuche (the largest indigenous group) and non-indigenous older adults aged 60 years or more in Chile. METHOD Disability was measured following a methodology that combines limitations of daily living, cognitive impairment and dependence previously validated in Chile. Finally, the DFLE was estimated using Sullivan's method combining life tables by ethnicity and disability proportions from the EDES survey designed for the study of ethnic differentials in health and longevity in Chile. RESULTS Non-Indigenous people have a higher total and Disability-free life expectancy compared to Mapuche people at all ages. While at age 60 a Mapuche expects to live 18.9 years, of which 9.4 are disability-free, a non-Indigenous expects to live 26.4 years, of which 14 are disability-free. In addition, although the length of life with disability increases with age for both populations, Mapuche who survive to age 80 or 90 expect to live 84% and 91% of their remaining life with disability, higher proportions compared to non-indigenous people (62.9% and 75%, respectively). CONCLUSIONS This is the first study addressing inequities in DFLE between the Mapuche and non-Indigenous population, reflected in lower total life expectancy, lower DFLE and higher DLE in Mapuche compared to the non-Indigenous population. Our results underscore the need for increased capacity to monitor mortality risks among older people, considering ethnic differences.
Collapse
Affiliation(s)
- Moisés H Sandoval
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile.
| | | | - Cecilia Albala
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| |
Collapse
|
23
|
Berlinger N, Largent EA, Buchbinder M, Solomon MZ. Choice in the Context of Dementia: Emerging Issues for Health Care Practice in Aging Societies. Hastings Cent Rep 2024; 54 Suppl 1:S2-S10. [PMID: 38382040 DOI: 10.1002/hast.1549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
This introduction to the special report "Facing Dementia: Clarifying End-of-Life Choices, Supporting Better Lives" explains why focused attention to dementia is needed in bioethics and in health care practice in a range of settings. It explains how this strongly age-associated condition shapes individual lives over years, revealing inequities in how dementia care is financed. The introduction explains the structure of the report, which consists of five essays, a consolidated set of recommendations from these essays, bibliographies, and other resources. The first essay is a landscape review written for health care professionals to support discussion, debate, and deliberation within professional societies and networks concerning a patient's voluntary choice to hasten their own death in the context of a dementia diagnosis. The landscape review is followed by three essays that suggest how several familiar concepts within care for persons with serious illness should be rethought to better support advance care planning, physician-patient conversations, and access to community-based palliative care and hospice when a person is facing dementia. The final essay presents a bold, practical argument for supporting better lives for people facing dementia, and for dementia caregivers, through primary care, the usual source of care for people with dementia.
Collapse
|
24
|
Chen H, Zhou X, Hu J, Li S, Wang Z, Zhu T, Cheng H, Zhang G. Genetic insights into the association of statin and newer nonstatin drug target genes with human longevity: a Mendelian randomization analysis. Lipids Health Dis 2023; 22:220. [PMID: 38082436 PMCID: PMC10714481 DOI: 10.1186/s12944-023-01983-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND It remains controversial whether the long-term use of statins or newer nonstatin drugs has a positive effect on human longevity. Therefore, this study aimed to investigate the genetic associations between different lipid-lowering therapeutic gene targets and human longevity. METHODS Two-sample Mendelian randomization analyses were conducted. The exposures comprised genetic variants that proxy nine drug target genes mimicking lipid-lowering effects (LDLR, HMGCR, PCKS9, NPC1L1, APOB, CETP, LPL, APOC3, and ANGPTL3). Two large-scale genome-wide association study (GWAS) summary datasets of human lifespan, including up to 500,193 European individuals, were used as outcomes. The inverse-variance weighting method was applied as the main approach. Sensitivity tests were conducted to evaluate the robustness, heterogeneity, and pleiotropy of the results. Causal effects were further validated using expression quantitative trait locus (eQTL) data. RESULTS Genetically proxied LDLR variants, which mimic the effects of lowering low-density lipoprotein cholesterol (LDL-C), were associated with extended lifespan. This association was replicated in the validation set and was further confirmed in the eQTL summary data of blood and liver tissues. Mediation analysis revealed that the genetic mimicry of LDLR enhancement extended lifespan by reducing the risk of major coronary heart disease, accounting for 22.8% of the mediation effect. The genetically proxied CETP and APOC3 inhibitions also showed causal effects on increased life expectancy in both outcome datasets. The lipid-lowering variants of HMGCR, PCKS9, LPL, and APOB were associated with longer lifespans but did not causally increase extreme longevity. No statistical evidence was detected to support an association between NPC1L1 and lifespan. CONCLUSION This study suggests that LDLR is a promising genetic target for human longevity. Lipid-related gene targets, such as PCSK9, CETP, and APOC3, might potentially regulate human lifespan, thus offering promising prospects for developing newer nonstatin therapies.
Collapse
Affiliation(s)
- Han Chen
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou Road, Nanjing, 210029, People's Republic of China.
- Branch of Health Promotion and Education, Jiangsu Anti-aging Association, Nanjing, People's Republic of China.
| | - Xiaoying Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou Road, Nanjing, 210029, People's Republic of China
| | - Jingwen Hu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Shuo Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou Road, Nanjing, 210029, People's Republic of China
| | - Zi Wang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou Road, Nanjing, 210029, People's Republic of China
| | - Tong Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Hong Cheng
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Guoxin Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou Road, Nanjing, 210029, People's Republic of China.
| |
Collapse
|
25
|
Palzes VA, Chi FW, Weisner C, Kline-Simon AH, Satre DD, Sterling S. Risk profiles of adults with heavy alcohol use: Drinking patterns, behavioral and metabolic factors, health problems, and racial and ethnic disparities. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2301-2312. [PMID: 38151789 PMCID: PMC10755251 DOI: 10.1111/acer.15211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Heavy alcohol use is a growing risk factor for chronic disease, yet little is known about its co-occurrence with other risk factors and health problems. This study aimed to identify risk profiles of adults with heavy alcohol use and examined potential disparities by race and ethnicity. METHODS This cross-sectional study included 211,333 adults with heavy alcohol use (in excess of daily or weekly limits recommended by National Institute on Alcohol Abuse and Alcoholism) between June 1, 2013 and December 31, 2014 in Kaiser Permanente Northern California. Latent class analysis was used to examine how heavy drinking patterns clustered with other behavioral and metabolic risk factors and health problems to form risk profiles. Multinomial logistic regression models were fit to examine associations between race, ethnicity, and risk profiles. RESULTS A 5-class model was selected as best fitting the data and representing clinically meaningful risk profiles: (1) "heavy daily drinking and lower health risks" (DAILY, 44.3%); (2) "substance use disorder and mental health disorder" (SUD/MH, 2.3%); (3) "heavy weekly drinking and lower health risks" (WEEKLY, 19.6%); (4) "heavy daily drinking and more health risks" (DAILY-R, 18.5%); (5) "heavy weekly drinking and more health risks" (WEEKLY-R, 15.3%). American Indian or Alaska Native (AIAN) and Black patients had higher odds than White patients of being in the SUD/MH, DAILY-R, and WEEKLY-R profiles than the DAILY profile. AIAN, Black, and Latino/Hispanic patients had higher odds than White patients of being in the SUD/MH, DAILY-R, and WEEKLY-R profiles rather than the WEEKLY profile. CONCLUSIONS AIAN, Black, and Latino/Hispanic patients with self-reported heavy drinking were more likely to be in risk profiles with greater alcohol consumption, more health risks, and higher morbidity. Targeted, culturally appropriate interventions for heavy alcohol use that may address other modifiable risk factors are needed to work towards health equity.
Collapse
Affiliation(s)
- Vanessa A. Palzes
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612-2304
| | - Felicia W. Chi
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612-2304
| | - Constance Weisner
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612-2304
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 675 18 Street, San Francisco, CA 94107
| | - Andrea H. Kline-Simon
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612-2304
| | - Derek D. Satre
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612-2304
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 675 18 Street, San Francisco, CA 94107
| | - Stacy Sterling
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612-2304
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 675 18 Street, San Francisco, CA 94107
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine
| |
Collapse
|
26
|
Hill AJ, Jones DB, Woodworth L. Physician-patient race-match reduces patient mortality. JOURNAL OF HEALTH ECONOMICS 2023; 92:102821. [PMID: 37871470 DOI: 10.1016/j.jhealeco.2023.102821] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/27/2023] [Accepted: 09/23/2023] [Indexed: 10/25/2023]
Abstract
This paper assesses the impacts of physician-patient race-match, especially Black patients paired with Black physicians, on patient mortality. We draw on administrative data from Florida, linking hospital encounters from mid-2011 through 2014 to information from the Florida Physician Workforce Survey. Focusing on uninsured patients experiencing unscheduled hospital admissions who are conditionally randomly assigned to physicians, we find that physician-patient race-match for Black patients reduces the likelihood of within-hospital mortality by 0.28 percentage points, a 27 % reduction relative to the overall mortality rate. An alternative identification strategy relying on instrumental variables provides a similar finding.
Collapse
Affiliation(s)
- Andrew J Hill
- Montana State University, Department of Agricultural Economics and Economics, P.O. Box 172920, Bozeman, MT 59717, United States of America.
| | - Daniel B Jones
- University of Pittsburgh, Graduate School of Public and International Affairs, 230 S. Bouquet St., Pittsburgh, PA 15213, United States of America
| | - Lindsey Woodworth
- University of South Carolina, Darla Moore School of Business, Department of Economics, 1014 Greene St., Columbia, SC 29208, United States of America
| |
Collapse
|
27
|
Winell K, Arffman M, Salomaa V. Decreasing national trends in diabetic complications hide regional differences: a prospective population-based study using health care registers in Finland. SCAND CARDIOVASC J 2023; 57:2247190. [PMID: 37614115 DOI: 10.1080/14017431.2023.2247190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/12/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023]
Abstract
Objectives. To examine whether possibilities to improve care among patients with diabetes are reflected in the numbers of cardiovascular complications at national and regional level in Finland. Methods. The study population included all patients with diabetes in Finland since 1964. The incidences of first acute coronary syndrome, ischemic stroke and lower limb amputation were examined for the period from 2010 to 2017. The age- and sex-standardised incidence rates were calculated for the first events. Adjusted Poisson regression mixed models were used to calculate average annual trends and assess regional variation of incidences during the periods 2010 to 2013 and 2014 to 2017 in the university hospital districts (UHDs) and hospital districts (HDs). Results. The nationwide incidence of first acute coronary syndrome decreased among patients with diabetes by 2.7% (95% confidence interval 2.3%; 3.0%), ischemic stroke by 2.0% (1.5%; 2.4%) and major lower limb amputation by 4.6% (3.1%; 5.9%) annually. The sexes differed only in the decrease in acute coronary events. The annual decrease among males was 2.1% (1.6%; 2.6%) and among females was 3.4% (2.8%; 4.0%) (p = .001). Marked variation was observed among UHDs and HDs in the incidences of cardiovascular events and lower limb amputations in patients with diabetes. The variation in annual trends of diabetic complications was most pronounced in acute coronary syndrome among UHDs with an estimated variance of 0.0006 (p = .034). Conclusions. The decrease in the incidence of first cardiovascular events among patients with diabetes continued from 2010 to 2017 in Finland. However, the declining national incidence rates hide regional differences which should be a target for improvement.
Collapse
Affiliation(s)
- Klas Winell
- THL - Finnish Institute of Health and Welfare, Helsinki, Finland
- Conmedic, Espoo, Finland
| | - Martti Arffman
- THL - Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Veikko Salomaa
- THL - Finnish Institute of Health and Welfare, Helsinki, Finland
| |
Collapse
|
28
|
Pérez-Stable EJ, Webb Hooper M. The Pillars of Health Disparities Science-Race, Ethnicity, and Socioeconomic Status. JAMA HEALTH FORUM 2023; 4:e234463. [PMID: 38127587 DOI: 10.1001/jamahealthforum.2023.4463] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
This Viewpoint examines the importance of race and ethnicity and socioeconomic status as the pillars of health disparities science.
Collapse
Affiliation(s)
- Eliseo J Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Monica Webb Hooper
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
29
|
Vidiella-Martin J, Been JV. Maternal Migration Background and Mortality Among Infants Born Extremely Preterm. JAMA Netw Open 2023; 6:e2347444. [PMID: 38091041 PMCID: PMC10719757 DOI: 10.1001/jamanetworkopen.2023.47444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/30/2023] [Indexed: 12/17/2023] Open
Abstract
Importance Extremely preterm infants require care provided in neonatal intensive care units (NICUs) to survive. In the Netherlands, a decision is made regarding active treatment between 24 weeks 0 days and 25 weeks 6 days after consultation with the parents. Objective To investigate the association between maternal migration background and admissions to NICUs and mortality within the first year among extremely preterm infants. Design, Setting, and Participants This cross-sectional study linked data of registered births in the Netherlands with household-level income tax records and municipality and mortality registers. Eligible participants were households with live births at 24 weeks 0 days to 25 weeks 6 days gestation between January 1, 2010, and December 31, 2017. Data linkage and analysis was performed from March 1, 2020, to June 30, 2023. Exposure Maternal migration background, defined as no migration background vs first- or second-generation migrant mother. Main Outcomes and Measures Admissions to NICUs and mortality within the first week, month, and year of life. Logistic regressions were estimated adjusted for year of birth, maternal age, parity, household income, sex, gestational age, multiple births, and small for gestational age. NICU-specific fixed effects were also included. Results Among 1405 live births (768 male [54.7%], 546 [38.9%] with maternal migration background), 1243 (88.5%) were admitted to the NICU; 490 of 546 infants (89.7%) born to mothers with a migration background vs 753 of 859 infants (87.7%) born to mothers with no migration background were admitted to NICU (fully adjusted RR, 1.03; 95% CI, 0.99-1.08). A total of 652 live-born infants (46.4%) died within the first year of life. In the fully adjusted model, infants born to mothers with a migration background had lower risk of mortality within the first week (RR, 0.81; 95% CI, 0.66-0.99), month (RR, 0.84; 95% CI, 0.72-0.97), and year of life (RR, 0.85; 95% CI, 0.75-0.96) compared with infants born to mothers with no migration background. Conclusions In this nationally representative cross-sectional study, infants born to mothers with a migration background at 24 weeks 0 days to 25 weeks 6 days of gestation in the Netherlands had lower risk of mortality within the first year of life than those born to mothers with no migration background, a result that was unlikely to be explained by mothers from different migration backgrounds attending different NICUs or differential preferences for active obstetric management across migration backgrounds. Further research is needed to understand the underlying mechanisms driving these disparities, including parental preferences for active care of extremely preterm infants.
Collapse
Affiliation(s)
- Joaquim Vidiella-Martin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Erasmus School of Economics, Tinbergen Institute and Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Jasper V. Been
- Division of Neonatology, Department of Neonatal and Paediatric Intensive Care, Erasmus MC Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Erasmus MC Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
30
|
Ziegler C, Muchira J. Climate Change: The Ultimate Determinant of Health. Prim Care 2023; 50:645-655. [PMID: 37866837 DOI: 10.1016/j.pop.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Climate change ubiquitously influences social determinants of health via various pathways. Disproportionately burdening communities who have contributed the least to greenhouse gas (GHG) emissions and benefitted the least from economic benefits obtained through high-emission activities that cause climate change, climate justice must be centered in any discussion of health equity. This article will explore how climate change contributes to health disparities in vulnerable populations, why this is a justice issue for primary care to address, and what we can do to promote equity, resilience, and adaption in our current economic system while mitigating GHG emissions, leveraging the health sector.
Collapse
Affiliation(s)
- Carol Ziegler
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA.
| | - James Muchira
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA. https://twitter.com/JamesMuturi5
| |
Collapse
|
31
|
Lafage R, Song J, Diebo B, Daniels AH, Passias PG, Ames CP, Bess S, Eastlack R, Gupta MC, Hostin R, Kebaish K, Kim HJ, Klineberg E, Mundis GM, Smith JS, Shaffrey C, Schwab F, Lafage V, Burton D. Alterations in Magnitude and Shape of Thoracic Kyphosis Following Surgical Correction for Adult Spinal Deformity. Global Spine J 2023:21925682231218003. [PMID: 38031967 DOI: 10.1177/21925682231218003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
STUDY DESIGN Retrospective review of prospective multicenter data. OBJECTIVES This study aimed to investigate the shape of TK before and after fusion in ASD patients treated with long fusion. METHODS ASD patients undergoing posterior spinal fusions including at least T5 to L1 without prior fusion extending to the thoracic spine were included. Patients were categorized based on the preoperative T1-T12 kyphosis into: Hypo-TK (if < 30°), Normal-TK, and Hyper-TK (if > 70°). Regional kyphosis at T10-L1 (Distal), T5-T10 (Middle), and T1-T5 (Proximal) and their relative contributions to total kyphosis were compared between groups, and the pre-to postoperative changes were investigated using paired t test. RESULTS In total, 329 patients were included in this analysis (mean age: 57 ± 16 years, 79.6% female). Preoperative T1-T12 TK for the entire cohort was 40.9 ± 2° (32% Hypo-TK, 11% Hyper-TK, 57% Normal-TK). The Hypo-TK group had the smallest distal TK (5.9 vs 17.1 & 26.0), and middle TK (8.0 vs 25.3 & 45.4), but the percentage of contribution to total kyphosis was not significantly different (Distal: 24.1% vs 34.1% vs 32.8%; Middle: 46.6% vs 53.9% vs 56.8%, all P > .1). Postoperatively, T1-12 TK increased significantly (40.9 ± 2.0° vs 57.8 ± 17.6°). Each group had a decrease in distal kyphosis (Hypo-TK 2.6 ± 10.4°; Normal-TK 8.9 ± 11.5°; Hyper-TK 14.9 ± 12°, all P < .05). The middle kyphosis significantly decreased for Hyper-TK (11.8 ± 12.4) and increased for both Normal-TK and Hypo-TK (3.8 ± 11° and 14.2 ± 11°). Proximal TK increased significantly for all groups by 14-18°. Deterioration from Normal-TK to Hyper-TK postoperatively was associated with lower rate of patient satisfaction (59.6% vs 77.3%, P = .032). CONCLUSIONS Posterior spinal fusion for ASD alters the magnitude and shape of thoracic kyphosis. While 60% of patients had a normal TK at baseline, 30% of those patients developed iatrogenic hyperkyphosis postoperatively. Patients with baseline hypokyphosis were more likely to be corrected to normal TK than hyperkyphotic patients. Future research should investigate TK restoration in ASD and its impact on clinical outcomes and complications.
Collapse
Affiliation(s)
- Renaud Lafage
- Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Junho Song
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bassel Diebo
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Christopher P Ames
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Shay Bess
- Denver International Spine Center, Denver, CO, USA
| | | | - Munish C Gupta
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | | | - Khaled Kebaish
- Department of Orthopaedic Surgery, Johns Hopkins Medical Center, Baltimore, MD, USA
| | - Han Jo Kim
- Hospital for Special Surgery, New York, NY, USA
| | - Eric Klineberg
- Department of Orthopaedic surgery, University of Texas Health, Houston, TX
| | | | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | | | - Frank Schwab
- Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Douglas Burton
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas, KS, USA
| |
Collapse
|
32
|
Silva A, Saiyed NS, Canty E, Benjamins MR. Pre-pandemic trends and Black:White inequities in life expectancy across the 30 most populous U.S. cities: a population-based study. BMC Public Health 2023; 23:2310. [PMID: 37993811 PMCID: PMC10664538 DOI: 10.1186/s12889-023-17214-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Racial inequities in life expectancy, driven by structural racism, have been documented at the state and county levels; however, less information is available at the city level where local policy change generally happens. Furthermore, an assessment of life expectancy during the decade preceding COVID-19 provides a point of comparison for life expectancy estimates and trends post COVID-19 as cities recover. METHODS Using National Vital Statistics System mortality data and American Community Survey population estimates, we calculated the average annual city-level life expectancies for the non-Hispanic Black (Black), non-Hispanic White (White), and total populations. We then calculated the absolute difference between the Black and White life expectancies for each of the 30 cities and the U.S. We analyzed trends over four time periods (2008-2010, 2011-2013, 2014-2016, and 2017-2019). RESULTS In 2017-2019, life expectancies ranged from 72.75 years in Detroit to 83.15 years in San Francisco (compared to 78.29 years for the U.S.). Black life expectancy ranged from 69.94 years in Houston to 79.04 years in New York, while White life expectancy ranged from 75.18 years in Jacksonville to 86.42 years in Washington, DC. Between 2008-2010 and 2017-2019, 17 of the biggest cities experienced a statistically significant improvement in life expectancy, while 9 cities experienced a significant decrease. Black life expectancy increased significantly in 14 cities and the U.S. but decreased significantly in 4 cities. White life expectancy increased significantly in 17 cities and the U.S. but decreased in 8 cities. In 2017-2019, the U.S. and all but one of the big cities had a significantly longer life expectancy for the White population compared to the Black population. There was more than a 13-year difference between Black and White life expectancies in Washington, DC (compared to 4.18 years at the national level). From 2008-2010 to 2017-2019, the racial gap decreased significantly for the U.S. and eight cities, while it increased in seven cities. CONCLUSION Urban stakeholders and equity advocates need data on mortality inequities that are aligned with city jurisdictions to help guide the allocation of resources and implementation of interventions.
Collapse
Affiliation(s)
- Abigail Silva
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL, USA.
| | | | - Emma Canty
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL, USA
| | | |
Collapse
|
33
|
Kennedy DP, Brown RA, D'Amico EJ, Dickerson DL, Johnson CL, Malika N, Rodriguez A, Arvizu-Sanchez V. Social Networks, Cultural Pride, and Historical Loss Among Non-Reservation American Indian / Alaska Native Emerging Adults. RESEARCH SQUARE 2023:rs.3.rs-3547685. [PMID: 38045309 PMCID: PMC10690312 DOI: 10.21203/rs.3.rs-3547685/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Health disparities among American Indian/Alaska Native (AI/AN) populations in the United States are the result of historical traumas, such as colonization, forced relocation, and federal policies focused on cultural assimilation. Culturally-tailored health interventions aim to address intergenerational trauma by emphasizing cultural strengths and building positive social connections. In this article, we explore the social network characteristics of participants of the first culturally-tailored health intervention for AI/AN emerging adults (18-25) living outside of tribal lands. Participants (N = 150; 86% female) were recruited across the United States via social media and completed online egocentric network interviews prior to the start of intervention workshops. Participants' networks were diverse in composition and structure. They were primarily composed of family and friends, were people they had regular contact with, were similar age, and provided participants with support. We tested for significant associations between network characteristics, individual characteristics (age, gender, travel to reservations, speaking tribal languages, etc.) and two dependent measures: 1) cultural pride and belongingness and 2) thoughts of historical loss. Multiple regression results show that higher proportions of network members who discussed AI/AN identity with participants and having more network members who engage in traditional practices was associated with stronger cultural pride and belongingness. Higher proportions of network members having discussion of AI/AN identity with participants was also associated with more frequent thoughts of historical loss. Controlling for network factors, no individual characteristics were associated with either dependent variable. We discuss implications for the development of culturally-tailored health interventions.
Collapse
|
34
|
Warren JR, Rumore G. The association between playing professional American football and longevity. Proc Natl Acad Sci U S A 2023; 120:e2308867120. [PMID: 37903248 PMCID: PMC10636321 DOI: 10.1073/pnas.2308867120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/18/2023] [Indexed: 11/01/2023] Open
Abstract
Recent research concludes that professional American football players (hereafter, "football players") live longer than American men in general, despite experiencing higher rates of chronic traumatic encephalopathy (CTE) and cardiovascular disease (CVD). This suggests that the longevity-enhancing benefits of playing football (e.g., physical fitness, money) outweigh the costs associated with CTE, CVD, and other longevity detriments of playing football. However, these surprising results may be the consequence of flawed research design. To investigate, we conducted two analyses. In analysis 1, we compared a) all professional American football players whose first season was 1986 or between 1988 and 1995 to b) a random sample of same-age American men observed as part of the National Health Interview Surveys in those same years selected on good health, at least 3 y of college, and not being poor. The exposure consists of playing one or more games of professional football; the outcome is risk of death within 25 y. In analysis 2, we use data on 1,365 men drafted to play in the (American) National Football League in the 1950s-906 of whom ultimately played professional football, and 459 of whom never played a game in any professional league. We estimate the association between playing football and survival through early 2023. In both analyses, we investigate differences between linemen and other position players. In contrast to most prior research, in both analyses, we find that linemen died earlier than otherwise similar men; men who played other positions died no earlier (or later).
Collapse
Affiliation(s)
- John Robert Warren
- Institute for Social Research and Data Innovation, University of Minnesota, Minneapolis, MN55455
| | - Gina Rumore
- Institute for Social Research and Data Innovation, University of Minnesota, Minneapolis, MN55455
| |
Collapse
|
35
|
Krist AH, South Paul JE, Hudson SV, Meisnere M, Singer SJ, Kudler H. Rethinking Health and Health Care: How Clinicians and Practice Groups Can Better Promote Whole Health and Well-Being for People and Communities. Med Clin North Am 2023; 107:1121-1144. [PMID: 37806727 DOI: 10.1016/j.mcna.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
A new National Academies of Sciences, Engineering, and Medicine report, "Achieving Whole Health: A New Approach for Veterans and the Nation," redefines what it means to be healthy and creates a roadmap for health systems, including the Veterans Health Administration and the nation, to scale and spread a whole health approach to care. The report identifies 5 foundational elements for whole health care and sets 6 national, state, and local policy goals for change. This article summarizes the report, emphasizes the importance of preventive medicine, and identifies concrete actions clinicians and practices can take now to deliver whole health care.
Collapse
Affiliation(s)
- Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Wright Regional Center for Clinical and Translational Science, Inova Health System.
| | | | - Shawna V Hudson
- Department of Family Medicine and Community Health, Robert Wood Johnson Medical School
| | - Marc Meisnere
- National Academies of Sciences, Engineering, and Medicine
| | - Sara J Singer
- Department of Medicine, Stanford University School of Medicine
| | - Harold Kudler
- Department of Psychiatry and Behavioral Sciences, Duke University; Department of Psychiatry, Uniformed Services University of the Health Sciences
| |
Collapse
|
36
|
Rice BM. Using nursing science to advance policy and practice in the context of social and structural determinants of health. Nurs Outlook 2023; 71:102060. [PMID: 37852871 PMCID: PMC10843015 DOI: 10.1016/j.outlook.2023.102060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/17/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Social and structural determinants of health play a large role in health inequities. PURPOSE To highlight how nursing science can be used to advance policy and practice in the context of social and structural determinants of health. METHODS This paper reports on the author's keynote presentation from the 2022 State of The Science Conference on Social and Structural Determinants of Health presented by the Council for the Advancement of Nursing Science. Key concepts are overviewed and defined, followed by examples of two community-engaged research projects with findings that inform practice and policy. The author concludes with individual-, social- and structural-level recommendations as a clarion call for nurses to use research to eliminate health inequities and promote justice for all. CONCLUSION What we know is, in part, only as good as what we do with that knowledge. When lives are at stake, gone are the days of knowing something and failing to act on that knowledge.
Collapse
Affiliation(s)
- Bridgette M Rice
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA.
| |
Collapse
|
37
|
Cao G, Liu J, Liu M, Liang W. Effects of the COVID-19 pandemic on life expectancy at birth at the global, regional, and national levels: A joinpoint time-series analysis. J Glob Health 2023; 13:06042. [PMID: 37862617 PMCID: PMC10588978 DOI: 10.7189/jogh.13.06042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
Background Current estimates indicate that coronavirus disease 2019 (COVID-19) caused 14.9 million excess deaths in 2020 and 2021. Thus, estimating the change in life expectancy at birth due to the COVID-19 pandemic could aid in understanding its impact and implementing public health initiatives. Methods We collected data on the life expectancy at birth of the combined population between 1990 and 2021 at the global, regional, and national levels from the 2022 Revision of World Population Prospects. In this time series study, we estimated the trend segments, the change of trend years (joinpoints), the annual percentage change (APC) in life expectancy at birth within each trend segment, and the average APC (AAPC) in life expectancy at birth during the full study period using joinpoint regression analysis. Results The global life expectancy at birth decreased from 72.8 years in 2019 to 71.0 years in 2021, with an annual decrease of 1.2% (95% confidence interval (CI) = 1.0, 1.5) during the 2019-2021 period, despite an overall increasing trend during the entire period from 1990 to 2021 (AAPC = 0.3%; 95% CI = 0.3, 0.4). We observed a significantly increasing trend in life expectancy at birth in all regions and nearly 87.7% (207/236) of the world's countries and areas during the entire period (1990-2021). All continental regions except Africa and Oceania experienced a significant decreasing trend in life expectancy at birth in 2019-2021, with an APC of -1.2% (95% CI = -1.5, -0.9) for Asia, -2.1% (95% CI = -2.7, -1.6) for Latin America and the Caribbean, -1.1% (95% CI = -1.6, -0.6) for Northern America, and -1.4% (95% CI = -1.9, -0.9) for Europe. Among all countries and areas, 107 countries and areas (45.3%) experienced a significant decreasing trend in life expectancy at birth in the most recent time segment, with 77 countries and areas (32.6%) experiencing a significant decreasing trend during the 2019-2021 period. Conclusions The world experienced a significant decreasing trend in life expectancy at birth in 2019-2021, with a decrease of 1.8 years; all continental regions except Africa and Oceania and 77 countries and areas experienced a significant decreasing trend in life expectancy at birth. These decreasing trends at global, regional, and national levels during the 2019-2021 period reflected the COVID-19 pandemic's direct and indirect adverse effects on life expectancy at birth.
Collapse
Affiliation(s)
- Guiying Cao
- School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases, Ministry of Education, Peking University, Beijing, China
| | - Min Liu
- School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases, Ministry of Education, Peking University, Beijing, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| |
Collapse
|
38
|
Weeks WB, Chang JE, Pagán JA, Lumpkin J, Michael D, Salcido S, Kim A, Speyer P, Aerts A, Weinstein JN, Lavista JM. Rural-urban disparities in health outcomes, clinical care, health behaviors, and social determinants of health and an action-oriented, dynamic tool for visualizing them. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002420. [PMID: 37788228 PMCID: PMC10547156 DOI: 10.1371/journal.pgph.0002420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023]
Abstract
While rural-urban disparities in health and health outcomes have been demonstrated, because of their impact on (and intervenability to improve) health and health outcomes, we sought to examine cross-sectional and longitudinal inequities in health, clinical care, health behaviors, and social determinants of health (SDOH) between rural and non-rural counties in the pre-pandemic era (2015 to 2019), and to present a Health Equity Dashboard that can be used by policymakers and researchers to facilitate examining such disparities. Therefore, using data obtained from 2015-2022 County Health Rankings datasets, we used analysis of variance to examine differences in 33 county level attributes between rural and non-rural counties, calculated the change in values for each measure between 2015 and 2019, determined whether rural-urban disparities had widened, and used those data to create a Health Equity Dashboard that displays county-level individual measures or compilations of them. We followed STROBE guidelines in writing the manuscript. We found that rural counties overwhelmingly had worse measures of SDOH at the county level. With few exceptions, the measures we examined were getting worse between 2015 and 2019 in all counties, relatively more so in rural counties, resulting in the widening of rural-urban disparities in these measures. When rural-urban gaps narrowed, it tended to be in measures wherein rural counties were outperforming urban ones in the earlier period. In conclusion, our findings highlight the need for policymakers to prioritize rural settings for interventions designed to improve health outcomes, likely through improving health behaviors, clinical care, social and environmental factors, and physical environment attributes. Visualization tools can help guide policymakers and researchers with grounded information, communicate necessary data to engage relevant stakeholders, and track SDOH changes and health outcomes over time.
Collapse
Affiliation(s)
- William B. Weeks
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| | - Ji E. Chang
- School of Global Public Health, New York University, New York, New York, United States of America
| | - José A. Pagán
- School of Global Public Health, New York University, New York, New York, United States of America
| | - Jeffrey Lumpkin
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| | - Divya Michael
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| | - Santiago Salcido
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| | - Allen Kim
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| | | | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
| | - James N. Weinstein
- Microsoft Research, Microsoft Corporation, Redmond, Washington, United States of America
- The Dartmouth Institute and Tuck School of Business, Dartmouth College, Hanover, New Hampshire, United States of America
- Kellogg School of Business, Northwestern University, Evanston, Illinois, United States of America
| | - Juan M. Lavista
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| |
Collapse
|
39
|
Kowal S, Ng CD, Schuldt R, Sheinson D, Jinnett K, Basu A. Estimating the US Baseline Distribution of Health Inequalities Across Race, Ethnicity, and Geography for Equity-Informative Cost-Effectiveness Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1485-1493. [PMID: 37414278 DOI: 10.1016/j.jval.2023.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/23/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES Information on how life expectancy, disability-free life expectancy, and quality-adjusted life expectancy varies across equity-relevant subgroups is required to conduct distributional cost-effectiveness analysis. These summary measures are not comprehensively available in the United States, given limitations in nationally representative data across racial and ethnic groups. METHODS Through linkage of US national survey data sets and use of Bayesian models to address missing and suppressed mortality data, we estimate health outcomes across 5 racial and ethnic subgroups (non-Hispanic American Indian or Alaska Native, non-Hispanic Asian and Pacific Islander, non-Hispanic black, non-Hispanic white, and Hispanic). Mortality, disability, and social determinant of health data were combined to estimate sex- and age-based outcomes for equity-relevant subgroups based on race and ethnicity, as well as county-level social vulnerability. RESULTS Life expectancy, disability-free life expectancy, and quality-adjusted life expectancy at birth declined from 79.5, 69.4, and 64.3 years, respectively, among the 20% least socially vulnerable (best-off) counties to 76.8, 63.6, and 61.1 years, respectively, among the 20% most socially vulnerable (worst-off) counties. Considering differences across racial and ethnic subgroups, as well as geography, gaps between the best-off (Asian and Pacific Islander; 20% least socially vulnerable counties) and worst-off (American Indian/Alaska Native; 20% most socially vulnerable counties) subgroups were large (17.6 life-years, 20.9 disability-free life-years, and 18.0 quality-adjusted life-years) and increased with age. CONCLUSIONS Existing disparities in health across geographies and racial and ethnic subgroups may lead to distributional differences in the impact of health interventions. Data from this study support routine estimation of equity effects in healthcare decision making, including distributional cost-effectiveness analysis.
Collapse
Affiliation(s)
| | - Carmen D Ng
- Genentech, Inc, South San Francisco, CA, USA
| | | | | | | | - Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA; Salutis Consulting LLC, Bellevue, Washington, WA, USA
| |
Collapse
|
40
|
Akushevich I, Yashkin A, Kovtun M, Stallard E, Yashin AI, Kravchenko J. Decomposition of disparities in life expectancy with applications to administrative health claims and registry data. Theor Popul Biol 2023; 153:50-68. [PMID: 37295513 PMCID: PMC10526891 DOI: 10.1016/j.tpb.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 05/11/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
Research shows that geographic disparities in life expectancy between leading and lagging states are increasing over time while racial disparities between Black and White Americans have been going down. In the 65+ age strata morbidity is the most common cause of death, making differences in morbidity and associated adverse health-related outcomes between advantaged and disadvantaged groups an important aspect of disparities in life expectancy at age 65 (LE65). In this study, we used Pollard's decomposition to evaluate the disease-related contributions to disparities in LE65 for two types of data with distinctly differing structures: population/registry and administrative claims. To do so, we analyzed Pollard's integral, which is exact by construction, and developed exact analytic solutions for both types of data without the need for numerical integration. The solutions are broadly applicable and easily implemented. Applying these solutions, we found that the largest relative contributions to geographic disparities in LE65 were chronic lower respiratory diseases, circulatory diseases, and lung cancer; and, to racial disparities: arterial hypertension, diabetes mellitus, and cerebrovascular diseases. Overall, the increase in LE65 observed over 1998-2005 and 2010-2017 was primarily due to a reduction in the contributions of acute and chronic ischemic diseases; this was partially offset by increased contributions of diseases of the nervous system including dementia and Alzheimer's disease.
Collapse
Affiliation(s)
- I Akushevich
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, United States of America.
| | - A Yashkin
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, United States of America
| | - M Kovtun
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, United States of America
| | - E Stallard
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, United States of America
| | - A I Yashin
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, United States of America
| | - J Kravchenko
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
| |
Collapse
|
41
|
Ukolova E, Burcin B. Racial/Ethnic disparities in the chains of morbid events leading to death: network analysis of US multiple cause of death data. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2023; 68:149-165. [PMID: 37899643 DOI: 10.1080/19485565.2023.2271841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Multiple-cause-of-death data have not yet been applied to the study of racial/ethnic differences in causal chains of events leading to death, nor they have been used to examine racial/ethnic disparities in cause-of-death certification. We use publicly available 2019 US death certificate data to reassemble chains of morbid events leading to death. From them, we construct and analyze directed multiple cause of death networks by race and sex of deaths aged 60+. Three perspectives to measure disparities are employed: (i) relative prevalence of cause-of-death-pairs, (ii) strength of associations between diseases, (iii) similarities in transition matrices. Non-Hispanic Blacks (NHB) had overall lower prevalence of cause of death pairs, Hispanics (HIS) were burdened more by alcohol-related mortality and Asian and Pacific Islanders (API) exceeded in transitions to cerebrovascular diseases. Lower similarity was observed in transitions to external causes of death, dementia and Alzheimer's disease, pulmonary heart diseases, interstitial respiratory diseases, and diseases of the liver. After excluding rare diseases, the similarity further decreased for ill-defined conditions, diabetes mellitus, other cardiovascular diseases, diseases of the pleura, and anemia. To sum up, races/ethnicities not only vary in structure and timing of death but they differ in morbid processes leading to death as well.
Collapse
Affiliation(s)
- Elizaveta Ukolova
- Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czechia
| | - Boris Burcin
- Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czechia
| |
Collapse
|
42
|
Vo JB, Gierach GL. Understanding disparities in the burden of mortality as a step towards health equity in the USA. Lancet 2023; 402:1022-1023. [PMID: 37544308 PMCID: PMC10680152 DOI: 10.1016/s0140-6736(23)01522-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Jacqueline B Vo
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Gretchen L Gierach
- Integrative Tumor Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA.
| |
Collapse
|
43
|
Cause-specific mortality by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities. Lancet 2023; 402:1065-1082. [PMID: 37544309 PMCID: PMC10528747 DOI: 10.1016/s0140-6736(23)01088-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Large disparities in mortality exist across racial-ethnic groups and by location in the USA, but the extent to which racial-ethnic disparities vary by location, or how these patterns vary by cause of death, is not well understood. We aimed to estimate age-standardised mortality by racial-ethnic group, county, and cause of death and describe the intersection between racial-ethnic and place-based disparities in mortality in the USA, comparing patterns across health conditions. METHODS We applied small-area estimation models to death certificate data from the US National Vital Statistics system and population data from the US National Center for Health Statistics to estimate mortality by age, sex, county, and racial-ethnic group annually from 2000 to 2019 for 19 broad causes of death. Race and ethnicity were categorised as non-Latino and non-Hispanic American Indian or Alaska Native (AIAN), non-Latino and non-Hispanic Asian or Pacific Islander (Asian), non-Latino and non-Hispanic Black (Black), Latino or Hispanic (Latino), and non-Latino and non-Hispanic White (White). We adjusted these mortality rates to correct for misreporting of race and ethnicity on death certificates and generated age-standardised results using direct standardisation to the 2010 US census population. FINDINGS From 2000 to 2019, across 3110 US counties, racial-ethnic disparities in age-standardised mortality were noted for all causes of death considered. Mortality was substantially higher in the AIAN population (all-cause mortality 1028·2 [95% uncertainty interval 922·2-1142·3] per 100 000 population in 2019) and Black population (953·5 [947·5-958·8] per 100 000) than in the White population (802·5 [800·3-804·7] per 100 000), but substantially lower in the Asian population (442·3 [429·3-455·0] per 100 000) and Latino population (595·6 [583·7-606·8] per 100 000), and this pattern was found for most causes of death. However, there were exceptions to this pattern, and the exact order among racial-ethnic groups, magnitude of the disparity in both absolute and relative terms, and change over time in this magnitude varied considerably by cause of death. Similarly, substantial geographical variation in mortality was observed for all causes of death, both overall and within each racial-ethnic group. Racial-ethnic disparities observed at the national level reflect widespread disparities at the county level, although the magnitude of these disparities varied widely among counties. Certain patterns of disparity were nearly universal among counties; for example, in 2019, mortality was higher among the AIAN population than the White population in at least 95% of counties for skin and subcutaneous diseases (455 [97·8%] of 465 counties with unmasked estimates) and HIV/AIDS and sexually transmitted infections (458 [98·5%] counties), and mortality was higher among the Black population than the White population in nearly all counties for skin and subcutaneous diseases (1436 [96·6%] of 1486 counties), diabetes and kidney diseases (1473 [99·1%]), maternal and neonatal disorders (1486 [100·0%] counties), and HIV/AIDS and sexually transmitted infections (1486 [100·0%] counties). INTERPRETATION Disparities in mortality among racial-ethnic groups are ubiquitous, occurring across locations in the USA and for a wide range of health conditions. There is an urgent need to address the shared structural factors driving these widespread disparities. FUNDING National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research, US National Institutes of Health.
Collapse
|
44
|
Kelly BC, Hanson HA, Utz RL, Hollingshaus MS, Meeks H, Tay DL, Ellington L, Stephens CE, Ornstein KA, Smith KR. Disparities and determinants of place of death: Insights from the Utah Population Database. DEATH STUDIES 2023; 48:663-675. [PMID: 37676820 PMCID: PMC11119959 DOI: 10.1080/07481187.2023.2255864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
To better understand determinants and potential disparities in end of life, we model decedents' place of death with explanatory variables describing familial, social, and economic resources. A retrospective cohort of 204,041 decedents and their family members are drawn from the Utah Population Database family caregiving dataset. Using multinomial regression, we model place of death, categorized as at home, in a hospital, in another location, or unknown. The model includes family relationship variables, sex, race and ethnicity, and a socioeconomic status score, with control variables for age at death and death year. We identified the effect of a family network of multiple caregivers, with 3+ daughters decreasing odds of a hospital death by 17 percent (OR: 0.83 [0.79, 0.87], p < 0.001). Place of death also varies significantly by race and ethnicity, with most nonwhite groups more likely to die in a hospital. These determinants may contribute to disparities in end of life.
Collapse
Affiliation(s)
- Brenna C Kelly
- Department of Geography, University of Utah, Salt Lake City, Utah, USA
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Heidi A Hanson
- Computational Sciences and Engineering Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee, USA
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Rebecca L Utz
- Department of Sociology, University of Utah, Salt Lake City, Utah, USA
| | - Mike S Hollingshaus
- Kem C. Gardner Policy Institute, David Eccles School of Business, University of Utah, Salt Lake City, Utah, USA
| | - Huong Meeks
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Djin L Tay
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | | | | | - Ken R Smith
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
| |
Collapse
|
45
|
Weeks WB, Chang JE, Pagán JA, Aerts A, Weinstein JN, Ferres JL. An observational, sequential analysis of the relationship between local economic distress and inequities in health outcomes, clinical care, health behaviors, and social determinants of health. Int J Equity Health 2023; 22:181. [PMID: 37670348 PMCID: PMC10478428 DOI: 10.1186/s12939-023-01984-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/10/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Socioeconomic status has long been associated with population health and health outcomes. While ameliorating social determinants of health may improve health, identifying and targeting areas where feasible interventions are most needed would help improve health equity. We sought to identify inequities in health and social determinants of health (SDOH) associated with local economic distress at the county-level. METHODS For 3,131 counties in the 50 US states and Washington, DC (wherein approximately 325,711,203 people lived in 2019), we conducted a retrospective analysis of county-level data collected from County Health Rankings in two periods (centering around 2015 and 2019). We used ANOVA to compare thirty-three measures across five health and SDOH domains (Health Outcomes, Clinical Care, Health Behaviors, Physical Environment, and Social and Economic Factors) that were available in both periods, changes in measures between periods, and ratios of measures for the least to most prosperous counties across county-level prosperity quintiles, based on the Economic Innovation Group's 2015-2019 Distressed Community Index Scores. RESULTS With seven exceptions, in both periods, we found a worsening of values with each progression from more to less prosperous counties, with least prosperous counties having the worst values (ANOVA p < 0.001 for all measures). Between 2015 and 2019, all except six measures progressively worsened when comparing higher to lower prosperity quintiles, and gaps between the least and most prosperous counties generally widened. CONCLUSIONS In the late 2010s, the least prosperous US counties overwhelmingly had worse values in measures of Health Outcomes, Clinical Care, Health Behaviors, the Physical Environment, and Social and Economic Factors than more prosperous counties. Between 2015 and 2019, for most measures, inequities between the least and most prosperous counties widened. Our findings suggest that local economic prosperity may serve as a proxy for health and SDOH status of the community. Policymakers and leaders in public and private sectors might use long-term, targeted economic stimuli in low prosperity counties to generate local, community health benefits for vulnerable populations. Doing so could sustainably improve health; not doing so will continue to generate poor health outcomes and ever-widening economic disparities.
Collapse
Affiliation(s)
| | - Ji E Chang
- NYU School of Global Public Health, New York, NY, USA
| | - José A Pagán
- NYU School of Global Public Health, New York, NY, USA
| | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
| | | | | |
Collapse
|
46
|
Formanack A, Doshi A, Valdez R, Williams I, Moorman JR, Chernyavskiy P. Race, Class, and Place Modify Mortality Rates for the Leading Causes of Death in the United States, 1999-2021. J Gen Intern Med 2023; 38:2686-2694. [PMID: 36973572 PMCID: PMC10042402 DOI: 10.1007/s11606-023-08062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/26/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Race and ethnicity, socioeconomic class, and geographic location are well-known social determinants of health in the US. Studies of population mortality often consider two, but not all three of these risk factors. OBJECTIVES To disarticulate the associations of race (whiteness), class (socioeconomic status), and place (county) with risk of cause-specific death in the US. DESIGN We conducted a retrospective analysis of death certificate data. Bayesian regression models, adjusted for age and race/ethnicity from the American Community Survey and the county Area Deprivation Index, were used for inference. MAIN MEASURES County-level mortality for 11 leading causes of death (1999-2019) and COVID-19 (2020-2021). KEY RESULTS County "whiteness" and socioeconomic status modified death rates; geospatial effects differed by cause of death. Other factors equal, a 20% increase in county whiteness was associated with 5-8% increase in death from three causes and 4-15% reduction in death from others, including COVID-19. Other factors equal, advantaged counties had significantly lower death rates, even when juxtaposed with disadvantaged ones. Patterns of residual risk, measured by spatial county effects, varied by cause of death; for example: cancer and heart disease death rates were better explained by age, socioeconomic status, and county whiteness than were COVID-19 and suicide deaths. CONCLUSIONS There are important independent contributions from race, class, and geography to risk of death in the US.
Collapse
Affiliation(s)
| | - Ayush Doshi
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Rupa Valdez
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ishan Williams
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - J Randall Moorman
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Pavel Chernyavskiy
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA.
| |
Collapse
|
47
|
Semenza DC, Baker N, Ziminski D. Firearm violence exposure and health in 2 national samples of Black and American Indian/Alaska Native adults. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad036. [PMID: 38756674 PMCID: PMC10986215 DOI: 10.1093/haschl/qxad036] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/07/2023] [Accepted: 08/21/2023] [Indexed: 05/18/2024]
Abstract
Exposure to firearm violence is widespread and disproportionately experienced by communities of color, with implications for broad health disparities. Survey data were collected from 2 nationally representative samples of Black (n = 3015) and American Indian/Alaska Native (AI/AN) (n = 527) adults in the United States in April and May 2023. The exposure measures were 4 types of firearm violence exposure. The outcome measures were self-rated health, number of poor physical health days, and number of poor mental health days. Regression results demonstrate that being threatened with a firearm and hearing about or witnessing a shooting were associated with poorer self-rated, mental, and physical health across both samples. Cumulative exposure to firearm violence was particularly associated with increasing harms to health for all outcomes. In general, individual and cumulative firearm violence exposures are linked to poorer health among Black and AI/AN adults in the United States. Significant enhancements and long-term investment are needed for firearm violence prevention to yield improvements to population health, particularly among communities burdened with high levels of exposure to firearm violence.
Collapse
Affiliation(s)
- Daniel C Semenza
- Department of Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, NJ 08102, United States
- Department of Urban-Global Public Health, Rutgers University, Piscataway, NJ 08854, United States
- New Jersey Gun Violence Research Center, Rutgers University, Piscataway, NJ 08854, United States
| | - Nazsa Baker
- New Jersey Gun Violence Research Center, Rutgers University, Piscataway, NJ 08854, United States
| | - Devon Ziminski
- New Jersey Gun Violence Research Center, Rutgers University, Piscataway, NJ 08854, United States
- School of Social Work, Rutgers University, New Brunswick, NJ 08901, United States
| |
Collapse
|
48
|
Arias-Uriona AM, Losantos M, Bedoya P. [Intersectionality as a theoretical-analytical tool to study health inequalities in the AmericasA interseccionalidade como ferramenta teórico-analítica para estudo das desigualdades em saúde nas Américas]. Rev Panam Salud Publica 2023; 47:e133. [PMID: 37654792 PMCID: PMC10464643 DOI: 10.26633/rpsp.2023.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/27/2023] [Indexed: 09/02/2023] Open
Abstract
Objective Analyze inequalities in self-perceived health among population groups located at the intersections of gender identity, ethnicity, and education level in countries of the Americas, classified by income level. Methods Panel data from the World Values Survey were used for the period 1990-2022. The study sample included 58 790 people between 16 and 65 years of age from 14 countries in the Americas. The dependent variable was poor self-perceived health, and the independent variables were gender, education level, and ethnicity. A multi-categorical variable with 12 strata was created for the intercategorical intersectionality analysis. An analysis of individual heterogeneity and diagnostic accuracy was performed using five logistic regression models, adjusted by age and by survey wave. Results A clear and persistent intersectional gradient for poor self-perceived health was observed in all country disaggregations by income. Compared to the category with the most advantage (men of majority ethnicity and higher education), the other groups had increased risk of poor health, with the highest risk among women of minority ethnicity and in Indigenous peoples with less than secondary education (three to four times higher). In addition, women had a higher risk of poor health than men in each pair of intersectional strata. Conclusions The intersectional analysis demonstrated a persistent social gradient of self-perceived ill health in the Americas.
Collapse
Affiliation(s)
- Ana M. Arias-Uriona
- Universidad Católica Boliviana San PabloInstituto de Investigaciones en Ciencias del Comportamiento (IICC)La PazEstado Plurinacional de BoliviaUniversidad Católica Boliviana San Pablo, Instituto de Investigaciones en Ciencias del Comportamiento (IICC), La Paz, Estado Plurinacional de Bolivia.
| | - Marcela Losantos
- Universidad Católica Boliviana San PabloInstituto de Investigaciones en Ciencias del Comportamiento (IICC)La PazEstado Plurinacional de BoliviaUniversidad Católica Boliviana San Pablo, Instituto de Investigaciones en Ciencias del Comportamiento (IICC), La Paz, Estado Plurinacional de Bolivia.
| | - Paola Bedoya
- Fundación Universitaria Los LibertadoresFacultad de Derecho y Ciencia PolíticaBogotáColombiaFundación Universitaria Los Libertadores, Facultad de Derecho y Ciencia Política, Bogotá, Colombia
| |
Collapse
|
49
|
Bailey RL, Stover PJ. Precision Nutrition: The Hype Is Exceeding the Science and Evidentiary Standards Needed to Inform Public Health Recommendations for Prevention of Chronic Disease. Annu Rev Nutr 2023; 43:385-407. [PMID: 37603433 PMCID: PMC11015823 DOI: 10.1146/annurev-nutr-061021-025153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
As dietary guidance for populations shifts from preventing deficiency disorders to chronic disease risk reduction, the biology supporting such guidance becomes more complex due to the multifactorial risk profile of disease and inherent population heterogeneity in the diet-disease relationship. Diet is a primary driver of chronic disease risk, and population-based guidance should account for individual responses. Cascading effects on evidentiary standards for population-based guidance are not straightforward. Precision remains a consideration for dietary guidance to prevent deficiency through the identification of population subgroups with unique nutritional needs. Reducing chronic disease through diet requires greater precision in (a) establishing essential nutrient needs throughout the life cycle in both health and disease; (b) considering effects of nutrients and other food substances on metabolic, immunological, inflammatory, and other physiological responses supporting healthy aging; and (c) considering healthy eating behaviors. Herein we provide a template for guiding population-based eating recommendations for reducing chronic diseases in heterogenous populations.
Collapse
Affiliation(s)
- Regan L Bailey
- Institute for Advancing Health through Agriculture and Department of Nutrition Science, Texas A&M University, College Station, Texas, USA;
| | - Patrick J Stover
- Institute for Advancing Health through Agriculture and Department of Nutrition Science, Texas A&M University, College Station, Texas, USA;
| |
Collapse
|
50
|
Reisinger L, Schmidt F, Benz K, Vignali L, Roesch S, Kronbichler M, Weisz N. Ageing as risk factor for tinnitus and its complex interplay with hearing loss-evidence from online and NHANES data. BMC Med 2023; 21:283. [PMID: 37533027 PMCID: PMC10394883 DOI: 10.1186/s12916-023-02998-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/21/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Tinnitus affects 10 to 15% of the population, but its underlying causes are not yet fully understood. Hearing loss has been established as the most important risk factor. Ageing is also known to accompany increased prevalence; however, the risk is normally seen in context with (age-related) hearing loss. Whether ageing per se is a risk factor has not yet been established. We specifically focused on the effect of ageing and the relationship between age, hearing loss, and tinnitus. METHODS We used two samples for our analyses. The first, exploratory analyses comprised 2249 Austrian individuals. The second included data from 16,008 people, drawn from a publicly available dataset (NHANES). We used logistic regressions to investigate the effect of age on tinnitus. RESULTS In both samples, ageing per se was found to be a significant predictor of tinnitus. In the more decisive NHANES sample, there was an additional interaction effect between age and hearing loss. Odds ratio analyses show that per unit increase of hearing loss, the odds of reporting tinnitus is higher in older people (1.06 vs 1.03). CONCLUSIONS Expanding previous findings of hearing loss as the main risk factor for tinnitus, we established ageing as a risk factor in its own right. Underlying mechanisms remain unclear, and this work calls for urgent research efforts to link biological ageing processes, hearing loss, and tinnitus. We therefore suggest a novel working hypothesis that integrates these aspects from an ageing brain viewpoint.
Collapse
Affiliation(s)
- Lisa Reisinger
- Centre for Cognitive Neuroscience and Department of Psychology, Paris-Lodron-University Salzburg, Salzburg, Austria.
| | - Fabian Schmidt
- Centre for Cognitive Neuroscience and Department of Psychology, Paris-Lodron-University Salzburg, Salzburg, Austria
| | - Kaja Benz
- Centre for Cognitive Neuroscience and Department of Psychology, Paris-Lodron-University Salzburg, Salzburg, Austria
| | | | - Sebastian Roesch
- Department of Otorhinolaryngology, Head and Neck Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Martin Kronbichler
- Centre for Cognitive Neuroscience and Department of Psychology, Paris-Lodron-University Salzburg, Salzburg, Austria
| | - Nathan Weisz
- Centre for Cognitive Neuroscience and Department of Psychology, Paris-Lodron-University Salzburg, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|