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Voss MW, Hung M, Li W, Richards LG, Price P, Terrill A, Barrett T. Costs of Forced Retirement: Measuring the Effect of Lost Work Opportunity on Health. J Occup Environ Med 2024; 66:e343-e348. [PMID: 38748399 PMCID: PMC11300168 DOI: 10.1097/jom.0000000000003137] [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: 08/06/2024]
Abstract
OBJECTIVE Unemployment is a known health stressor that also increases early retirements. This study addresses mixed literature on retiree health and underreporting of forced retirement to better identify potential health impacts of lost work opportunity. METHODS A Lost-work Opportunity Score (LOS) was created using variables from the Health and Retirement Study assessing unemployment, forced retirement, and earlier-than-planned retirement for 2576 respondents. Reliability and unidimensionality of the score with multivariate regression analyses examined health impacts controlling for demographics and prior health status. RESULTS The LOS possessed unidimensionality with a Cronbach's alpha of a = 0.76 while predicting self-reported health declines (LOS = 2; β = 0.381, OR = 1.464, P < 0.05) and depression increase (LOS = 2; β = 0.417, OR = 1.517, P < 0.05). CONCLUSIONS LOS predicts 46% increased odds of negative self-reported health change after retirement associated with two LOS events, with implications to support aging workers.
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Affiliation(s)
- Maren Wright Voss
- Harvard T.H. Chan School of Public Health, Center for Work, Health, and Wellbeing, Cambridge, MA, USA
| | - Man Hung
- Roseman University, College of Dental Medicine; South Jordan, UT, USA
| | - Wei Li
- Utah System of Higher Education, Commissioner’s Office, Salt Lake City, UT, USA
| | - Lorie Gage Richards
- University of Utah, Occupational and Recreational Therapies, Salt Lake City, UT, USA
| | - Pollie Price
- University of Utah, Occupational and Recreational Therapies, Salt Lake City, UT, USA
| | - Alexandra Terrill
- University of Utah, Occupational and Recreational Therapies, Salt Lake City, UT, USA
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2
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Liu B, Tang L, Peng N, Wang L. Lung and bone metastases patterns in limb osteosarcoma: Surgical treatment of primary site improves overall survival. Medicine (Baltimore) 2023; 102:e35671. [PMID: 37861481 PMCID: PMC10589517 DOI: 10.1097/md.0000000000035671] [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: 06/27/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
Osteosarcoma (OS) is one of the most prevalent malignant bone tumors. The proportion of patients with limb OS was relatively high. Lung metastasis (LM) and bone metastasis are the first and second most common metastatic types of OS, respectively. A total of 270 new cases of LM, 55 new cases of bone metastases (BM), and 36 new cases of lung and BM were diagnosed in the surveillance, epidemiology and end results database from 2010 to 2019. Univariate and multivariate logistic regression analyses were used to identify the risk factors for lung and/or BM, and Cox regression analyses were performed to identify the prognostic factors for lung and/or BM. Kaplan-Meier curves and log-rank tests were used to analyze the overall survival of limb OS patients with lung and/or BM. Female sex, telangiectatic OS type, central OS type, T3 stage, N1 stage, BM, surgical treatments, radiotherapy and chemotherapy were significantly correlated with LM. T3 stage, LM, liver metastases, and radiotherapy significantly correlated with BM. The small cell OS type, T2 stage, T3 stage, N1 stage, liver metastases, and radiotherapy were significantly correlated with lung and BM. Among limb OS patients with LM, the mean survival months of older age, black race, N1 stage, BM, brain metastases, no surgery, and no chemotherapy were lower than those of the control group. In limb OS patients with LM and BM, the mean survival months in the no surgery group was lower than in the surgery group. T stage and radiotherapy significantly influence the occurrence of limb OS with lung and/or BM. Surgery at the primary site has been shown to be effective in improving the survival rate of patients with lung and/or BM.
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Affiliation(s)
- Binbin Liu
- Department of Orthopedics, Cangzhou Central Hospital, Cangzhou, Hebei, P.R. China
| | - Liyuan Tang
- Drug Clinical Trial Institution, Cangzhou Central Hospital, Cangzhou, Hebei, P.R. China
| | - Ningning Peng
- Department of Orthopedics, Cangzhou Central Hospital, Cangzhou, Hebei, P.R. China
| | - Liguo Wang
- Department of Orthopedics, Cangzhou Central Hospital, Cangzhou, Hebei, P.R. China
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3
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Tang L, Liu B. Lung and bone metastases patterns in osteosarcoma: Chemotherapy improves overall survival. Medicine (Baltimore) 2023; 102:e32692. [PMID: 36705375 PMCID: PMC9875956 DOI: 10.1097/md.0000000000032692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Osteosarcoma (OS) is a malignant tumor originating from the mesenchymal tissue. Simultaneous reports of lung and bone metastases (BM) in OS are rare in the literature. A total of 353 new cases of lung metastases (LM), 93 new cases of BM, and 59 new cases of LM and BM were diagnosed in the Surveillance, Epidemiology and End Results (SEER) database from 2010 to 2019. Univariate and multivariate logistic regression analyses were used to identify risk factors for LM and/or BM, and Cox regression analyses were performed to identify the prognostic factors for LM and/or BM. Kaplan-Meier (K-M) curves and log-rank tests were used to analyze the overall survival of patients with LM and/or BM. LM was diagnosed in 353 patients. Female sex, tumor size >100 mm, telangiectatic OS type, central OS type, N1 stage, other locations, BM, surgical treatments, radiotherapy and chemotherapy were significantly correlated with LM. 93 patients were diagnosed with BM. 25 to 59 years old, T1 stage, presence of LM, liver metastases, radiotherapy, and surgical treatments were significantly correlated with the BM. 59 patients were diagnosed with LM and BM. The chondroblastic OS type, small cell OS type, T1 stage, N1 stage, other locations, liver metastases, radiotherapy, and surgical treatments were significantly correlated with LM and BM. Metastases, radiotherapy, and surgery at the primary site were significantly associated with LM and/or BM. Chemotherapy at the primary site has been shown to be effective in improving the survival rate of LM and/or BM. Of the OS patients with LM, 61.47% died, and older age, BM, no surgery, and no chemotherapy were harmful to survival. 72.04% of OS patients with BM died, and N1 stage, no surgery, and no chemotherapy were harmful for survival. 69.49% of OS patients with LM and BM died, and older age and no chemotherapy were harmful for survival.
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Affiliation(s)
- Liyuan Tang
- Drug Clinical Trial Institution, Cangzhou Central Hospital, Cangzhou, Hebei, P.R. China
| | - Binbin Liu
- Department of Orthopedics, Cangzhou Central Hospital, Cangzhou, Hebei, P.R. China
- *Correspondence: Binbin Liu, Department of Orthopedics, Cangzhou Central Hospital, No. 16, Xinhua West Road, Cangzhou, 061000, Hebei, P.R. China (e-mail: )
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Employment Status and Alcohol-Attributable Mortality Risk-A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127354. [PMID: 35742600 PMCID: PMC9224380 DOI: 10.3390/ijerph19127354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/30/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022]
Abstract
Being unemployed has been linked to various health burdens. In particular, there appears to be an association between unemployment and alcohol-attributable deaths. However, risk estimates presented in a previous review were based on only two studies. Thus, we estimated updated sex-stratified alcohol-attributable mortality risks for unemployed compared with employed individuals. A systematic literature search was conducted in August 2020 using the following databases: Embase, MEDLINE, PsycINFO, and Web of Science. The relative risk (RR) of dying from an alcohol-attributable cause of death for unemployed compared with employed individuals was summarized using sex-stratified random-effects DerSimonian-Laird meta-analyses. A total of 10 studies were identified, comprising about 14.4 million women and 19.0 million men, among whom there were about 3147 and 17,815 alcohol-attributable deaths, respectively. The pooled RRs were 3.64 (95% confidence interval (CI): 2.04–6.66) and 4.93 (95% CI 3.45–7.05) for women and men, respectively. The findings of our quantitative synthesis provide evidence that being unemployed is associated with an over three-fold higher risk of alcohol-attributable mortality compared with being employed. Consequently, a global public health strategy connecting brief interventions and specialized care with social services assisting those currently unemployed is needed.
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Coman EN, Steinbach S, Cao G. Spatial perspectives in family health research. Fam Pract 2022; 39:556-562. [PMID: 34910138 DOI: 10.1093/fampra/cmab165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Emil N Coman
- University of Connecticut School of Medicine, Health Disparities Institute, Hartford, CT, United States
| | - Sandro Steinbach
- University of Connecticut, Department of Agricultural and Resource Economics, Storrs, CT, United States
| | - Guofeng Cao
- University of Colorado Boulder, Department of Geography, Boulder, CO, United States
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6
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Lleras-Muney A. EDUCATION AND INCOME GRADIENTS IN LONGEVITY: THE ROLE OF POLICY. THE CANADIAN JOURNAL OF ECONOMICS. REVUE CANADIENNE D'ECONOMIQUE 2022; 55:5-37. [PMID: 37987018 PMCID: PMC10659761 DOI: 10.1111/caje.12582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Education and income are strong predictors of health and longevity. In the last 20 years many efforts have been made to understand if these relationships are causal and what the possible role of policy should be as a result. The evidence from various studies is ambiguous: the effects of education and income policies on health are heterogeneous and vary over time, and across places and populations. I discuss explanations for these disparate results and suggest directions for future research.
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Affiliation(s)
- Adriana Lleras-Muney
- NATIONAL BUREAU OF ECONOMIC RESEARCH, 1050 Massachusetts Avenue, Cambridge, MA 02138
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Xu T, Clark AJ, Pentti J, Rugulies R, Lange T, Vahtera J, Magnusson Hanson LL, Westerlund H, Kivimäki M, Rod NH. Characteristics of Workplace Psychosocial Resources and Risk of Diabetes: A Prospective Cohort Study. Diabetes Care 2022; 45:59-66. [PMID: 34740912 PMCID: PMC9004314 DOI: 10.2337/dc20-2943] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 10/05/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine whether characteristics of workplace psychosocial resources are associated with the risk of type 2 diabetes among employees. RESEARCH DESIGN AND METHODS Participants were 49,835 employees (77% women, aged 40-65 years, and diabetes free at baseline) from the Finnish Public Sector cohort study. Characteristics of horizontal (culture of collaboration and support from colleagues) and vertical (leadership quality and organizational procedural justice) psychosocial resources were self-reported. Incident type 2 diabetes (n = 2,148) was ascertained through linkage to electronic health records from national registers. We used latent class modeling to assess the clustering of resource characteristics. Cox proportional hazards models were used to examine the relationship between the identified clusters and risk of type 2 diabetes during 10.9 years of follow-up, adjusting for age, sex, marital status, educational level, type of employment contract, comorbidity, and diagnosed mental disorders. RESULTS We identified four patterns of workplace psychosocial resources: unfavorable, favorable vertical, favorable horizontal, and favorable vertical and horizontal. Compared with unfavorable, favorable vertical (hazard ratio 0.87 [95% CI 0.78; 0.97]), favorable horizontal (0.77 [0.67; 0.88]), and favorable vertical and horizontal (0.77 [0.68; 0.86]) resources were associated with a lower risk of type 2 diabetes, with the strongest associations seen in employees at age ≥55 years (Pinteraction = 0.03). These associations were robust to multivariable adjustments and were not explained by reverse causation. CONCLUSIONS A favorable culture of collaboration, support from colleagues, leadership quality, and organizational procedural justice are associated with a lower risk of employees developing type 2 diabetes than in those without such favorable workplace psychosocial resources.
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Affiliation(s)
- Tianwei Xu
- 1Stress Research Institute, Stockholm University, Stockholm, Sweden.,2Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,3National Research Centre of the Working Environment, Copenhagen, Denmark
| | - Alice J Clark
- 2Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,4Novo Nordisk A/S, Søborg, Denmark
| | - Jaana Pentti
- 5Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,6Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Reiner Rugulies
- 2Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,3National Research Centre of the Working Environment, Copenhagen, Denmark.,7Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Theis Lange
- 2Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jussi Vahtera
- 6Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.,8Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Hugo Westerlund
- 1Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Mika Kivimäki
- 5Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,9Department of Epidemiology and Public Health, University College, London, U.K.,10Finnish Institute of Occupational Health, Helsinki, Finland
| | - Naja H Rod
- 2Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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8
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Jajtner KM, Brucker DL, Mitra S. Midlife Work Limitations are Associated with Lower Odds of Survival and Healthy Aging. J Gerontol B Psychol Sci Soc Sci 2021; 77:790-802. [PMID: 34791218 PMCID: PMC8974351 DOI: 10.1093/geronb/gbab214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Health conditions that limit work are associated with myriad socioeconomic disadvantages and around half of Americans could face a work limitation at some point in their working career. Our study examines the relationship between midlife work limitations and two aging outcomes: longevity and healthy aging. METHODS Using longitudinal data from the Panel Study of Income Dynamics and restricted mortality data, multivariate logistic regressions estimate the odds of desirable aging outcomes around age 65 for individuals with various midlife work limitation histories in samples of around 2,000 individuals. RESULTS Midlife work limitations are consistently linked with a lower likelihood of desirable aging outcomes. Temporary limitations are associated with 59% and 69% lower survival and healthy aging odds, respectively. Chronic limitations are associated with approximately 80% lower survival odds and 90% lower healthy aging odds at age 65. DISCUSSION Even temporary work limitations can be highly disadvantageous for aging outcomes, emphasizing the need to understand different work limitation histories. Future research should identify underlying mechanisms linking midlife work limitations and less desirable aging outcomes.
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Affiliation(s)
- Katie M Jajtner
- Center for Demography of Health and Aging, University of Wisconsin–Madison, Madison, Wisconsin, USA,Address correspondence to: Katie M. Jajtner, PhD, University of Wisconsin–Madison, 1180 Observatory Dr. Rm. 4408, Madison, WI 53706, USA. E-mail:
| | - Debra L Brucker
- Institute on Disability, University of New Hampshire, Durham, New Hampshire, USA
| | - Sophie Mitra
- Department of Economics, Fordham University, Bronx, New York, USA
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9
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Cervini-Plá M, Vall-Castelló J. Business cycle and mortality in Spain. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:1289-1299. [PMID: 34160727 PMCID: PMC8526462 DOI: 10.1007/s10198-021-01336-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 06/08/2021] [Indexed: 05/25/2023]
Abstract
In the last couple of decades, there has been a lot of interest on the impact of macroeconomic fluctuations on health and mortality rates. Many studies, for different countries, find that mortality is procyclical. However, studies examining the effects of more recent recessions are less conclusive, finding mortality to be less procyclical, or even countercyclical. In this paper, using data of Spanish provinces from 1999 to 2016, we investigate how this relationship works in the context of a country that is subject to extreme business cycle fluctuations. Furthermore, we analyze the impact of unemployment for different mortality causes and we explore differences by sex, age group and level of education. In general terms, we find mortality to be procyclical so that when the economy is in a recession, mortality falls. When exploring mortality causes, we show that deaths from cardiovascular disease, cancer, senility, transport accidents and homicides are procyclical. By sex, we find procyclicality for both men and women. By age, mortality is procyclical for all age groups; however, the causes of death that result in this procyclical behavior are specific to each age group. By educational level, suicide appears as a countercyclical cause for individuals with intermediate levels of education.
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Affiliation(s)
- María Cervini-Plá
- Universitat Autònoma de Barcelona, Edifici B. Campus UAB, Bellaterra (Cerdanyola del Vallès), 08193, Barcelona, Spain.
- EQUALITAS, Madrid, Spain.
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10
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Eisenberg-Guyot J, Mooney SJ, Barrington WE, Hajat A. Union Burying Ground: Mortality, Mortality Inequities, and Sinking Labor Union Membership in the United States. Epidemiology 2021; 32:721-730. [PMID: 34224470 PMCID: PMC8338895 DOI: 10.1097/ede.0000000000001386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Over the last several decades in the United States, socioeconomic life-expectancy inequities have increased 1-2 years. Declining labor-union density has fueled growing income inequities across classes and exacerbated racial income inequities. Using Panel Study of Income Dynamics (PSID) data, we examined the longitudinal union-mortality relationship and estimated whether declining union density has also exacerbated mortality inequities. METHODS Our sample included respondents ages 25-66 to the 1979-2015 PSID with mortality follow-up through age 68 and year 2017. To address healthy-worker bias, we used the parametric g-formula. First, we estimated how a scenario setting all (versus none) of respondents' employed-person-years to union-member employed-person-years would have affected mortality incidence. Next, we examined gender, racial, and educational effect modification. Finally, we estimated how racial and educational mortality inequities would have changed if union-membership prevalence had remained at 1979 (vs. 2015) levels throughout follow-up. RESULTS In the full sample (respondents = 23,022, observations = 146,681), the union scenario was associated with lower mortality incidence than the nonunion scenario (RR = 0.90, 95% CI = 0.80, 0.99; RD per 1,000 = -19, 95% CI = -37, -1). This protective association generally held across subgroups, although it was stronger among the more-educated. However, we found little evidence mortality inequities would have lessened if union membership had remained at 1979 levels. CONCLUSIONS To our knowledge, this was the first individual-level US-based study with repeated union-membership measurements to analyze the union-mortality relationship. We estimated a protective union-mortality association, but found little evidence declining union density has exacerbated mortality inequities; importantly, we did not incorporate contextual-level effects. See video abstract at, http://links.lww.com/EDE/B839.
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Affiliation(s)
- Jerzy Eisenberg-Guyot
- Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, NY
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
| | - Stephen J. Mooney
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | - Wendy E. Barrington
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
- Department of Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, WA
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
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11
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Kujur SK, Goswami D. Do Covid-19 induced NHRD policies have a dampening effect on employment? HUMAN RESOURCE DEVELOPMENT INTERNATIONAL 2021. [DOI: 10.1080/13678868.2021.1936404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sandeep Kumar Kujur
- Department of Economics, Institute of Public Enterprise, Hyderabad, Telangana, India
| | - Diti Goswami
- Department of Humanities and Social Sciences, Indian Institute of Technology Delhi, New Delhi, India
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12
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Eisenberg-Guyot J, Mooney SJ, Barrington WE, Hajat A. Does the Union Make Us Strong? Labor-Union Membership, Self-Rated Health, and Mental Illness: A Parametric G-Formula Approach. Am J Epidemiol 2021; 190:630-641. [PMID: 33047779 PMCID: PMC8024047 DOI: 10.1093/aje/kwaa221] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 09/25/2020] [Accepted: 10/08/2020] [Indexed: 11/14/2022] Open
Abstract
Union members enjoy better wages and benefits and greater power than nonmembers, which can improve health. However, the longitudinal union-health relationship remains uncertain, partially because of healthy-worker bias, which cannot be addressed without high-quality data and methods that account for exposure-confounder feedback and structural nonpositivity. Applying one such method, the parametric g-formula, to US-based Panel Study of Income Dynamics data, we analyzed the longitudinal relationships between union membership, poor/fair self-rated health (SRH), and moderate mental illness (Kessler 6-item score of ≥5). The SRH analyses included 16,719 respondents followed from 1985-2017, while the mental-illness analyses included 5,813 respondents followed from 2001-2017. Using the parametric g-formula, we contrasted cumulative incidence of the outcomes under 2 scenarios, one in which we set all employed-person-years to union-member employed-person-years (union scenario), and one in which we set no employed-person-years to union-member employed-person-years (nonunion scenario). We also examined whether the contrast varied by sex, sex and race, and sex and education. Overall, the union scenario was not associated with reduced incidence of poor/fair SRH (relative risk = 1.01, 95% confidence interval (CI): 0.95, 1.09; risk difference = 0.01, 95% CI: -0.03, 0.04) or moderate mental illness (relative risk = 1.02, 95% CI: 0.92, 1.12; risk difference = 0.01, 95% CI: -0.04, 0.06) relative to the nonunion scenario. These associations largely did not vary by subgroup.
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Affiliation(s)
- Jerzy Eisenberg-Guyot
- Correspondence to: Dr. Jerzy Eisenberg-Guyot, Department of Epidemiology, School of Public Health, University of Washington, 3980 15th Avenue NE, Box #351619, Seattle, WA 98195 (e-mail: )
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13
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Experiences of involuntary job loss and health during the economic crisis in Portugal. Porto Biomed J 2021; 6:e121. [PMID: 33884317 PMCID: PMC8055490 DOI: 10.1097/j.pbj.0000000000000121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 11/27/2020] [Indexed: 11/26/2022] Open
Abstract
Background: The economic recession that started in 2008 left many unemployed across several European countries. Many studies have analyzed the relationship between job loss, health, and well-being in other contexts. This study aimed to explore experiences of involuntary unemployment during the economic recession and their relationship with health, conceptualized as a state of physical, mental, and social well-being among unemployed individuals. Methods: Semistructured qualitative interviews were carried out among a convenience sample of participants who became unemployed during the economic recession. The analysis was conducted to identify patterns and themes. Results: Participants (n = 22; 8 men and 14 women; 23–51 years) experienced feelings of loss of identity, stress, and a sense of powerlessness due to unemployment, as well as a lack of purpose and structure in their daily lives. Six themes were identified: work as the basis for life structure and personal fulfillment; response to unemployment and the importance of its duration; unemployment leading to isolation and loss of a role in society; impact of a change in financial situation on social life and consumption patterns; the physical and psychological health consequences of unemployment; and searching for ways to cope with unemployment and to feel well. Conclusions: Losing a job is an adverse experience that impairs an individual's perception of overall health and well-being. From a public health perspective, the results of this study highlight the need for policymakers’ awareness to help mitigate the potential consequences of involuntary job loss in the short- and long-term.
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14
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Moss JL, Johnson NJ, Yu M, Altekruse SF, Cronin KA. Comparisons of individual- and area-level socioeconomic status as proxies for individual-level measures: evidence from the Mortality Disparities in American Communities study. Popul Health Metr 2021; 19:1. [PMID: 33413469 PMCID: PMC7792135 DOI: 10.1186/s12963-020-00244-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 12/16/2020] [Indexed: 01/10/2023] Open
Abstract
Background Area-level measures are often used to approximate socioeconomic status (SES) when individual-level data are not available. However, no national studies have examined the validity of these measures in approximating individual-level SES. Methods Data came from ~ 3,471,000 participants in the Mortality Disparities in American Communities study, which links data from 2008 American Community Survey to National Death Index (through 2015). We calculated correlations, specificity, sensitivity, and odds ratios to summarize the concordance between individual-, census tract-, and county-level SES indicators (e.g., household income, college degree, unemployment). We estimated the association between each SES measure and mortality to illustrate the implications of misclassification for estimates of the SES-mortality association. Results Participants with high individual-level SES were more likely than other participants to live in high-SES areas. For example, individuals with high household incomes were more likely to live in census tracts (r = 0.232; odds ratio [OR] = 2.284) or counties (r = 0.157; OR = 1.325) whose median household income was above the US median. Across indicators, mortality was higher among low-SES groups (all p < .0001). Compared to county-level, census tract-level measures more closely approximated individual-level associations with mortality. Conclusions Moderate agreement emerged among binary indicators of SES across individual, census tract, and county levels, with increased precision for census tract compared to county measures when approximating individual-level values. When area level measures were used as proxies for individual SES, the SES-mortality associations were systematically underestimated. Studies using area-level SES proxies should use caution when selecting, analyzing, and interpreting associations with health outcomes.
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Affiliation(s)
- Jennifer L Moss
- Cancer Prevention Fellowship Program, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA. .,Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, 134 Sipe Ave., #205, P.O. Box 850, MC HS72, Hershey, PA, 17033, USA.
| | - Norman J Johnson
- Center for Administrative Records Research and Applications, Research & Methodologies Directorate, US Bureau of the Census, Suitland, MD, USA
| | - Mandi Yu
- Statistical Research & Applications Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Sean F Altekruse
- Cardiovascular Epidemiology Branch, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Kathleen A Cronin
- Office of the Associate Director, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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Pereyra-Zamora P, Copete JM, Oliva-Arocas A, Caballero P, Moncho J, Vergara-Hernández C, Nolasco A. Changes in Socioeconomic Inequalities in Amenable Mortality after the Economic Crisis in Cities of the Spanish Mediterranean Coast. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6489. [PMID: 32899994 PMCID: PMC7559182 DOI: 10.3390/ijerph17186489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Abstract
Several studies have described a decreasing trend in amenable mortality, as well as the existence of socioeconomic inequalities that affect it. However, their evolution, particularly in small urban areas, has largely been overlooked. The aim of this study is to analyse the socioeconomic inequalities in amenable mortality in three cities of the Valencian Community, namely, Alicante, Castellon, and Valencia, as well as their evolution before and after the start of the economic crisis (2000-2007 and 2008-2015). The units of analysis have been the census tracts and a deprivation index has been calculated to classify them according to their level of socioeconomic deprivation. Deaths and population were also grouped by sex, age group, period, and five levels of deprivation. The specific rates by sex, age group, deprivation level, and period were calculated for the total number of deaths due to all causes and amenable mortality and Poisson regression models were adjusted in order to estimate the relative risk. This study confirms that the inequalities between areas of greater and lesser deprivation in both all-cause mortality and amenable mortality persisted along the two study periods in the three cities. It also shows that these inequalities appear with greater risk of death in the areas of greatest deprivation, although not uniformly. In general, the risks of death from all causes and amenable mortality have decreased significantly from one period to the other, although not in all the groups studied. The evolution of death risks from before the onset of the crisis to the period after presented, overall, a general pro-cyclical trend. However, there are population subgroups for which the trend was counter-cyclical. The use of the deprivation index has made it possible to identify specific geographical areas with vulnerable populations in all three cities and, at the same time, to identify the change in the level of deprivation (ascending or descending) of the geographical areas throughout the two periods. It is precisely these areas where more attention is needed in order to reduce inequalities.
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Affiliation(s)
- Pamela Pereyra-Zamora
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (J.M.C.); (A.O.-A.); (P.C.); (J.M.); (A.N.)
| | - José M. Copete
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (J.M.C.); (A.O.-A.); (P.C.); (J.M.); (A.N.)
| | - Adriana Oliva-Arocas
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (J.M.C.); (A.O.-A.); (P.C.); (J.M.); (A.N.)
| | - Pablo Caballero
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (J.M.C.); (A.O.-A.); (P.C.); (J.M.); (A.N.)
| | - Joaquín Moncho
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (J.M.C.); (A.O.-A.); (P.C.); (J.M.); (A.N.)
| | - Carlos Vergara-Hernández
- Área de Desigualdades en Salud, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), 46035 Valencia, Spain;
| | - Andreu Nolasco
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (J.M.C.); (A.O.-A.); (P.C.); (J.M.); (A.N.)
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16
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Montez JK, Beckfield J, Cooney JK, Grumbach JM, Hayward MD, Koytak HZ, Woolf SH, Zajacova A. US State Policies, Politics, and Life Expectancy. Milbank Q 2020; 98:668-699. [PMID: 32748998 PMCID: PMC7482386 DOI: 10.1111/1468-0009.12469] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Policy Points Changes in US state policies since the 1970s, particularly after 2010, have played an important role in the stagnation and recent decline in US life expectancy. Some US state policies appear to be key levers for improving life expectancy, such as policies on tobacco, labor, immigration, civil rights, and the environment. US life expectancy is estimated to be 2.8 years longer among women and 2.1 years longer among men if all US states enjoyed the health advantages of states with more liberal policies, which would put US life expectancy on par with other high‐income countries.
Context Life expectancy in the United States has increased little in previous decades, declined in recent years, and become more unequal across US states. Those trends were accompanied by substantial changes in the US policy environment, particularly at the state level. State policies affect nearly every aspect of people's lives, including economic well‐being, social relationships, education, housing, lifestyles, and access to medical care. This study examines the extent to which the state policy environment may have contributed to the troubling trends in US life expectancy. Methods We merged annual data on life expectancy for US states from 1970 to 2014 with annual data on 18 state‐level policy domains such as tobacco, environment, tax, and labor. Using the 45 years of data and controlling for differences in the characteristics of states and their populations, we modeled the association between state policies and life expectancy, and assessed how changes in those policies may have contributed to trends in US life expectancy from 1970 through 2014. Findings Results show that changes in life expectancy during 1970‐2014 were associated with changes in state policies on a conservative‐liberal continuum, where more liberal policies expand economic regulations and protect marginalized groups. States that implemented more conservative policies were more likely to experience a reduction in life expectancy. We estimated that the shallow upward trend in US life expectancy from 2010 to 2014 would have been 25% steeper for women and 13% steeper for men had state policies not changed as they did. We also estimated that US life expectancy would be 2.8 years longer among women and 2.1 years longer among men if all states enjoyed the health advantages of states with more liberal policies. Conclusions Understanding and reversing the troubling trends and growing inequalities in US life expectancy requires attention to US state policy contexts, their dynamic changes in recent decades, and the forces behind those changes. Changes in US political and policy contexts since the 1970s may undergird the deterioration of Americans’ health and longevity.
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Affiliation(s)
| | | | | | | | | | | | | | - Anna Zajacova
- University of Western Ontario.,Coauthors listed alphabetically
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17
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Voss MW, Al Snih S, Li W, Hung M, Richards LG. Boundaries of the Construct of Unemployment in the Preretirement Years: Exploring an Expanded Measurement of Lost-Work Opportunity. WORK, AGING AND RETIREMENT 2020; 6:59-63. [PMID: 31949916 PMCID: PMC6947921 DOI: 10.1093/workar/waz006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There is uncertainty related to whether retirement negatively affects health-possibly due to complexity around retirement decisions. Lost-work opportunity through unemployment or forced retirement has been shown to negatively affect health. Lost-work opportunity can be captured in two measurement fields, either a reported experience of being forced into retirement or reported unemployment. However, 17% of individuals retiring due to the loss of work opportunity identified in qualitative interviewing (i.e., unemployment, temporary lay-offs, company buy-outs, forced relocations, etc.) do not report this unemployment or involuntary retirement in quantitative survey responses. We propose broadening the conceptualization of late-career unemployment to incorporate other lost work opportunity scenarios. Using the Health and Retirement Study (HRS), a lost-work opportunity score (LOS) was computed from items indicating unemployment and forced or unplanned retirement. Correlations were computed between this LOS and all continuous variables in the RAND longitudinal compilation of the HRS to determine its convergent and discriminant validity. The LOS demonstrated a Chronbach's alpha of α = .82 and had convergent validity with constructs of employment (9 variables), finances (36 variables), and health (14 variables), as predicted by the literature on retirement timing. No other continuous variables in the HRS were identified with a moderate or strong correlation to LOS, demonstrating discriminant validity. Further research should explore whether a combination of variables in the HRS can improve the accuracy of measuring lost-work opportunity. Improved precision in measurement, through an expanded conceptualization of lost-work opportunity, may help explicate the retirement-related factors that affect health, to inform policy and support healthy aging decisions at a societal level.
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Affiliation(s)
- Maren Wright Voss
- Health and Wellness Extension, Utah State University, Logan, Utah, USA
- College of Health, Division of Rehabilitation Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Soham Al Snih
- Division of Rehabilitation Sciences, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Wei Li
- Department of Family and Preventative Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Man Hung
- Roseman University of Health Sciences, College of Dental Medicine, South Jordan, Utah, USA
| | - Lorie Gage Richards
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, Utah, USA
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18
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Shi R, Meacham S, Davis GC, You W, Sun Y, Goessl C. Factors influencing high respiratory mortality in coal-mining counties: a repeated cross-sectional study. BMC Public Health 2019; 19:1484. [PMID: 31703658 PMCID: PMC6839055 DOI: 10.1186/s12889-019-7858-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 10/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies have associated elevated mortality risk in central Appalachia with coal-mining activities, but few have explored how different non-coal factors influence the association within each county. Consequently, there is a knowledge gap in identifying effective ways to address health disparities in coal-mining counties. To specifically address this knowledge gap, this study estimated the effect of living in a coal-mining county on non-malignant respiratory diseases (NMRD) mortality, and defined this as "coal-county effect." We also investigated what factors may accentuate or attenuate the coal-county effect. METHODS An ecological epidemiology protocol was designed to observe the characteristics of three populations and to identify the effects of coal-mining on community health. Records for seven coal-mining counties (n = 19,692) were obtained with approvals from the Virginia Department of Health Office of Vital Statistics for the years 2005 to 2012. Also requested were records from three adjacent coal counties (n = 10,425) to provide a geographic comparison. For a baseline comparison, records were requested for eleven tobacco-producing counties (n = 27,800). We analyzed the association of 57,917 individual mortality records in Virginia with coal-mining county residency, county-level socioeconomic status, health access, behavioral risk factors, and coal production. The development of a two-level hierarchical model allowed the coal-county effect to vary by county-level characteristics. Wald tests detected sets of significant factors explaining the variation of impacts across counties. Furthermore, to illustrate how the model estimations help explain health disparities, two coal-mining county case studies were presented. RESULTS The main result revealed that coal-mining county residency increased the probability of dying from NMRD. The coal-county effect was accentuated by surface coal mining, high smoking rates, decreasing health insurance coverage, and a shortage of doctors. In Virginia coal-mining regions, the average coal-county effect increased by 147% (p-value< 0.01) when one doctor per 1000 left, and the effect increased by 68% (p-value< 0.01) with a 1% reduction of health insurance rates, holding other factors fixed. CONCLUSIONS This study showed a high mortality risk of NMRD associated with residents living in Virginia coal-mining counties. Our results also revealed the critical role of health access in reducing health disparities related to coal exposure.
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Affiliation(s)
- Ruoding Shi
- Department of Agricultural & Applied Economics, Virginia Tech, 250 Drillfield Drive, Blacksburg, VA 24061 USA
| | - Susan Meacham
- Edward Via College of Osteopathic Medicine, Biomedical Sciences, 2265 Kraft Drive, Blacksburg, VA 24061 USA
| | - George C. Davis
- Department of Agricultural & Applied Economics, Virginia Tech, 250 Drillfield Drive, Blacksburg, VA 24061 USA
| | - Wen You
- Department of Public Health Sciences, University of Virginia, 200 Jeanette Lancaster Way, Charlottesville, VA 22903 USA
| | - Yu Sun
- China Center for Health Economic Research, Peking University, Beijing, 100871 China
| | - Cody Goessl
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE 68198 USA
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19
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Gugushvili A, Kaiser C. Equality of opportunity is linked to lower mortality in Europe. J Epidemiol Community Health 2019; 74:151-157. [PMID: 31690589 PMCID: PMC6993020 DOI: 10.1136/jech-2019-212540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/28/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022]
Abstract
Background This study investigates if intergenerational equality of opportunity is linked to mortality in 30 European countries. Equality of opportunity may lead to greater returns on health investments and, consequently, improved health outcomes. In turn, a perceived lack of fairness in the distribution of life chances and limited possibilities for upward intergenerational mobility can cause anxiety among individuals and gradually compromise their health. Methods We used information on 163 467 individuals’ and their parents’ Socio-Economic Index of Occupational Status from a large survey data set—the European Social Survey—to generate three complementary measures of equality of opportunity. We then linked these to administrative data on total, gender-specific and cause-specific mortality rates assembled by Eurostat from the national statistical offices. Results We found that lower equality of opportunity, measured by the attainment of individuals from the lowest and highest quartiles of socioeconomic status and by the overall intergenerational correlation in socioeconomic status, was related to higher mortality rates, particularly in relation to diseases of the nervous system and the sense organs, diseases of the respiratory system and external causes of mortality. Our measures of equality of opportunity were more consistently linked with mortality of men than women. Conclusion Equality of opportunity may be an important explanation of mortality that warrants further research. Measures that aim at facilitating intergenerational social mobility can be justified not only via normative considerations of equality of opportunity but also in terms of individuals’ chances to enjoy healthy lives.
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Affiliation(s)
- Alexi Gugushvili
- Department of Social Policy and Intervention and Nuffield College, University of Oxford, Oxford, UK .,Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Caspar Kaiser
- Department of Social Policy and Intervention and Nuffield College, University of Oxford, Oxford, UK
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20
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Bilal U, Glass TA, Del Cura-Gonzalez I, Sanchez-Perruca L, Celentano DD, Franco M. Neighborhood social and economic change and diabetes incidence: The HeartHealthyHoods study. Health Place 2019; 58:102149. [PMID: 31220800 DOI: 10.1016/j.healthplace.2019.102149] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 05/09/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
We studied the association between neighborhood social and economic change and type 2 diabetes incidence in the city of Madrid (Spain). We followed 199,621 individuals living in 393 census tracts for diabetes incidence for 6 years using electronic health records, starting in 2009. We measured neighborhood social and economic change from 2005 to 2009 using a finite mixture model with 16 indicators that resulted in four types of neighborhood change. Adjusted results showed an association between neighborhood change and diabetes incidence: compared to those living in Aging/Stable areas, people living in Declining SES, New Housing and Improving SES areas have an 8% (HR = 0.92, 95% CI 0.87 to 0.99), 9% (HR = 0.91, 95% CI 0.81 to 1.01) and 11% (HR = 0.89, 95% CI 0.81 to 0.98) decrease in diabetes incidence. This evidence can help guide policies for diabetes prevention by focusing efforts on specific urban areas.
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Affiliation(s)
- Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA; Social and Cardiovascular Research Group, Universidad de Alcala, Alcala de Henares, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Thomas A Glass
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Isabel Del Cura-Gonzalez
- Primary Care Research Unit, Gerencia de Atención Primaria, Madrid, Spain; Department Preventive Medicine and Public Health, University Rey Juan Carlos, Madrid, Spain; Red de Investigación en Servicios de Salud y Enfermedades Crónicas (REDISSEC) ISCIII, Madrid, Spain
| | - Luis Sanchez-Perruca
- Primary Care Research Unit, Gerencia de Atención Primaria, Madrid, Spain; Red de Investigación en Servicios de Salud y Enfermedades Crónicas (REDISSEC) ISCIII, Madrid, Spain
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Manuel Franco
- Social and Cardiovascular Research Group, Universidad de Alcala, Alcala de Henares, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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21
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Noelke C, Chen YH, Osypuk TL, Acevedo-Garcia D. Economic Downturns and Inequities in Birth Outcomes: Evidence From 149 Million US Births. Am J Epidemiol 2019; 188:1092-1100. [PMID: 30989169 PMCID: PMC7476222 DOI: 10.1093/aje/kwz042] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 01/03/2023] Open
Abstract
Using birth certificate data for nearly all registered US births from 1976 to 2016 and monthly data on state unemployment rates, we reexamined the link between macroeconomic variation and birth outcomes. We hypothesized that economic downturns reduce exposure to work-related stressors and pollution while increasing exposure to socioeconomic stressors like job loss. Because of preexisting inequalities in health and other resources, we expected that less-educated mothers and black mothers would be more exposed to macroeconomic variation. Using fixed-effect regression models, we found that a 1-percentage-point increase in state unemployment during the first trimester of pregnancy increased the probability of preterm birth by 0.1 percentage points, while increases in the state unemployment rate during the second/third trimester reduced the probability of preterm birth by 0.06 percentage points. During the period encompassing the Great Recession, the magnitude of these associations doubled in size. We found substantial variation in the impact of economic conditions across different groups, with highly educated white women least affected and less-educated black women most affected. The results highlight the increased relevance of economic conditions for birth outcomes and population health as well as continuing, large inequities in the exposure and impact of macroeconomic fluctuations on birth outcomes.
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Affiliation(s)
- Clemens Noelke
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Yu-Han Chen
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Theresa L Osypuk
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Dolores Acevedo-Garcia
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
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22
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Longitudinal employment trajectories and health in middle life: Insights from linked administrative and survey data. DEMOGRAPHIC RESEARCH 2019. [DOI: 10.4054/demres.2019.40.47] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Unemployment and cause-specific mortality among the Belgian working-age population: The role of social context and gender. PLoS One 2019; 14:e0216145. [PMID: 31048926 PMCID: PMC6497266 DOI: 10.1371/journal.pone.0216145] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 04/15/2019] [Indexed: 11/19/2022] Open
Abstract
Background Life expectancy increased in industrialized countries, but inequalities in health and mortality by socioeconomic position (SEP) still persist. Several studies have documented educational inequalities, yet the association between health and employment status remains unclear. However, this is an important issue considering the instability of the labour market and the fact that unemployment now also touches ‘non-traditional groups’ (e.g. the high-educated). This study will 1) probe into the association between unemployment and cause-specific mortality; 2) look into the possible protective effect of sociodemographic variables; 3) assess the association between unemployment, SEP, gender and cause-specific mortality. Material and methods Individually linked data of the Belgian census (2001) and Register data on emigration and cause-specific mortality during 2001–2011 are used. The study population contains the Belgian population eligible for employment at census, based on age (25–59 years) and being in good health. Both absolute and relative measures of all-cause and cause-specific mortality by employment status have been calculated, stratified by gender and adjusted for sociodemographic and socioeconomic indicators. Results Unemployed men and women were at a higher risk for all-cause and cause-specific mortality compared with their employed counterparts. The excess mortality among unemployed Belgians was particularly high for endocrine and digestive diseases, mental disorders, and falls, and more pronounced among men than among women. Other indicators of SEP did only slightly decrease the mortality disadvantage of being unemployed. Discussion The findings stress the need for actions to ameliorate the health status of unemployed people, especially for the most vulnerable groups in society.
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Wang Q, Tapia Granados JA. Economic growth and mental health in 21st century China. Soc Sci Med 2019; 220:387-395. [DOI: 10.1016/j.socscimed.2018.11.031] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/16/2018] [Accepted: 11/21/2018] [Indexed: 12/22/2022]
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Tapia Granados JA, Christine PJ, Ionides EL, Carnethon MR, Diez Roux AV, Kiefe CI, Schreiner PJ. Cardiovascular Risk Factors, Depression, and Alcohol Consumption During Joblessness and During Recessions Among Young Adults in CARDIA. Am J Epidemiol 2018; 187:2339-2345. [PMID: 29955769 PMCID: PMC6211238 DOI: 10.1093/aje/kwy127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 06/01/2018] [Accepted: 06/15/2018] [Indexed: 11/14/2022] Open
Abstract
Research has shown that recessions are associated with lower cardiovascular mortality, but unemployed individuals have a higher risk of cardiovascular disease (CVD) or death. We used data from 8 consecutive examinations (1985-2011) of the Coronary Artery Risk Development in Young Adults (CARDIA) cohort, modeled in fixed-effect panel regressions, to investigate simultaneously the associations of CVD risk factors with the employment status of individuals and the macroeconomic conditions prevalent in the state where the individual lives. We found that unemployed individuals had lower levels of blood pressure, high-density lipoprotein cholesterol, and physical activity, and they had significantly higher depression scores, but they were similar to their counterparts in smoking status, alcohol consumption, low-density lipoprotein cholesterol levels, body mass index, and waist circumference. A 1-percentage-point higher unemployment rate at the state level was associated with lower systolic (-0.41 mm Hg, 95% CI: -0.65, -0.17) and diastolic (-0.19, 95% CI: -0.39, 0.01) blood pressure, higher physical activity levels, higher depressive symptom scores, lower waist circumference, and less smoking. We conclude that levels of CVD risk factors tend to improve during recessions, but mental health tends to deteriorate. Unemployed individuals are significantly more depressed, and they likely have lower levels of physical activity and high-density lipoprotein cholesterol.
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Affiliation(s)
- José A Tapia Granados
- Department of Politics, College of Arts and Sciences, Drexel University, Philadelphia, Pennsylvania
| | - Paul J Christine
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
- Department of Internal Medicine, College of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Edward L Ionides
- Department of Statistics, College of Literature, Science and the Arts, University of Michigan, Ann Arbor, Michigan
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ana V Diez Roux
- School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Catarina I Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
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Voss MW, Wadsworth LL, Birmingham W, Merryman MB, Crabtree L, Subasic K, Hung M. Health Effects of Late-Career Unemployment. J Aging Health 2018; 32:106-116. [PMID: 30338714 DOI: 10.1177/0898264318806792] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: Job loss has a demonstrated negative impact on physical and mental health. Involuntary retirement has also been linked to poorer physical and mental health outcomes. This study examined whether late-career unemployment is related to involuntary retirement and health declines postretirement. Method: Analysis was conducted using the 2000-2012 U.S. Health and Retirement Study (HRS) survey data with unemployment months regressed with demographic and baseline health measures on physical and mental health. Results: Individuals with late-career unemployment reported more involuntary retirement timing (47.0%) compared with those reporting no unemployment (27.9%). Late-career unemployment had no significant effect on self-reported physical health (β = .003, p = .84), but was significantly associated with lower levels of mental health (β = .039; p < .01). Conclusion: Self-reports of late-career unemployment are not associated with physical health in retirement, but unemployment is associated with involuntary retirement timing and mental health declines in retirement. Unemployment late in the working career should be addressed as a public mental health concern.
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Affiliation(s)
- Maren Wright Voss
- Utah State University, Logan, UT, USA.,Towson University, Towson, MD, USA
| | | | | | | | | | | | - Man Hung
- The University of Utah, Salt Lake City, UT, USA
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Bilal U, Cooper R, Abreu F, Nau C, Franco M, Glass TA. Economic growth and mortality: do social protection policies matter? Int J Epidemiol 2018; 46:1147-1156. [PMID: 28338775 DOI: 10.1093/ije/dyx016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2017] [Indexed: 12/31/2022] Open
Abstract
Background In the 20th century, periods of macroeconomic growth have been associated with increases in population mortality. Factors that cause or mitigate this association are not well understood. Evidence suggests that social policy may buffer the deleterious impact of economic growth. We sought to explore associations between changing unemployment (as a proxy for economic change) and trends in mortality over 30 years in the context of varying social protection expenditures. Methods We model change in all-cause mortality in 21 OECD (Organization for Economic Cooperation and Development) countries from 1980 to 2010. Data from the Comparative Welfare States Data Set and the WHO Mortality Database were used. A decrease in the unemployment rate was used as a proxy for economic growth and age-adjusted mortality rates as the outcome. Social protection expenditure was measured as percentage of gross domestic product expended. Results A 1% decrease in unemployment (i.e. the proxy for economic growth) was associated with a 0.24% increase in the overall mortality rate (95% confidence interval: 0.07;0.42) in countries with no changes in social protection. Reductions in social protection expenditure strengthened this association between unemployment and mortality. The magnitude of the association was diminished over time. Conclusions Our results are consistent with the hypothesis that social protection policies that accompany economic growth can mitigate its potential deleterious effects on health. Further research should identify specific policies that are most effective.
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Affiliation(s)
- Usama Bilal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Social and Cardiovascular Epidemiology Research Group, Universidad de Alcala, Madrid, Spain
| | - Richard Cooper
- Department of Public Health Sciences, Loyola University Stritch School of Medicine, Chicago, IL, USA
| | | | - Claudia Nau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Manuel Franco
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Social and Cardiovascular Epidemiology Research Group, Universidad de Alcala, Madrid, Spain
| | - Thomas A Glass
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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De Moortel D, Hagedoorn P, Vanroelen C, Gadeyne S. Employment status and mortality in the context of high and low regional unemployment levels in Belgium (2001-2011): A test of the social norm hypothesis across educational levels. PLoS One 2018; 13:e0192526. [PMID: 29420646 PMCID: PMC5805313 DOI: 10.1371/journal.pone.0192526] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/25/2018] [Indexed: 11/18/2022] Open
Abstract
Because of compositional effects (more highly educated unemployed) and differences in the vulnerability towards the health consequences of unemployment (i.e. disappointment paradox hypothesis and/or status inconsistency for highly educated unemployed), it is argued that indicators of educational attainment need to be included when investigating the social norm of unemployment. Data from the 2001 census linked to register data from 2001-2011 are used, selecting all Belgian employed and unemployed between 30 and 59-year-old at time of the census. Poisson multilevel modelling was used to account for clustering of respondents within sub-districts. For individuals with low education levels, the relative difference in mortality rate ratios between the unemployed and employed is smallest in those regions where aggregate unemployment levels are high. For highly educated, this social norm effect was not found. This study suggest that the social norm effect is stronger for workers with low education levels, while highly educated workers suffer from disappointment and status inconsistency.
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Affiliation(s)
- Deborah De Moortel
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
- Research Foundation Flanders, Brussels, Belgium
- Centre for Health and Society, Institute of Medical Sociology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Paulien Hagedoorn
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
| | - Christophe Vanroelen
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
- Research Foundation Flanders, Brussels, Belgium
- Health Inequalities Research Group (GREDS), Universitat Pompeu Fabra, Barcelona, Spain
| | - Sylvie Gadeyne
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
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Abouk R, Adams S. Examining the relationship between medical cannabis laws and cardiovascular deaths in the US. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 53:1-7. [PMID: 29227828 DOI: 10.1016/j.drugpo.2017.11.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 11/02/2017] [Accepted: 11/23/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Several countries and many U.S. states have allowed, for cannabis to be used as therapy to treat chronic conditions or pain., This has increased the use of cannabis, particularly among older people.Because cannabis has been linked to adverse cardiac events in the medical literature, there may be unintended consequences on increased use among older people. METHODS We analyze cardiac-related mortality data from the U.S. National Vital Statistics System for 1990-2014. We use difference-in-difference fixed-effects models to assess whether there are increased rates of cardiac-related mortality following passage of medical cannabis programs. We also analyze whether states with more liberal rules on dispensing cannabis show higher mortality rates. RESULTS For men, there is a statistically significant 2.3% increase in the rate of cardiac death following passage. For women, there is a 1.3% increase that is also statistically significant. he effects increase or both men and women with age. The effects are also stronger in states with more a lax approach to cannabis dispensing. CONCLUSION Policymakers should be aware of a potential unintended consequence of allowing broader use of cannabis, specifically for those more at risk of cardiovascular events.
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Affiliation(s)
- Rahi Abouk
- Department of Economics, Finance and Global Business, William Paterson University, United States
| | - Scott Adams
- Department of Economics, University of Wisconsin-Milwaukee, United States.
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Tapia Granados JA, Ionides EL. Population health and the economy: Mortality and the Great Recession in Europe. HEALTH ECONOMICS 2017; 26:e219-e235. [PMID: 28345272 DOI: 10.1002/hec.3495] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 12/22/2016] [Accepted: 01/19/2017] [Indexed: 06/06/2023]
Abstract
We analyze the evolution of mortality-based health indicators in 27 European countries before and after the start of the Great Recession. We find that in the countries where the crisis has been particularly severe, mortality reductions in 2007-2010 were considerably bigger than in 2004-2007. Panel models adjusted for space-invariant and time-invariant factors show that an increase of 1 percentage point in the national unemployment rate is associated with a reduction of 0.5% (p < .001) in the rate of age-adjusted mortality. The pattern of mortality oscillating procyclically is found for total and sex-specific mortality, cause-specific mortality due to major causes of death, and mortality for ages 30-44 and 75 and over, but not for ages 0-14. Suicides appear increasing when the economy decelerates-countercyclically-but the evidence is weak. Results are robust to using different weights in the regression, applying nonlinear methods for detrending, expanding the sample, and using as business cycle indicator gross domestic product per capita or employment-to-population ratios rather than the unemployment rate. We conclude that in the European experience of the past 20 years, recessions, on average, have beneficial short-term effects on mortality of the adult population.
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Schafer MH, Upenieks L, MacNeil A. Disorderly Households, Self-Presentation, and Mortality: Evidence From a National Study of Older Adults. Res Aging 2017; 40:762-790. [PMID: 29137529 DOI: 10.1177/0164027517741347] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This article examines whether disorderly household conditions and bodily self-presentation predict mortality, above and beyond four sets of variables conceptually linked to both death and disorder. Data come from 2005/2006 and 2010/2011 waves of the National Social Life, Health, and Aging Project. We used naturalistic observation of respondents' homes and bodies, along with a diverse range of additional covariates, to predict probability of death. Older adults living in disorderly households were at highest risk of death over 5 years, primarily because they confronted high levels of frailty. Disorderly bodily self-presentation was also related to mortality risk, but this association could be only partially explained by demographic factors, health conditions, frailty, and low social connectedness. Findings suggest that disorder in the residential context-dress and hygiene in particular-is a strong predictor of mortality. Support providers should be mindful of changes in bodily presentation among community-dwelling older adults.
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Affiliation(s)
- Markus H Schafer
- 1 Department of Sociology, University of Toronto, Toronto, Ontario, Canada
| | - Laura Upenieks
- 1 Department of Sociology, University of Toronto, Toronto, Ontario, Canada
| | - Andie MacNeil
- 1 Department of Sociology, University of Toronto, Toronto, Ontario, Canada
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Strumpf EC, Charters TJ, Harper S, Nandi A. Did the Great Recession affect mortality rates in the metropolitan United States? Effects on mortality by age, gender and cause of death. Soc Sci Med 2017; 189:11-16. [PMID: 28772108 DOI: 10.1016/j.socscimed.2017.07.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 07/04/2017] [Accepted: 07/20/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Mortality rates generally decline during economic recessions in high-income countries, however gaps remain in our understanding of the underlying mechanisms. This study estimates the impacts of increases in unemployment rates on both all-cause and cause-specific mortality across U.S. metropolitan regions during the Great Recession. METHODS We estimate the effects of economic conditions during the recent and severe recessionary period on mortality, including differences by age and gender subgroups, using fixed effects regression models. We identify a plausibly causal effect by isolating the impacts of within-metropolitan area changes in unemployment rates and controlling for common temporal trends. We aggregated vital statistics, population, and unemployment data at the area-month-year-age-gender-race level, yielding 527,040 observations across 366 metropolitan areas, 2005-2010. RESULTS We estimate that a one percentage point increase in the metropolitan area unemployment rate was associated with a decrease in all-cause mortality of 3.95 deaths per 100,000 person years (95%CI -6.80 to -1.10), or 0.5%. Estimated reductions in cardiovascular disease mortality contributed 60% of the overall effect and were more pronounced among women. Motor vehicle accident mortality declined with unemployment increases, especially for men and those under age 65, as did legal intervention and homicide mortality, particularly for men and adults ages 25-64. We find suggestive evidence that increases in metropolitan area unemployment increased accidental drug poisoning deaths for both men and women ages 25-64. CONCLUSIONS Our finding that all-cause mortality decreased during the Great Recession is consistent with previous studies. Some categories of cause-specific mortality, notably cardiovascular disease, also follow this pattern, and are more pronounced for certain gender and age groups. Our study also suggests that the recent recession contributed to the growth in deaths from overdoses of prescription drugs in working-age adults in metropolitan areas. Additional research investigating the mechanisms underlying the health consequences of macroeconomic conditions is warranted.
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Affiliation(s)
- Erin C Strumpf
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC H3A 1A2, Canada; Department of Economics, McGill University, 855 Sherbrooke St. West, Montreal, QC H3A 2T7, Canada; Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, QC H3A 1A2, Canada.
| | - Thomas J Charters
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC H3A 1A2, Canada; Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, QC H3A 1A2, Canada
| | - Sam Harper
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC H3A 1A2, Canada; Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, QC H3A 1A2, Canada
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC H3A 1A2, Canada; Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, QC H3A 1A2, Canada
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Life Expectancy Gain Due to Employment Status Depends on Race, Gender, Education, and Their Intersections. J Racial Ethn Health Disparities 2017. [PMID: 28634876 DOI: 10.1007/s40615-017-0381-x] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Despite the well-established health effects of socioeconomic status (SES), SES resources such as employment may differently influence health outcomes across sub-populations. This study used a national sample of US adults to test if the effect of baseline employment (in 1986) on all-cause mortality over a 25-year period depends on race, gender, education level, and their intersections. METHODS Data came from the Americans' Changing Lives (ACL) study, which followed 2025 Whites and 1156 Blacks for 25 years from 1986 to 2011. The focal predictor of interest was baseline employment (1986), operationalized as a dichotomous variable. The main outcome of interest was time to all-cause mortality from 1986 to 2011. Covariates included baseline age, health behaviors (smoking, drinking, and exercise), physical health (obesity, chronic disease, function, and self-rated health), and mental health (depressive symptoms). A series of Cox proportional hazard models were used to test the association between employment and mortality risk in the pooled sample and based on race, gender, education, and their intersections. RESULTS Baseline employment in 1986 was associated with a lower risk of mortality over a 25-year period, net of covariates. In the pooled sample, baseline employment interacted with race (HR = .69, 95% CI = .49-.96), gender (HR = .73, 95% CI = .53-1.01), and education (HR = .64, 95% CI = .46-.88) on mortality, suggesting diminished protective effects for Blacks, women, and individuals with lower education, compared to Whites, men, and those with higher education. In stratified models, the association was significant for Whites (HR = .71, 95%CI = .59-.90), men (HR = .60, 95%CI = .43-.83), and individuals with high education (HR = .66, 95%CI = .50-.86) but not for Blacks (HR = .77, 95%CI = .56-1.01), women (HR = .88, 95%CI = .69-1.12), and those with low education (HR = .92, 95%CI = .67-1.26). The largest effects of employment on life expectancy were seen for highly educated men (HR = .50, 95%CI = .32-.78), White men (HR = .55, 95%CI = .38-.79), and highly educated Whites (HR = .63, 95%CI = .46-.84). The effects were non-significant for Black men (HR = 1.10, 95%CI = .68-1.78), Whites with low education (HR = 1.01, 95%CI = .67-1.51), and women with low education (HR = 1.06, 95%CI = .71-1.57). CONCLUSION In the USA, the health gain associated with employment is conditional on one's race, gender, and education level, along with their intersections. Blacks, women, and individuals with lower education gain less from employment than do Whites, men, and highly educated people. More research is needed to understand how the intersections of race, gender, and education alter health gains associated with socioeconomic resources.
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Sameem S, Sylwester K. The business cycle and mortality: Urban versus rural counties. Soc Sci Med 2017; 175:28-35. [DOI: 10.1016/j.socscimed.2016.12.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 12/07/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
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Honest Labor Bears a Lovely Face: Will Late-Life Unemployment Impact Health and Satisfaction in Retirement? J Occup Environ Med 2016; 59:184-190. [PMID: 28002355 DOI: 10.1097/jom.0000000000000933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Unemployment among older adults during recessionary cycles has been tied to early retirement decisions and negative health outcomes. This study explored episodes of unemployment experienced between age 50 and retirement as predictors of retirement age and health outcomes. METHODS A total of 1540 participants from the U.S. Health and Retirement Study aged 50 years and older who transitioned from workforce to retirement were analyzed with descriptive statistics and multiple regression controlling for unemployment, demographics, and health status. RESULTS Late-life unemployment significantly related to earlier retirement age and lowered life satisfaction, independent of income effects. We found no main effect for late-life unemployment on physical health status. CONCLUSIONS Potential improvements in future life satisfaction might be gained if job search obstacles are removed for older unemployed adults, reducing reliance on involuntary early retirement as an income source.
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36
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Does contextual unemployment matter for health status across the life course? A longitudinal multilevel study exploring the link between neighbourhood unemployment and functional somatic symptoms. Health Place 2016; 43:113-120. [PMID: 27997864 DOI: 10.1016/j.healthplace.2016.11.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/27/2016] [Accepted: 11/17/2016] [Indexed: 11/22/2022]
Abstract
This study examines whether neighbourhood unemployment is related to functional somatic symptoms, independently of the individual employment, across the life course and at four specific life course periods (age 16, 21, 30 and 42). Self-reported questioner data was used from a 26-year prospective Swedish cohort (n=1010) with complementary neighbourhood register data. A longitudinal and a set of age-specific cross-sectional hierarchal linear regressions was carried out. The results suggest that living in a neighbourhood with high unemployment has implications for residents' level of functional somatic symptoms, regardless of their own unemployment across time, particularly at age 30.
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Avendano M, Moustgaard H, Martikainen P. Are some populations resilient to recessions? Economic fluctuations and mortality during a period of economic decline and recovery in Finland. Eur J Epidemiol 2016; 32:77-85. [PMID: 27730407 PMCID: PMC5331077 DOI: 10.1007/s10654-016-0152-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 04/22/2016] [Indexed: 12/24/2022]
Abstract
This paper uses individual-level longitudinal data on working-age Finns to examine the health effects of economic fluctuations during a period of economic decline (1989–1996) and recovery (1997–2007) in Finland. We used a nationally representative, longitudinal sample formed by linking population, employment and mortality registers (n = 698,484; 7,719,870 person-years). We implemented a region fixed-effect model that exploits within-regional variations over time in the unemployment rate to identify the effect of economic fluctuations on mortality, controlling for individual employment transitions. Unemployment rates increased from 5.2 % in 1989 to 19.8 % in 1996, declining gradually thereafter and reaching 9.7 % in 2007. Results indicate that these large fluctuations in the economy had no impact on the overall mortality of most working age Finns. The exception was highly educated men, who experienced an increase of 7 % (Rate ratio = 1.07, 95 % confidence interval 1.04, 1.10) for every one-point increase in the regional unemployment rate during the period 1989–1996 due to increased mortality from cardiovascular disease and suicide. This increase, however, was not robust in models that used the employment to population ratio as measure of the economy. Unemployment rates were unrelated to mortality among females, lower educated men, and among any group during economic recovery (1997–2007). For most Finns, we found no consistent evidence of changes in mortality in response to contractions or expansions in the economy. Possible explanations include the weak impact of the recession on wages, as well as the generous unemployment insurance and social benefit system in Finland.
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Affiliation(s)
- Mauricio Avendano
- Department of Global Health & Social Medicine, King's College London, East Wing, Strand Campus, Strand, London, WC2R 2LS, UK.
- Department Social and Behavioral Sciences, Harvard T.H. Chan School of Public health, Boston, MA, USA.
| | - Heta Moustgaard
- Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland
- Centre for Health Equity Studies (CHESS), Stockholms Universitet and Karolinska Institutet, Stockholm, Sweden
- The Max Planck Institute for Demographic Research, Rostock, Germany
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Tran TV, Canfield J, Chan K. The association between unemployment status and physical health among veterans and civilians in the United States. SOCIAL WORK IN HEALTH CARE 2016; 55:720-731. [PMID: 27348549 DOI: 10.1080/00981389.2016.1191582] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study analyzed data from the 2012 Behavioral Risk Factor Surveillance System to examine the association between unemployment status and physical health among a sample of 170,924 civilians and 12,129 veterans (aged 18-50 years). Multivariate regression analysis was used to test the interaction effect between employment status and veteran/civilian status on physical health. Veterans who were unemployed long term (longer than 27 weeks) reported a significantly greater number of days with poor physical health than civilians who experienced long-term unemployment. Timely prevention and intervention efforts to integrate veterans into the workforce could lead to substantially improved physical health outcomes. Public health policies and programs that are funded to assist veterans in securing and maintaining gainful employment can have lasting implications for their overall improved health and physical well-being.
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Affiliation(s)
- Thanh V Tran
- a School of Social Work , Boston College , Chestnut Hill , Massachusetts , USA
| | - Julie Canfield
- a School of Social Work , Boston College , Chestnut Hill , Massachusetts , USA
| | - Keith Chan
- b SUNY School of Social Welfare , University at Albany , Albany , New York , USA
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Tapia Granados JA, Ionides EL. Statistical evidence shows that mortality tends to fall during recessions: a rebuttal to Catalano and Bruckner. Int J Epidemiol 2016; 45:1683-1686. [PMID: 27634887 DOI: 10.1093/ije/dyw206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- José A Tapia Granados
- Department of Politics, Drexel University, 3021-E MacAlister Hall, 3250-60 Chestnut Street, Philadelphia, PA 19104
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Gallagher S, Sumner RC, Muldoon OT, Creaven AM, Hannigan A. Unemployment is associated with lower cortisol awakening and blunted dehydroepiandrosterone responses. Psychoneuroendocrinology 2016; 69:41-9. [PMID: 27018925 DOI: 10.1016/j.psyneuen.2016.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/16/2016] [Accepted: 03/16/2016] [Indexed: 11/26/2022]
Abstract
Previous research has investigated the endocrinological consequences of unemployment as a likely pathway behind chronic stress and negative health outcomes. Despite these early attempts at delineating the neuroendocrine consequences of the chronic stress experienced by the unemployed, identifying a consistent and stable effect has remained elusive. Here we sought to strengthen existing knowledge into the effect of the stress of employment status on cortisol by improving on the methodological weaknesses of earlier studies and extend this line of enquiry by measuring the steroid hormone Dehydroepiandrosterone-Sulfate (DHEAS). Saliva samples were collected from unemployed and employed participants at four time points across two days. As expected, unemployed people reported higher stress, lower social support and lower self-esteem. Unexpectedly, the unemployed showed lower overall cortisol output, a likely consequence of a higher cortisol awakening response (CAR) in the employed. However, they also had a higher DHEA output across the day, albeit the diurnal pattern across the day was more dysregulated compared to that seen in those employed with a blunted response evident in the evening; the cortisol:DHEAS ratio was also lower in the unemployed group. Further, these hormone differences were correlated with self-esteem and stress. Taken together these results suggest that the relationship between employment status and endocrine responses is far more complicated than previously thought. We have shown for the first time that unemployed people have a lower CAR, but also show a blunted DHEA response relative to those employed and we suggest that this may be a feature of chronic stress exposure or perhaps dependent on the prevailing socio-economic context.
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Affiliation(s)
- Stephen Gallagher
- Laboratory for the Study of Anxiety, Stress & Health (SASHLab), Department of Psychology, University of Limerick, Castletroy, County Limerick, Ireland; Health Research Institute, University of Limerick, Castletroy, County Limerick, Ireland.
| | - Rachel C Sumner
- Laboratory for the Study of Anxiety, Stress & Health (SASHLab), Department of Psychology, University of Limerick, Castletroy, County Limerick, Ireland
| | - Orla T Muldoon
- Health Research Institute, University of Limerick, Castletroy, County Limerick, Ireland; Centre for Social Issues Research (CSI-R), University of Limerick, Castletroy, County Limerick, Ireland
| | - Ann-Marie Creaven
- Laboratory for the Study of Anxiety, Stress & Health (SASHLab), Department of Psychology, University of Limerick, Castletroy, County Limerick, Ireland; Centre for Social Issues Research (CSI-R), University of Limerick, Castletroy, County Limerick, Ireland
| | - Ailish Hannigan
- Health Research Institute, University of Limerick, Castletroy, County Limerick, Ireland; Graduate Entry Medical School, University of Limerick, Castletroy, County Limerick, Ireland
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41
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Vanderbloemen L, Dorling D, Minton J. Visualising variation in mortality rates across the life course and by sex, USA and comparator states, 1933-2010. J Epidemiol Community Health 2016; 70:826-31. [PMID: 26933122 DOI: 10.1136/jech-2014-205226] [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: 11/11/2014] [Accepted: 01/30/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Previous research showed that younger adult males in the USA have, since the 1950s, died at a faster rate than females of the same age. In this paper, we quantify this difference, and explore possible explanations for the differences at different ages and in different years. METHODS Using data from the Human Mortality Database (HMD), the number of additional male deaths per 10 000 female deaths was calculated for each year from 1933 to 2010, and for each year of age from 0 to 60 years, for the USA, and a number of other countries for comparison. The data were explored visually using shaded contour plots. RESULTS Gender differences in excess mortality have increased. Coming of age (between the ages of 15 and 25 years of age) is especially perilous for men relative to women now compared with the past in the USA; the visualisations highlight this change as important. CONCLUSIONS Sex differences in mortality risks at various ages are not static. While women may today have an advantage when it comes to life expectancy, in the USA, this has greatly increased since the 1930s. Just as young adulthood for women has been made safer through safer antenatal and childbirth practices, changes in public policy can make the social environment safer for men.
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Affiliation(s)
- Laura Vanderbloemen
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Danny Dorling
- School of Geography and the Environment, University of Oxford, Oxford, UK
| | - Jonathan Minton
- School of Social and Political Sciences, College of Social Sciences, University of Glasgow, Glasgow, UK
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Ásgeirsdóttir TL, Corman H, Noonan K, Reichman NE. Lifecycle effects of a recession on health behaviors: Boom, bust, and recovery in Iceland. ECONOMICS AND HUMAN BIOLOGY 2016; 20:90-107. [PMID: 26687768 DOI: 10.1016/j.ehb.2015.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 06/05/2023]
Abstract
This study uses individual-level longitudinal data from Iceland, a country that experienced a severe economic crisis in 2008 and substantial recovery by 2012, to investigate the extent to which the effects of a recession on health behaviors are lingering or short-lived and to explore trajectories in health behaviors from pre-crisis boom, to crisis, to recovery. Health-compromising behaviors (smoking, heavy drinking, sugared soft drinks, sweets, fast food, and tanning) declined during the crisis, and all but sweets continued to decline during the recovery. Health-promoting behaviors (consumption of fruit, fish oil, and vitamins/minerals and getting recommended sleep) followed more idiosyncratic paths. Overall, most behaviors reverted back to their pre-crisis levels or trends during the recovery, and these short-term deviations in trajectories were probably too short-lived in this recession to have major impacts on health or mortality. A notable exception is for binge drinking, which declined by 10% during the 2 crisis years, continued to fall (at a slower rate of 8%) during the 3 recovery years, and did not revert back to the upward pre-crisis trend during our observation period. These lingering effects, which directionally run counter to the pre-crisis upward trend in consumption and do not reflect price increases during the recovery period, suggest that alcohol is a potential pathway by which recessions improve health and/or reduce mortality.
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Affiliation(s)
| | - Hope Corman
- Department of Economics, Rider University and National Bureau of Economic Research, 2083 Lawrenceville Rd., Lawrenceville, NJ 08648, United States.
| | - Kelly Noonan
- Department of Economics, Rider University and National Bureau of Economic Research, 2083 Lawrenceville Rd., Lawrenceville, NJ 08648, United States.
| | - Nancy E Reichman
- Dept. of Pediatrics, Rutgers University-Robert Wood Johnson Medical School, Child Health Institute of New Jersey, 89 French St., Room 4269, New Brunswick, NJ 08903, United States.
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Margerison-Zilko C, Goldman-Mellor S, Falconi A, Downing J. Health Impacts of the Great Recession: A Critical Review. CURR EPIDEMIOL REP 2016; 3:81-91. [PMID: 27239427 DOI: 10.1007/s40471-016-0068-6] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The severity, sudden onset, and multipronged nature of the Great Recession (2007-2009) provided a unique opportunity to examine the health impacts of macroeconomic downturn. We comprehensively review empirical literature examining the relationship between the Recession and mental and physical health outcomes in developed nations. Overall, studies reported detrimental impacts of the Recession on health, particularly mental health. Macro- and individual-level employment- and housing-related sequelae of the Recession were associated with declining fertility and self-rated health, and increasing morbidity, psychological distress, and suicide, although traffic fatalities and population-level alcohol consumption declined. Health impacts were stronger among men and racial/ethnic minorities. Importantly, strong social safety nets in some European countries appear to have buffered those populations from negative health effects. This literature, however, still faces multiple methodological challenges, and more time may be needed to observe the Recession's full health impact. We conclude with suggestions for future work in this field.
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Affiliation(s)
- Claire Margerison-Zilko
- Department of Epidemiology and Biostatistics, Michigan State University, 909 Fee Rd., Rm 601, East Lansing, MI 48824, Ph: 517-353-8623
| | - Sidra Goldman-Mellor
- Department of Public Health, University of California, Merced, 5200 N. Lake Rd., Merced, CA 95342, Ph: (209) 228-2498
| | - April Falconi
- General Internal Medicine, Stanford University, Palo Alto, CA 94305, Ph: (703) 328-4851
| | - Janelle Downing
- School of Public Health, University of California, Berkeley, 545 University Hall, University of California, Berkeley, CA 94720-7360, Ph: (510) 643-8571
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Tapia Granados JA. Commentary: William Ogburn, Dorothy Thomas and the influence of recessions and expansions on mortality. Int J Epidemiol 2015; 44:1484-90. [PMID: 26613711 DOI: 10.1093/ije/dyv288] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- José A Tapia Granados
- Department of Politics, Drexel University, 3141 Chestnut St., 3021E MacAlister Hall, Philadelphia, PA 19104, USA. E-mail:
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Noelke C, Avendano M. Who suffers during recessions? Economic downturns, job loss, and cardiovascular disease in older Americans. Am J Epidemiol 2015; 182:873-82. [PMID: 26476283 DOI: 10.1093/aje/kwv094] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 04/01/2015] [Indexed: 12/28/2022] Open
Abstract
Job loss in the years before retirement has been found to increase risk of cardiovascular disease (CVD), but some studies suggest that CVD mortality among older workers declines during recessions. We hypothesized that recessionary labor market conditions were associated with reduced CVD risk among persons who did not experience job loss and increased CVD risk among persons who lost their jobs. In our analyses, we used longitudinal, nationally representative data from Americans 50 years of age or older who were enrolled in the Health and Retirement Study and surveyed every 2 years from 1992 to 2010 about their employment status and whether they had experienced a stroke or myocardial infarction. To measure local labor market conditions, Health and Retirement Study data were linked to county unemployment rates. Among workers who experienced job loss, recessionary labor market conditions at the time of job loss were associated with a significantly higher CVD risk (hazard ratio = 2.54, 95% confidence interval: 1.39, 4.65). In contrast, among workers who did not experience job loss, recessionary labor market conditions were associated with a lower CVD risk (hazard ratio = 0.50, 95% confidence interval: 0.31, 0.78). These results suggest that recessions might be protective in the absence of job loss but hazardous in the presence of job loss.
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Bacigalupe A, Shahidi FV, Muntaner C, Martín U, Borrell C. Why is There so Much Controversy Regarding the Population Health Impact of the Great Recession? Reflections on Three Case Studies. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2015; 46:5-35. [DOI: 10.1177/0020731415611634] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In the aftermath of the Great Recession, public health scholars have grown increasingly interested in studying the health consequences of macroeconomic change. Reflecting existing debates on the nature of this relationship, research on the effects of the recent economic crisis has sparked considerable controversy. On the one hand there is evidence to support the notion that macroeconomic downturns are associated with positive health outcomes. On the other hand, a growing number of studies warn that the current economic crisis can be expected to pose serious problems for the public’s health. This article contributes to this debate through a review of recent evidence from three case studies: Iceland, Spain, and Greece. It shows that the economic crisis has negatively impacted some population health indicators (e.g., mental health) in all three countries, but especially in Greece. Available evidence defies deterministic conclusions, including increasingly “conventional” claims about economic downturns improving life expectancy and reducing mortality. While our results echo previous research in finding that the relationship between economic crises and population health is complex, they also indicate that this complexity is not arbitrary. On the contrary, changing social and political contexts provide meaningful, if partial, explanations for the perplexing nature of recent empirical findings.
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Affiliation(s)
- Amaia Bacigalupe
- Department of Sociology 2, University of the Basque Country (UPV/EHU), Leioa, Spain
- OPIK-Research Group on Social Determinants of Health and Demographic Change
| | - Faraz Vahid Shahidi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Carles Muntaner
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Bloomberg School of Nursing, University of Toronto, Toronto, Ontario, Canada
- Department of Public Health Sciences, Korea University
| | - Unai Martín
- Department of Sociology 2, University of the Basque Country (UPV/EHU), Leioa, Spain
- OPIK-Research Group on Social Determinants of Health and Demographic Change
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona 08023, Spain
- Ciber de Epidemiología y Salud Pública, 28029, Spain
- Universitat Pompeu Fabra, Barcelona 08003, Spain
- Institut de Recerca Biomèdica Sant Pau (IIB Sant Pau), Barcelona 08025, Spain
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Tapia Granados JA, Rodriguez JM. Health, economic crisis, and austerity: A comparison of Greece, Finland and Iceland. Health Policy 2015; 119:941-53. [PMID: 25979416 DOI: 10.1016/j.healthpol.2015.04.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/23/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
Reports have attributed a public health tragedy in Greece to the Great Recession and the subsequent application of austerity programs. It is also claimed that the comparison of Greece with Iceland and Finland-where austerity policies were not applied-reveals the harmful effect of austerity on health and that by protecting spending in health and social budgets, governments can offset the harmful effects of economic crises on health. We use data on life expectancy, mortality rates, incidence of infectious diseases, rates of vaccination, self-reported health and other measures to examine the evolution of population health and health services performance in Greece, Finland and Iceland since 1990-2011 or 2012-the most recent years for which data are available. We find that in the three countries most indicators of population health continued improving after the Great Recession started. In terms of population health and performance of the health care system, in the period after 2007 for which data are available, Greece did as good as Iceland and Finland. The evidence does not support the claim that there is a health crisis in Greece. On the basis of the extant evidence, claims of a public health tragedy in Greece seem overly exaggerated.
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Affiliation(s)
- José A Tapia Granados
- Department of History and Political Science, Drexel University, Philadelphia, PA, United States.
| | - Javier M Rodriguez
- Mathematica Policy Research and Population Studies Center, Institute for Social Research, University of Michigan,, Ann Arbor, MI, USA
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Tsai AC. Home foreclosure, health, and mental health: a systematic review of individual, aggregate, and contextual associations. PLoS One 2015; 10:e0123182. [PMID: 25849962 PMCID: PMC4388711 DOI: 10.1371/journal.pone.0123182] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/01/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The U.S. foreclosure crisis intensified markedly during the Great Recession of 2007-09, and currently an estimated five percent of U.S. residential properties are more than 90 days past due or in the process of foreclosure. Yet there has been no systematic assessment of the effects of foreclosure on health and mental health. METHODS AND FINDINGS I applied systematic search terms to PubMed and PsycINFO to identify quantitative or qualitative studies about the relationship between home foreclosure and health or mental health. After screening the titles and abstracts of 930 publications and reviewing the full text of 76 articles, dissertations, and other reports, I identified 42 publications representing 35 unique studies about foreclosure, health, and mental health. The majority of studies (32 [91%]) concluded that foreclosure had adverse effects on health or mental health, while three studies yielded null or mixed findings. Only two studies examined the extent to which foreclosure may have disproportionate impacts on ethnic or racial minority populations. CONCLUSIONS Home foreclosure adversely affects health and mental health through channels operating at multiple levels: at the individual level, the stress of personally experiencing foreclosure was associated with worsened mental health and adverse health behaviors, which were in turn linked to poorer health status; at the community level, increasing degradation of the neighborhood environment had indirect, cross-level adverse effects on health and mental health. Early intervention may be able to prevent acute economic shocks from eventually developing into the chronic stress of foreclosure, with all of the attendant benefits this implies for health and mental health status. Programs designed to encourage early return of foreclosed properties back into productive use may have similar health and mental health benefits.
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Affiliation(s)
- Alexander C. Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Mbarara University of Science and Technology, Mbarara, Uganda
- * E-mail:
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The Effects of Unemployment Rate on Health Status of Chinese People. IRANIAN JOURNAL OF PUBLIC HEALTH 2015; 44:28-35. [PMID: 26060773 PMCID: PMC4450011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 11/28/2014] [Indexed: 10/27/2022]
Abstract
BACKGROUND The aim of the study was to estimate the short-run and long-run effects of unemployment rate on health outcomes of Chinese population, which is under studied before. METHODS The Chinese aggregate data was analyzed (provincial data from 1990-2011). The fixed effect model and infinite distributed lag model (IDL) were applied to analyze the data. It aimed to estimate the short-run and long-run association between unemployment rate and health status of population in China. The mortality was applied as an indicator for health outcomes of entire population. RESULTS In the short run, when the unemployment rate was decreased by 1%, mortality will be reduced by approximately 4 % (P<0.01). In the long-run, mortality will be increased by 6.8% with increased unemployment rate of 1% (P <0.05). CONCLUSION The result in China demonstrated that the unemployment rate was positively associated with mortality. The result also showed that the increased unemployment rate has been harmful to health outcomes of population. It will be significant to reduce the unemployment rate for improving potential public health benefits in developing countries like China.
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