Racial Disparities in Mortality Among Middle-Aged and Older Men: Does Marriage Matter?

Cause-specific mortality by partnership status: simultaneous analysis using longitudinal data from England and Wales

Background

This paper examines cause-specific mortality by partnership status. Although non-marital cohabitation has spread rapidly in industrialised countries, only a few studies have investigated mortality by partnership status and no recent study has investigated cause-specific mortality by partnership status.

Methods

We use data from the Office for National Statistics Longitudinal Study and apply competing risks survival models.

Results

The simultaneous analysis shows that married individuals have lower mortality than non-married from circulatory, respiratory, digestive, alcohol and accident related causes of deaths, but not from cancer. The analysis by partnership status reveals that once we distinguish premarital and postmarital cohabitants from other non-married groups, the differences between partnered and non-partnered individuals become even more pronounced for all causes of death; this is largely due to similar cause-specific mortality levels between married and cohabiting individuals.

Conclusions

With declining marriage rates and the spread of cohabitation and separation, a distinction between partnered and non-partnered individuals is critical to understanding whether and how having a partner shapes the individuals’ health behaviour and mortality. The cause-specific analysis supports both the importance of selection into partnership and the protective effect of living with someone together.

Sodium and potassium urinary excretion and their ratio in the elderly: results from the Nutrition UP 65 study

BACKGROUND

We aimed to describe urinary sodium and potassium excretion and their ratio in a representative sample of Portuguese elderly population, according to sociodemographic characteristics and weight status.

METHODS

A cluster sampling approach was used, representing older Portuguese adults (≥65 years) according to age, sex, education level, and regional area within the Nutrition UP 65 study. This cross-sectional evaluation was conducted in 2015 and 2016. From a sample size of 1,500 participants, 1,318 were eligible for the present analysis, 57.3% were women, and 23.5% were aged ≥80 years. Sodium and potassium consumption was evaluated through one 24 h urinary excretion. Inadequate sodium intake was defined as ≥2,000 mg/day, inadequate potassium intake was considered as <3,510 mg/day, and inadequate sodium-to-potassium ratio was defined as >1, according to the World Health Organization cutoffs.

RESULTS

The proportion of the participants with an inadequate intake was 80.0% in women and 91.5% in men (sodium), 96.2% of women and 79.4% of men (potassium), and 98.4% of women and 99.1% of men (sodium-to-potassium ratio). Higher sodium adequacy was observed among the older elderly, unmarried, with lower household income, and underweight/normal weight. Higher potassium adequacy was observed in the younger elderly, married, and with higher income.

CONCLUSION

The majority of the Portuguese elderly population was classified as having inadequate sodium, potassium, and sodium-to-potassium ratio urinary excretion. Therefore, strategies for reducing sodium and increasing potassium intake are priorities in the Portuguese elderly population.

Healthcare Providers' Recommendations for Physical Activity among US Arthritis Population: A Cross-Sectional Analysis by Race/Ethnicity

Introduction

We examined racial/ethnic disparities in healthcare providers' recommendations for physical activity among individuals with arthritis and evaluated this association among groups of individuals who adhered to physical activity guidelines and those who did not.

Methods

With a cross-sectional design based on Behavioral Risk Factor Surveillance System, we analyzed individuals with self-reported physician-diagnosed arthritis, ≥18 years of age (n = 83,376). Outcome variable was healthcare providers' recommendations for physical activity. Race/ethnicity was categorized as African American, Hispanic, and White. Associations were examined using multivariate logistic regression.

Results

African Americans (Adjusted OR: 0.66; 95% CI: 0.55–0.79) and Hispanics (Adjusted OR: 0.68; 95% CI: 0.56–0.83) were less likely to receive providers' recommendations.

Conclusions

Although the importance of physical activity to improve health outcomes for adults with arthritis, as well as providers' influence on individuals' behavior change, is well established, providers are less likely to recommend physical activity to minorities. Further studies are required to identify the causes for this quality-of-care issue.

Latino Health Behavior: An Exploratory Analysis of Health Risk and Health Protective Factors in a Community Sample

BACKGROUND

Demographic and cultural factors have been found to affect health behaviors in Latinos in both positive and negative ways, but few studies have examined the impact of culture and adherence to machismo norms on health behaviors in a mixed gender community sample of Latinos. Of particular interest was if positive (caballerismo) or negative aspects of machismo would affect Latino health behaviors.

METHODS

A paper survey was given to a community sample of Latinos in northern Utah to explore the variables that affect both health promoting and health risking behaviors in this cross-sectional study (final N = 144 participants).

RESULTS

Life satisfaction, self-reported health, health insurance status, language preference, and gender were significantly related to overall health score. Surprisingly, the cultural variables of fatalism, machismo, and caballerismo were nonsignificant in all analyses.

CONCLUSION

Access to health care mediated by health insurance and self-reported health status may be the most effective way to encourage Latinos to engage in protective health behaviors.

Recurrent glioblastoma: who receives tumor specific treatment and how often?

The recurrence of glioblastoma (rGBM) is inevitable and often short-term. Therefore, information on the prognosis and effectiveness of tumor-specific versus purely palliative approaches should be more in-depth than a mere list of available treatment options for patients in this situation. However, follow-up data on the course of the disease in unselected patient populations after completion of primary treatment are scarce. This single-center analysis investigated the rate and number of glioblastoma recurrences after initial radiotherapy in 189 consecutive GM patients, focusing on the incidence of early death and the frequency of tumor-specific treatment (TST) versus best-supportive care (BSC) as well as the outcomes for the different approaches. In 61 % of initial population first recurrence (rGBM) could be determined by histology or imaging. 47 % received TST. 58 % of the patients with rGBM and TST were diagnosed with a second recurrence. Up to five recurrences were treated. 35-45 % of patients died before undergoing imaging studies to confirm the next recurrence. Multivariate analysis identified male sex and KPS score as independent factors (p < 0.01) for the choice of TST over BSC. Median overall survival from the diagnosis of first recurrence was 267 days in the TST group versus 65 days in patients receiving BSC (p < 0.0001). Nearly half of all rGBM patients received second-line TST, but a remarkably high proportion died early. Gender and KPS played a role in the choice of TST over BSC for recurrence treatment.

Socioeconomic factors associated with outcome after cardiac arrest in patients under the age of 65

AIM

In a prior study of seven North American cities Pittsburgh had the highest crude rate of cardiac arrest deaths in patients 18 to 64 years of age, particularly in neighborhoods with lower socioeconomic status (SES). We hypothesized that lower SES, associated poor health behaviors (e.g., illicit drug use) and pre-existing comorbid conditions (grouped as socioeconomic factors [SE factors]) could affect the type and severity of cardiac arrest, thus outcomes.

METHODS

We retrospectively identified patients aged 18 to 64 years treated for in-hospital (IHCA) and out-of hospital arrest (OHCA) at two Pittsburgh hospitals between January 2010 and July 2012. We abstracted data on baseline demographics and arrest characteristics like place of residence, insurance and employment status. Favorable cerebral performance category [CPC] (1 or 2) was our primary outcome. We examined the associations between SE factors, cardiac arrest variables and outcome as well as post-resuscitation care.

RESULTS

Among 415 subjects who met inclusion criteria, unfavorable CPC were more common in patients who were unemployed, had a history of drug abuse or hypertension. In OHCA, favorable CPC was more often associated with presentation with ventricular fibrillation/tachycardia (OR 3.53, 95% CI 1.43-8.74, p = 0.006) and less often associated with non-cardiovascular arrest etiology (OR 0.22, 95% CI 0.08-0.62, p = 0.004). We found strong associations between specific SE factors and arrest factors associated with outcome in OHCA patients only. Significant differences in post-resuscitation care existed based on injury severity, not on SES.

CONCLUSIONS

SE factors strongly influence type and severity of OHCA but not IHCA resulting in an association with outcomes.