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Krok-Schoen JL, Naughton MJ, Felix AS, Wiley Cené C, Springfield S, Yu M, McLaughlin EM, Shadyab AH, Nolan TS, Kroenke CH, Garcia L, Follis S, Jackson RD. Resiliency Among Women's Health Initiative Women Aged 80 and Older by Race, Ethnicity, and Neighborhood Socioeconomic Status. J Gerontol B Psychol Sci Soc Sci 2023; 78:1445-1458. [PMID: 36933001 PMCID: PMC10461531 DOI: 10.1093/geronb/gbad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVES A comprehensive examination of resilience by race, ethnicity, and neighborhood socioeconomic status (NSES) among women aged ≥80 is needed, given the aging of the U.S. population, increasing longevity, and growing racial and ethnic diversity. METHODS Participants were women aged ≥80 enrolled in the Women's Health Initiative. Resilience was assessed with a modified version of the Brief Resilience Scale. Descriptive statistics and multiple linear regression examined the association of demographic, health, and psychosocial variables with resilience by race, ethnicity, and NSES. RESULTS Participants (n = 29,367, median age = 84.3) were White (91.4%), Black (3.7%), Hispanic (1.9%), and Asian (1.7%) women. There were no significant differences by race and ethnicity on mean resiliency scores (p = .06). Significant differences by NSES were observed regarding mean resiliency scores between those with low NSES (3.94 ± 0.83, out of 5) and high NSES (4.00 ± 0.81). Older age, higher education, higher self-rated health, lower stress, and living alone were significant positive correlates of resilience in the sample. Social support was correlated with resilience among White, Black, and Asian women, but not for Hispanic women. Depression was a significant correlate of lower resilience, except among Asian women. Living alone, smoking, and spirituality were significantly associated with higher resilience among women with moderate NSES. DISCUSSION Multiple factors were associated with resilience among women aged ≥80 in the Women's Health Initiative. Despite some differing correlates of resilience by race, ethnicity, and NSES, there were many similarities. These results may aid in the design of resilience interventions for the growing, increasingly diverse population of older women.
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Affiliation(s)
- Jessica L Krok-Schoen
- Division of Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Michelle J Naughton
- Division of Cancer Prevention and Control, Department of Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Ashley S Felix
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Crystal Wiley Cené
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Sparkle Springfield
- Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, Illinois, USA
| | - Mengda Yu
- Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Eric M McLaughlin
- Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California at San Diego, La Jolla, California, USA
| | - Timiya S Nolan
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Candyce H Kroenke
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Lorena Garcia
- Division of Epidemiology, Department of Public Health Sciences, University of California Davis School of Medicine, Medical Sciences 1-C, Davis, California, USA
| | - Shawna Follis
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Rebecca D Jackson
- Department of Internal Medicine/Endocrinology, Diabetes and Metabolism, College of Medicine, The Ohio State University, Columbus, Ohio, USA
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Looti AL, Ovbiagele B, Markovic D, Towfighi A. All-Cause, Cardiovascular, and Stroke Mortality Among Foreign-Born Versus US-Born Individuals of African Ancestry. J Am Heart Assoc 2023; 12:e026331. [PMID: 37119071 PMCID: PMC10227213 DOI: 10.1161/jaha.122.026331] [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: 04/13/2022] [Accepted: 03/03/2023] [Indexed: 04/30/2023]
Abstract
Background Little is known about the effect of region of origin on all-cause mortality, cardiovascular mortality, and stroke mortality among Black individuals. We examined associations between nativity and mortality (all-cause, cardiovascular, and stroke) in Black individuals in the United States. Methods and Results Using the National Health Interview Service 2000 to 2014 data and mortality-linked files through 2015, we identified participants aged 25 to 74 years who self-identified as Black (n=64 717). Using a Cox regression model, we examined the association between nativity and all-cause, cardiovascular, and stroke mortality. We recorded 4329 deaths (205 stroke and 932 cardiovascular deaths). In the model adjusted for age and sex, compared with US-born Black individuals, all-cause (hazard ratio [HR], 0.44 [95% CI, 0.37-0.53]) and cardiovascular mortality (HR, 0.66 [95% CI, 0.44-0.87]) rates were lower among Black individuals born in the Caribbean, South America, and Central America, but stroke mortality rates were similar (HR, 1.01 [95% CI, 0.52-1.94]). African-born Black individuals had lower all-cause mortality (HR, 0.43 [95% CI, 0.27-0.69]) and lower cardiovascular mortality (HR, 0.42 [95% CI, 0.18-0.98]) but comparable stroke mortality (HR, 0.48 [95% CI, 0.11-2.05]). When the model was further adjusted for education, income, smoking, body mass index, hypertension, and diabetes, the difference in mortality between foreign-born Black individuals and US-born Black individuals was no longer significant. Time since migration did not significantly affect mortality outcomes among foreign-born Black individuals. Conclusions In the United States, foreign-born Black individuals had lower all-cause mortality, a difference that was observed in recent and well-established immigrants. Foreign-born Black people had age- and sex-adjusted lower cardiovascular mortality than US-born Black people.
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Affiliation(s)
- Alain Lekoubou Looti
- Department of NeurologyPenn State University, Hershey Medical CenterHersheyPAUSA
| | - Bruce Ovbiagele
- Department of NeurologyUniversity of CaliforniaSan FranciscoCAUSA
| | - Daniela Markovic
- Department of BiomathematicsUniversity of California at Los AngelesLos AngelesCAUSA
| | - Amytis Towfighi
- Department of NeurologyUniversity of Southern CaliforniaLos AngelesCAUSA
- Los Angeles County Department of Health ServicesLos AngelesCAUSA
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Bernstein SF, Sasson I. Black and white differences in subjective survival expectations: An evaluation of competing mechanisms. SSM Popul Health 2023; 21:101339. [PMID: 36785548 PMCID: PMC9918793 DOI: 10.1016/j.ssmph.2023.101339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
While black-white inequality in longevity is well documented in the United States, little is known about how individuals from different race/ethnic groups form their own personal survival expectations. Prior research has found that despite having higher mortality, blacks on average report higher survival expectations relative to whites. Using data from the Health and Retirement Study, we examined racial differences in subjective survival expectations across birth cohorts and provide explanatory mechanisms. We find that blacks-men in particular-were overly optimistic about their survival, but this effect had waned with successive birth cohorts. Furthermore, whereas subjective survival expectations and actual survival were correlated among white men, among black men the most optimistic fared worst. Blacks and whites differed not only in their response patterns, but also in how they weighed the different factors (socioeconomic, psychosocial, health, parental longevity) associated with expected survival. Importantly, those who estimated their survival probability with certainty had positive psychosocial characteristics, irrespective of race, but only whites had better health. These findings underscore the importance of group differences in subjective survival expectations as another potential form of inequality. Racial differences in how long individual expect to live may account for differences in social and economic behavior and outcomes, irrespective of actual longevity differentials.
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Affiliation(s)
- Shayna Fae Bernstein
- Department of Sociology and Anthropology, Tel Aviv University, Tel Aviv, 6997801, Israel,Corresponding author.
| | - Isaac Sasson
- Department of Sociology and Anthropology, Tel Aviv University, Tel Aviv, 6997801, Israel,Herczeg Institute on Aging, Tel Aviv University, Israel
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Akushevich I, Kravchenko J, Yashkin A, Doraiswamy PM, Hill CV. Expanding the scope of health disparities research in Alzheimer's disease and related dementias: Recommendations from the "Leveraging Existing Data and Analytic Methods for Health Disparities Research Related to Aging and Alzheimer's Disease and Related Dementias" Workshop Series. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12415. [PMID: 36935764 PMCID: PMC10020680 DOI: 10.1002/dad2.12415] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/06/2023] [Accepted: 02/15/2023] [Indexed: 03/18/2023]
Abstract
Topics discussed at the "Leveraging Existing Data and Analytic Methods for Health Disparities Research Related to Aging and Alzheimer's Disease and Related Dementias" workshop, held by Duke University and the Alzheimer's Association with support from the National Institute on Aging, are summarized. Ways in which existing data resources paired with innovative applications of both novel and well-known methodologies can be used to identify the effects of multi-level societal, community, and individual determinants of race/ethnicity, sex, and geography-related health disparities in Alzheimer's disease and related dementia are proposed. Current literature on the population analyses of these health disparities is summarized with a focus on identifying existing gaps in knowledge, and ways to mitigate these gaps using data/method combinations are discussed at the workshop. Substantive and methodological directions of future research capable of advancing health disparities research related to aging are formulated.
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Affiliation(s)
- Igor Akushevich
- Social Science Research InstituteBiodemography of Aging Research UnitDuke UniversityDurhamNorth CarolinaUSA
| | - Julia Kravchenko
- Duke University School of MedicineDepartment of SurgeryDurhamNorth CarolinaUSA
| | - Arseniy Yashkin
- Social Science Research InstituteBiodemography of Aging Research UnitDuke UniversityDurhamNorth CarolinaUSA
| | - P. Murali Doraiswamy
- Departments of Psychiatry and MedicineDuke University School of MedicineDurhamNorth CarolinaUSA
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Chapman CH, Schechter CB, Cadham CJ, Trentham-Dietz A, Gangnon RE, Jagsi R, Mandelblatt JS. Identifying Equitable Screening Mammography Strategies for Black Women in the United States Using Simulation Modeling. Ann Intern Med 2021; 174:1637-1646. [PMID: 34662151 PMCID: PMC9997651 DOI: 10.7326/m20-6506] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Screening mammography guidelines do not explicitly consider racial differences in breast cancer epidemiology, treatment, and survival. OBJECTIVE To compare tradeoffs of screening strategies in Black women versus White women under current guidelines. DESIGN An established model from the Cancer Intervention and Surveillance Modeling Network simulated screening outcomes using race-specific inputs for subtype distribution; breast density; mammography performance; age-, stage-, and subtype-specific treatment effects; and non-breast cancer mortality. SETTING United States. PARTICIPANTS A 1980 U.S. birth cohort of Black and White women. INTERVENTION Screening strategies until age 74 years with varying initiation ages and intervals. MEASUREMENTS Outcomes included benefits (life-years gained [LYG], breast cancer deaths averted, and mortality reduction), harms (mammographies, false positives, and overdiagnoses), and benefit-harm ratios (tradeoffs) by race. Efficiency (benefits per unit resource), mortality disparity reduction, and equity in tradeoffs were evaluated. Equitable strategies for Black women were defined as those with tradeoffs closest to benchmark values for screening White women biennially from ages 50 to 74 years. RESULTS Biennial screening from ages 45 to 74 years was most efficient for Black women, whereas biennial screening from ages 40 to 74 years was most equitable. Initiating screening 10 years earlier in Black versus White women reduced Black-White mortality disparities by 57% with similar LYG per mammogram for both populations. Selection of the most equitable strategy was sensitive to assumptions about disparities in real-world treatment effectiveness: The less effective treatment was for Black women, the more intensively Black women could be screened before tradeoffs fell short of those experienced by White women. LIMITATION Single model. CONCLUSION Initiating biennial screening in Black women at age 40 years reduces breast cancer mortality disparities and yields benefit-harm ratios that are similar to tradeoffs of White women screened biennially from ages 50 to 74 years. PRIMARY FUNDING SOURCE National Cancer Institute at the National Institutes of Health.
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Affiliation(s)
- Christina Hunter Chapman
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, and University of Michigan Medical School, Ann Arbor, Michigan (C.H.C.)
| | | | - Christopher J Cadham
- Georgetown University Medical Center and Georgetown Lombardi Comprehensive Cancer Center, Washington, DC (C.J.C., J.S.M.)
| | - Amy Trentham-Dietz
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin (A.T., R.E.G.)
| | - Ronald E Gangnon
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin (A.T., R.E.G.)
| | - Reshma Jagsi
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, Michigan (R.J.)
| | - Jeanne S Mandelblatt
- Georgetown University Medical Center and Georgetown Lombardi Comprehensive Cancer Center, Washington, DC (C.J.C., J.S.M.)
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Co M, Couch E, Gao Q, Martinez A, Das-Munshi J, Prina M. Differences in survival and mortality in minority ethnic groups with dementia: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2021; 36:1640-1663. [PMID: 34324226 DOI: 10.1002/gps.5590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/12/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Although there are disparities in both risk of developing dementia and accessibility of dementia services for certain minority ethnic groups in the United States and United Kingdom, disparities in survival after a dementia diagnosis are less well-studied. Our objective was to systematically review the literature to investigate racial/ethnic differences in survival and mortality in dementia. METHODS We searched Embase, Ovid MEDLINE, Global Health and PsycINFO from inception to November 2018 for studies comparing survival or mortality over time in at least two race/ethnicity groups. Studies from any country were included but analysed separately. We used narrative synthesis and random-effects meta-analysis to synthesise findings. The Newcastle-Ottawa Scale was used to assess quality and risk of bias in individual studies. RESULTS We identified 22 articles, most from the United States (n = 17), as well as the United Kingdom (n = 3) and the Netherlands (n = 1). In a meta-analysis of US studies, hazard of mortality was lower in Black/African American groups (Pooled Hazard Ratio = 0.86, 95% CI = 0.82-0.91, I2 = 17%, from four studies) and Hispanic/Latino groups (Pooled HR = 0.65, 95% CI = 0.50-0.84, I2 = 86%, from four studies) versus comparison groups. However, study quality was mixed, and in particular, quality of reporting of race/ethnicity was inconsistent. CONCLUSION Literature indicates that Black/African American and Hispanic/Latino groups may experience lower mortality in dementia versus comparison groups in the United States, but further research, using clearer and more and consistent reporting of race/ethnicity, is necessary to understand what drives these patterns and their implications for policy and practice.
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Affiliation(s)
- Melissa Co
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Elyse Couch
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Qian Gao
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Andrea Martinez
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Trust, London, UK
| | - Matthew Prina
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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7
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Wrigley-Field E. Multidimensional Mortality Selection: Why Individual Dimensions of Frailty Don't Act Like Frailty. Demography 2020; 57:747-777. [PMID: 32215838 DOI: 10.1007/s13524-020-00858-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Theoretical models of mortality selection have great utility in explaining otherwise puzzling phenomena. The most famous example may be the Black-White mortality crossover: at old ages, Blacks outlive Whites, presumably because few frail Blacks survive to old ages while some frail Whites do. Yet theoretical models of unidimensional heterogeneity, or frailty, do not speak to the most common empirical situation for mortality researchers: the case in which some important population heterogeneity is observed and some is not. I show that, when one dimension of heterogeneity is observed and another is unobserved, neither the observed nor the unobserved dimension need behave as classic frailty models predict. For example, in a multidimensional model, mortality selection can increase the proportion of survivors who are disadvantaged, or "frail," and can lead Black survivors to be more frail than Whites, along some dimensions of disadvantage. Transferring theoretical results about unidimensional heterogeneity to settings with both observed and unobserved heterogeneity produces misleading inferences about mortality disparities. The unusually flexible behavior of individual dimensions of multidimensional heterogeneity creates previously unrecognized challenges for empirically testing selection models of disparities, such as models of mortality crossovers.
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Affiliation(s)
- Elizabeth Wrigley-Field
- Department of Sociology and Minnesota Population Center, University of Minnesota, Minneapolis, MN, 55455, USA.
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8
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Cobb S, Assari S. Investigation of the Predictors of Self-rated Health of Economically Disadvantaged African American Men and Women: Evidence for Sponge Hypothesis. INTERNATIONAL JOURNAL OF EPIDEMIOLOGIC RESEARCH 2020; 7:25-34. [PMID: 32395609 DOI: 10.34172/ijer.2020.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background and aims According to the sponge hypothesis, compared to men's self-rated health (SRH), women's SRH is more likely to reflect conditions other than chronic medical conditions (CMCs) such as psychiatric disorders (PDs). As a result, poor SRH is a weaker predictive factor for mortality risk for women than men. Most of this literature, however, is done in samples that are predominantly middleclass White. To test the sponge hypothesis among economically disadvantaged African Americans (AAs), this study compared low-income AA men and women for the effects of the number of PDs and CMCs on SRH. Materials and Methods This cross-sectional study recruited a non-random sample (n = 150) of economically disadvantaged AA adults with PD(s). Structured face-to-face interviews were used to collect data. SRH was measured using a single-item measure. PDs and CMCs were also self-reported. We applied linear regression models to test the interactions between SRH and the number of PDs and CMC as well as gender. Results The number of PDs and CMCs were associated with SRH in the pooled sample of low-income AA adults with PD(s). However, we found a significant interaction between the number of PDs and gender. This interaction suggested a stronger association between PDs and SRH for AA women than AA men. Gender did not alter the association between the number of CMCs and SRH. Conclusion The number of PDs is a determinant of SRH for low-income AA women but not AA men, supporting the sponge hypothesis.
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Affiliation(s)
- Sharon Cobb
- School of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, USA
| | - Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, USA
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Tajeu GS, Safford MM, Howard G, Howard VJ, Chen L, Long DL, Tanner RM, Muntner P. Black-White Differences in Cardiovascular Disease Mortality: A Prospective US Study, 2003-2017. Am J Public Health 2020; 110:696-703. [PMID: 32191519 PMCID: PMC7144446 DOI: 10.2105/ajph.2019.305543] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives. To determine factors that explain the higher Black:White cardiovascular disease (CVD) mortality rates among US adults.Methods. We analyzed data from the Reasons for Geographic and Racial Differences in Stroke study from 2003 to 2017 to estimate Black:White hazard ratios (HRs) for CVD mortality within subgroups younger than 65 years and aged 65 years or older.Results. Among 29 054 participants, 41.0% who were Black and 54.9% who were women, 1549 CVD deaths occurred. Among participants younger than 65 years, the demographic-adjusted Black:White CVD mortality HR was 2.23 (95% confidence interval [CI] = 1.87, 2.65) and 1.21 (95% CI = 1.00, 1.47) after full adjustment. Among participants aged 65 years or older, the demographic-adjusted Black:White CVD mortality HR was 1.58 (95% CI = 1.39, 1.79) and 1.12 (95% CI = 0.97, 1.29) after full adjustment. When we used mediation analysis, socioeconomic status explained 21.2% (95% CI = 13.6%, 31.4%) and 38.0% (95% CI = 20.9%, 61.7%) of the Black:White CVD mortality risk difference among participants younger than 65 years and aged 65 years or older, respectively. CVD risk factors explained 56.6% (95% CI = 42.0%, 77.2%) and 41.3% (95% CI = 22.9%, 65.3%) of the Black:White CVD mortality difference for participants younger than 65 years and aged 65 years or older, respectively.Conclusions. The higher Black:White CVD mortality risk is primarily explained by racial differences in socioeconomic status and CVD risk factors.
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Affiliation(s)
- Gabriel S Tajeu
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - Monika M Safford
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - George Howard
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - Virginia J Howard
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - Ligong Chen
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - D Leann Long
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - Rikki M Tanner
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
| | - Paul Muntner
- Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham
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How do age and major risk factors for mortality interact over the life-course? Implications for health disparities research and public health policy. SSM Popul Health 2019; 8:100438. [PMID: 31321279 PMCID: PMC6612923 DOI: 10.1016/j.ssmph.2019.100438] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/20/2019] [Accepted: 06/23/2019] [Indexed: 12/30/2022] Open
Abstract
A critical question in life-course research is whether the relationship between a risk factor and mortality strengthens, weakens, or remains constant with age. The objective of this paper is to shed light on the importance of measurement scale in examining this question. Many studies address this question solely on the multiplicative (relative) scale and report that the hazard ratio of dying associated with a risk factor declines with age. A wide set of risk factors have been shown to conform to this pattern including those that are socioeconomic, behavioral, and physiological in nature. Drawing from well-known principles on interpreting statistical interactions, we show that evaluations on the additive (absolute) scale often lead to a different set of conclusions about how the association between a risk factor and mortality changes with age than interpretations on the multiplicative scale. We show that on the additive scale the excess death risks posed by key socio-demographic and behavioral risk factors increase with age. Studies have not generally recognized the additive interpretation, but it has relevancy for testing life-course theories and informing public health interventions. We discuss these implications and provide general guidance on choosing a scale. Data from the U.S. National Health Interview Survey are used to provide empirical support. Studies often conclude that the effect of demographic and behavioral risk factors on mortality weakens with age. We show that this conclusion is premature as studies often fail to interpret their findings on the additive scale. We show empirically that on the additive scale the excess death risks posed by key risk factors strengthens with age. The general pattern of increasing susceptibility by age on the additive scale has not been previously recognized. We argue that the pattern has critical implications for sociological theory and public health policy.
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11
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Clark DG, Boan AD, Sims-Robinson C, Adams RJ, Amella EJ, Benitez A, Lackland DT, Ovbiagele B. Differential Impact of Index Stroke on Dementia Risk in African-Americans Compared to Whites. J Stroke Cerebrovasc Dis 2018; 27:2725-2730. [PMID: 30076114 DOI: 10.1016/j.jstrokecerebrovasdis.2018.05.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/17/2018] [Accepted: 05/28/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To compare whites and African-Americans in terms of dementia risk following index stroke. METHODS The data consisted of billing and International Classification of Diseases, Ninth Revision diagnosis codes from the South Carolina Revenue and Fiscal Affairs office on all hospital discharges within the state between 2000 and 2012. The sample consisted of 68,758 individuals with a diagnosis of ischemic stroke prior to 2010 (49,262 white [71.65%] and 19,496 African-Americans [28.35%]). We identified individuals in the dataset who were subsequently diagnosed with any of 5 categories of dementia and evaluated time to dementia diagnosis in Cox Proportional Hazards models. We plotted cumulative hazard curves to illustrate the effect of race on dementia risk after controlling for age, sex, and occurrence of intervening stroke. RESULTS Age at index stroke was significantly different between the 2 groups, with African-Americans being younger on average (70.0 [SD 12.5] in whites versus 64.5 [SD 14.1] in African-Americans, P < .0001). Adjusted hazard ratios revealed that African-American race increased risk for all 5 categories of dementia following incident stroke, ranging from 1.37 for AD to 1.95 for vascular dementia. Age, female sex, and intervening stroke likewise increased risk for dementia. CONCLUSIONS African-Americans are at higher risk for dementia than whites within 5 years of ischemic stroke, regardless of dementia subtype. Incident strokes may have a greater likelihood of precipitating dementia in African-Americans due to higher prevalence of nonstroke cerebrovascular disease or other metabolic or vascular factors that contribute to cognitive impairment.
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Affiliation(s)
- D G Clark
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina; Department of Neurology, Ralph H. Johnson VA Medical Center, Charleston, South Carolina.
| | - A D Boan
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina; Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - C Sims-Robinson
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - R J Adams
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - E J Amella
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - A Benitez
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - D T Lackland
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - B Ovbiagele
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
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Lewis G, Werbeloff N, Hayes JF, Howard R, Osborn DPJ. Diagnosed depression and sociodemographic factors as predictors of mortality in patients with dementia. Br J Psychiatry 2018; 213:471-476. [PMID: 29898791 PMCID: PMC6429254 DOI: 10.1192/bjp.2018.86] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Potentially modifiable risk factors for developing dementia have been identified. However, risk factors for increased mortality in patients with diagnosed dementia are not well understood. Identifying factors that influence prognosis would help clinicians plan care and address unmet needs.AimsTo investigate diagnosed depression and sociodemographic factors as predictors of mortality in patients with dementia in UK secondary clinical care services. METHOD We conducted a cohort study of patients with a dementia diagnosis in an electronic health records database in a UK National Health Service mental health trust. RESULTS In 3374 patients with 10 856 person-years of follow-up, comorbid depression was not associated with mortality (adjusted hazard ratio 0.94; 95% CI 0.71-1.24). Single patients had higher mortality than those who were married (adjusted hazard ratio 1.25; 95% CI 1.03-1.50). Patients of Asian ethnicity had lower mortality rates than White British patients (adjusted hazard ratio 0.50; 95% CI 0.34-0.73). CONCLUSIONS Clinically diagnosed depression does not increase mortality in patients with dementia. Patients who are single are a potential high-mortality risk group. Lower mortality rates in Asian patients with dementia that have been reported in the USA also apply in the UK.Declaration of interestNone.
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Affiliation(s)
- Gemma Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, UK,Correspondence: Gemma Lewis, Division of Psychiatry, University College London, 149 Tottenham Court Road, London W1T 7NF, UK.
| | - Nomi Werbeloff
- Division of Psychiatry, Faculty of Brain Sciences, University College London, UK
| | - Joseph F. Hayes
- Division of Psychiatry, Faculty of Brain Sciences, University College London and Camden and Islington NHS Foundation Trust, UK
| | - Robert Howard
- Division of Psychiatry, Faculty of Brain Sciences, University College London and Camden and Islington NHS Foundation Trust, UK
| | - David P. J. Osborn
- Division of Psychiatry, Faculty of Brain Sciences, University College London and Camden and Islington NHS Foundation Trust, UK
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13
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Laditka JN, Laditka SB. Work disability in the United States, 1968-2015: Prevalence, duration, recovery, and trends. SSM Popul Health 2018; 4:126-134. [PMID: 29349281 PMCID: PMC5769114 DOI: 10.1016/j.ssmph.2017.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 12/03/2017] [Accepted: 12/23/2017] [Indexed: 01/12/2023] Open
Abstract
The United States workforce is aging. At the same time more people have chronic conditions, for longer periods. Given these trends the importance of work disability, physical or nervous problems that limit a person's type or amount of work, is increasing. No research has examined transitions among multiple levels of work disability, recovery from work disability, or trends. Limited research has focused on work disability among African Americans and Hispanics, or separately for women and men. We examined these areas using data from 30,563 adults in the 1968-2015 Panel Study of Income Dynamics. We estimated annual probabilities of work disability, recovery, and death with multinomial logistic Markov models. Microsimulations accounting for age and education estimated outcomes for African American, Hispanic, and non-Hispanic white women and men. Results from these nationally representative data suggested that the majority of Americans experience work disability during working life. Most spells ended with recovery or reduced severity. Among women, African Americans and Hispanics had less moderate and severe work disability than whites. Among men, African Americans became severely work disabled more often than whites, recovered from severe spells more often and had shorter severe spells, yet had more severe work disability at age 65. Hispanic men were more likely to report at least one spell of severe work disability than whites; they also had substantially more recovery from severe work disability, and a lower percentage of working years with work disability. Among African Americans and Hispanics, men were considerably more likely than women to have severe work disability at age 65. Work disability declined significantly across the study period for all groups. Although work disability has declined over several decades, it remains common. Results suggest that the majority of work disability spells end with recovery, underscoring the importance of rehabilitation and workplace accommodation.
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Affiliation(s)
| | - Sarah B. Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, United States
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14
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Berridge C, Mor V. Disparities in the Prevalence of Unmet Needs and Their Consequences Among Black and White Older Adults. J Aging Health 2017; 30:1427-1449. [PMID: 28737106 DOI: 10.1177/0898264317721347] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We document differential prevalence of need for assistance with personal, instrumental, and mobility tasks and adverse consequences of unmet needs, nursing home relocation, and mortality among Black and White older adults. METHOD Data are from the National Health and Aging Trends Study. Using logistic and multinomial logistic regression, we determine whether race is predictive of reporting need or adverse consequence and test the role of race as a moderator of the relationship between baseline need and three 1-year outcomes. RESULTS Black older adults are more likely to experience a consequence of unmet need (35.33% vs. 29.97%, p = .028) in unadjusted models. In adjusted models, we find no moderating effect of race on baseline need on nursing home placement (0.00, 95% confidence interval [CI] = [-2.43, 2.42], p = .991), mortality (0.73, 95% = [-1.58, 0.11], p = .089), or a Round 2 consequence of unmet (-0.51, 95% CI = [-1.15, 0.14], p = .121). DISCUSSION This work highlights the complex relationship between race, need, unmet need, mortality, and nursing home entry.
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Affiliation(s)
| | - Vincent Mor
- 2 Brown University, Providence, RI, USA.,3 Providence VAMC Health Services Research Service
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15
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“Selection Bias by Death” and Other Ways Collider Bias May Cause the Obesity Paradox. Epidemiology 2017; 28:e16-e17. [DOI: 10.1097/ede.0000000000000591] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Kimmel PL, Fwu CW, Abbott KC, Ratner J, Eggers PW. Racial Disparities in Poverty Account for Mortality Differences in US Medicare Beneficiaries. SSM Popul Health 2016; 2:123-129. [PMID: 27152319 PMCID: PMC4852486 DOI: 10.1016/j.ssmph.2016.02.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Higher mortality in Blacks than Whites has been consistently reported in the US, but previous investigations have not accounted for poverty at the individual level. The health of its population is an important part of the capital of a nation. We examined the association between individual level poverty and disability and racial mortality differences in a 5% Medicare beneficiary random sample from 2004 to 2010. Cox regression models examined associations of race with all-cause mortality, adjusted for demographics, comorbidities, disability, neighborhood income, and Medicare “Buy-in” status (a proxy for individual level poverty) in 1,190,510 Black and White beneficiaries between 65 and 99 years old as of January 1, 2014, who had full and primary Medicare Part A and B coverage in 2004, and lived in one of the 50 states or Washington, DC. Overall, black beneficiaries had higher sex-and-age adjusted mortality than Whites (hazard ratio [HR] 1.18). Controlling for health-related measures and disability reduced the HR for Black beneficiaries to 1.03. Adding “Buy-in” as an individual level covariate lowered the HR for Black beneficiaries to 0.92. Neither of the residential measures added to the predictive model. We conclude that poorer health status, excess disability, and most importantly, greater poverty among Black beneficiaries accounts for racial mortality differences in the aged US Medicare population. Poverty fosters social and health inequalities, including mortality disparities, notwithstanding national health insurance for the US elderly. Controlling for individual level poverty, in contrast to the common use of area level poverty in previous analyses, accounts for the White survival advantage in Medicare beneficiaries, and should be a covariate in analyses of administrative databases. Socioeconomic disparities have important consequences for patient outcomes. Including poverty in analyses mitigates racial mortality disparities in the elderly. Poverty is an essential factor associated with Medicare racial mortality disparities.
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Affiliation(s)
- Paul L Kimmel
- Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 2 Democracy Plaza, Room 611, 6707 Democracy Boulevard, Bethesda MD 20892-5458, USA, Telephone: +21-301-594-1409
| | - Chyng-Wen Fwu
- Social & Scientific Systems, Inc. 8757 Georgia Avenue, 12 floor, Silver Spring, MD 20910, USA
| | - Kevin C Abbott
- Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 6707 Democracy Boulevard Bethesda, MD 20892-5458, USA
| | | | - Paul W Eggers
- Division of Kidney Urologic and Hematologic Diseases,National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 6707 Democracy Boulevard, Bethesda MD 20892-5458, USA
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Beydoun MA, Beydoun HA, Mode N, Dore GA, Canas JA, Eid SM, Zonderman AB. Racial disparities in adult all-cause and cause-specific mortality among us adults: mediating and moderating factors. BMC Public Health 2016; 16:1113. [PMID: 27770781 PMCID: PMC5075398 DOI: 10.1186/s12889-016-3744-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 10/05/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Studies uncovering factors beyond socio-economic status (SES) that would explain racial and ethnic disparities in mortality are scarce. METHODS Using prospective cohort data from the Third National Health and Nutrition Examination Survey (NHANES III), we examined all-cause and cause-specific mortality disparities by race, mediation through key factors and moderation by age (20-49 vs. 50+), sex and poverty status. Cox proportional hazards, discrete-time hazards and competing risk regression models were conducted (N = 16,573 participants, n = 4207 deaths, Median time = 170 months (1-217 months)). RESULTS Age, sex and poverty income ratio-adjusted hazard rates were higher among Non-Hispanic Blacks (NHBs) vs. Non-Hispanic Whites (NHW). Within the above-poverty young men stratum where this association was the strongest, the socio-demographic-adjusted HR = 2.59, p < 0.001 was only partially attenuated by SES and other factors (full model HR = 2.08, p = 0.003). Income, education, diet quality, allostatic load and self-rated health, were among key mediators explaining NHB vs. NHW disparity in mortality. The Hispanic paradox was observed consistently among women above poverty (young and old). NHBs had higher CVD-related mortality risk compared to NHW which was explained by factors beyond SES. Those factors did not explain excess risk among NHB for neoplasm-related death (fully adjusted HR = 1.41, 95 % CI: 1.02-2.75, p = 0.044). Moreover, those factors explained the lower risk of neoplasm-related death among MA compared to NHW, while CVD-related mortality risk became lower among MA compared to NHW upon multivariate adjustment. CONCLUSIONS In sum, racial/ethnic disparities in all-cause and cause-specific mortality (particularly cardiovascular and neoplasms) were partly explained by socio-demographic, SES, health-related and dietary factors, and differentially by age, sex and poverty strata.
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Affiliation(s)
- M. A. Beydoun
- NIH Biomedical Research Center, National Institute on Aging, IRP, 251 Bayview Blvd. Suite 100 Room #:04B118, Baltimore, MD 21224 USA
| | - H. A. Beydoun
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - N. Mode
- NIH Biomedical Research Center, National Institute on Aging, IRP, 251 Bayview Blvd. Suite 100 Room #:04B118, Baltimore, MD 21224 USA
| | - G. A. Dore
- NIH Biomedical Research Center, National Institute on Aging, IRP, 251 Bayview Blvd. Suite 100 Room #:04B118, Baltimore, MD 21224 USA
| | - J. A. Canas
- Pediatric Endocrinology, Diabetes and Metabolism Nemours Children’s Clinic, Jacksonville, FL USA
| | - S. M. Eid
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - A. B. Zonderman
- NIH Biomedical Research Center, National Institute on Aging, IRP, 251 Bayview Blvd. Suite 100 Room #:04B118, Baltimore, MD 21224 USA
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Laditka JN, Laditka SB. Associations of Educational Attainment With Disability and Life Expectancy by Race and Gender in the United States. J Aging Health 2016; 28:1403-1425. [PMID: 26690254 DOI: 10.1177/0898264315620590] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study provides estimates of associations of education with life expectancy and the percentage of remaining life from age 40 with disability. METHOD We used the Panel Study of Income Dynamics, 1999-2011 ( n = 8,763; 94,246 person-years), measuring five education levels. We estimated probabilities of disability and death with multinomial logistic Markov models, and used microsimulations beginning at age 40, controlling for gender, race/ethnicity, age, and disability. RESULTS With college education, African American and White women, and African American and White men, respectively, lived 46.6%, 44.0%, 55.2%, and 50.4% more years from age 40 than those educated at less than the ninth grade ( p < .001). Corresponding percentages of life with disability were lower with high education, by 37.9%, 38.9%, 41.0%, and 39.9% ( p < .001). There was little evidence of outcome differences between African Americans and Whites within education levels. DISCUSSION Low education is associated with shorter lives with much more disability.
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Affiliation(s)
- James N Laditka
- 1 University of North Carolina at Charlotte, University City Boulevard, USA
| | - Sarah B Laditka
- 1 University of North Carolina at Charlotte, University City Boulevard, USA
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Laditka JN, Laditka SB. Unemployment, disability and life expectancy in the United States: A life course study. Disabil Health J 2015; 9:46-53. [PMID: 26385529 DOI: 10.1016/j.dhjo.2015.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 07/18/2015] [Accepted: 08/09/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Unemployment may be associated with health through factors including stress, depression, unhealthy behaviors, reduced health care, and loss of social networks. Little is known about associations of total lifetime unemployment with disability and life expectancy. HYPOTHESIS People with high unemployment (≥the median) will live shorter lives with more disability than those with less unemployment. METHODS Data were nationally representative of African Americans and non-Hispanic whites, from the Panel Study of Income Dynamics (37 waves 1968-2011, n = 7,970, mean work years = 24.7). Seven waves (1999-2011, 58,268 person-years) measured disability in activities of daily living. We estimated monthly probabilities of disability and death associated with unemployment using multinomial logistic Markov models adjusted for age, sex, race/ethnicity, education, health status at baseline and throughout work life, and social support. We used the probabilities to create large populations with microsimulation, each individual having known monthly disability status, age 40 to death. We analyzed the populations to measure outcomes. RESULTS Respectively for African American and white women and African American and white men, life expectancies (with 95% confidence intervals) from age 40 with low unemployment were ages: 77.1 (75.0-78.3), 80.6 (78.4-81.4), 71.4 (69.6-72.5), and 76.9 (74.9-77.9). Corresponding high unemployment results were: 73.7 (71.7-75.0), 77.5 (75.1-78.0), 68.4 (66.8-69.0), and 73.7 (71.5-74.3). The percentage of life disabled from age 40 was greater with high unemployment for the same groups, by 23.9%, 21.0%, 21.3%, and 21.1% (all p < 0.01). CONCLUSIONS High lifetime unemployment may be associated with a larger proportion of later life with disability and lower life expectancy.
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Affiliation(s)
- James N Laditka
- Department of Public Health Sciences, Public Policy, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, USA
| | - Sarah B Laditka
- Department of Public Health Sciences, Public Policy, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, USA.
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Laditka JN, Laditka SB. Associations of multiple chronic health conditions with active life expectancy in the United States. Disabil Rehabil 2015; 38:354-61. [DOI: 10.3109/09638288.2015.1041614] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- James N. Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Sarah B. Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
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21
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Pudrovska T. Early-Life Socioeconomic Status and Mortality at Three Life Course Stages: An Increasing Within-Cohort Inequality. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2014; 55:181-195. [PMID: 24818953 PMCID: PMC7416735 DOI: 10.1177/0022146514531986] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Using the 1957-2011 data from 10,317 participants in the Wisconsin Longitudinal Study, I examine how socioeconomic status (SES) at age 18 affects all-cause mortality between ages 18 and 72. Integrating fundamental cause theory, gender relations theory, and a life course perspective, I evaluate the cumulative advantage (CA) and age-as-leveler processes as well as gender differences in these processes. Findings indicate that higher early-life SES at age 18 is related to lower mortality over the life course, and the effect of early-life SES is not explained by socioeconomic achievement and health behaviors in adulthood. Consistent with the CA model, early-life SES generates increasing within-cohort inequality with age, and this CA process is stronger for women than men. Results also show that unequal selection by SES obscures the CA process and creates an illusion of the age-as-leveler process. This study calls for a lifelong gendered approach to socioeconomic health disparities.
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