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Krieger N. Theorizing epidemiology, the stories bodies tell, and embodied truths: a status update on contending 21 st c CE epidemiological theories of disease distribution. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024; 54:331-342. [PMID: 39149891 DOI: 10.1177/27551938241269188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
This critical review considers the status of 21st-century epidemiological theories of disease distribution, updating to 2024 prior analyses published up through 2014, and discusses the implications of these theories for research, practice, and pedagogy. Three key trends stand out: (a) the continued dominance of individualistic biomedical and lifestyle theories; (b) growth and elaboration of social epidemiological alternatives; and (c) the ongoing inattention to epidemiologic theories of disease distribution in the training of epidemiologists and public health professionals and in current efforts to improve the rigor of epidemiological research and causal inference. In a context of growing global political polarization, climate crisis, broader environmental and ecological crises, and stubbornly persistent health inequities within and between nations, producing actionable knowledge relevant to improving the people's health and advancing health justice will require much greater engagement with social epidemiologic theories of disease distribution in research, pedagogy, and practice. At issue is critically engaging with the embodied truths manifested in the stories bodies tell in population patterns of health, disease, and well-being.
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Affiliation(s)
- Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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2
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Woolf SH. Increasing Mortality Rates in the US, but Not From COVID-19. JAMA 2024; 332:959-960. [PMID: 39207745 DOI: 10.1001/jama.2024.13626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
This Viewpoint explores increasing mortality rates in the US due to a variety of causes unrelated to the COVID-19 pandemic.
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Affiliation(s)
- Steven H Woolf
- Department of Family Medicine, Virginia Commonwealth University School of Medicine, Richmond
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3
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Goldberg D. Care of Diabetes and the Sacrifice of Evidence-Based Medicine and Health Equity. J Gen Intern Med 2024; 39:2333-2337. [PMID: 38981942 PMCID: PMC11347529 DOI: 10.1007/s11606-024-08907-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 06/20/2024] [Indexed: 07/11/2024]
Abstract
The American Diabetes Association and the European Association for the Study of Diabetes published a 2022 consensus report recommending changes in diabetes care. This Perspective raises three concerns: with how the report summarizes evidence, how it frames the social determinants of health (SDOH), and with its transnational composition and conflicts of interest. The Perspective analyzes three new clinical recommendations that change the role of metformin from first-line therapy to a first-line option, for the inclusion of weight management as a co-primary treatment goal with glycemic control for patients without cardiac or renal complications, and for addition of the SDOH as a universal component of diabetes care together with lifestyle changes and self-management support. The Perspective considers how the poor evidence assessments of the recommendations and the imprecise framing of the SDOH introduce bias. The composition of the panel's membership poorly represents and accounts for the challenges faced by vulnerable US communities or safety net providers. The report is placed in a historical context for diabetes of organized medicine's failures to overcome prejudices and promote health equity. The Perspective concludes that the report perpetuates a pattern of prejudice within organized medicine at the expense of scientific precision and health equity.
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Affiliation(s)
- David Goldberg
- Chinle Comprehensive Healthcare Facility, Chinle, AZ, USA.
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4
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Miller MC, Mishio Bawa E, Absher JR, Bonilha L, Ross LA, Chai HW, Milano NJ, Adams RJ. Longevity in the South Carolina Alzheimer's disease registry. Front Neurol 2024; 15:1425495. [PMID: 39233680 PMCID: PMC11371588 DOI: 10.3389/fneur.2024.1425495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 08/05/2024] [Indexed: 09/06/2024] Open
Abstract
Background South Carolina has arguably the most robust Alzheimer's Registry in the United States. For enhanced planning in both clinical practice and research and better utilization of the Registry data, it is important to understand survival after Registry entry. To this end, we conducted exploratory analyses to examine the patterns of longevity/survival in the South Carolina Alzheimer's Disease Registry. Methods The sample included 42,028 individuals in the South Carolina Alzheimer's Disease Registry (SCADR). Participants were grouped into four cohorts based on their year of diagnosis. Longevity in the Registry (LIR), or the length of survival in the registry, was calculated based on the years of reported diagnosis and death. Results The median LIR varied between 24 to 36 months depending on the cohort, with 75% of individuals in the three recent cohorts surviving for at least 12 months. Across all cohorts, 25% of the participants survived at least 60 months. The median LIR of females was longer than that of males. Individuals whose race was classified as Asian, American Indian, and other than listed had longer LIR compared to White, African American, and Hispanic individuals. Median LIR was shorter for Registry cases diagnosed at an earlier age (less than 65 years). Conclusion Our data indicate that significant longevity is to be expected in the SCADR but that there is interesting variability which needs to be explored in subsequent studies. The SCADR is a rich data source prime for use in research studies and analyses.
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Affiliation(s)
- Maggi C Miller
- Department of Epidemiology and Biostatistics, Office for the Study of Aging, University of South Carolina, Columbia, SC, United States
| | - Eric Mishio Bawa
- Department of Epidemiology and Biostatistics, Office for the Study of Aging, University of South Carolina, Columbia, SC, United States
| | - John R Absher
- Brain Health Network, University of South Carolina, Columbia, SC, United States
- Department of Medicine, Division of Neurology, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
- School of Health Research, Clemson University, Clemson, SC, United States
| | - Leonard Bonilha
- Department of Pharmacology, Physiology, Neuroscience, School of Medicine Columbia, University of South Carolina, Columbia, SC, United States
| | - Lesley A Ross
- School of Health Research, Clemson University, Clemson, SC, United States
| | - Hye Won Chai
- School of Health Research, Clemson University, Clemson, SC, United States
| | - Nicholas J Milano
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
| | - Robert J Adams
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
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Tosi LL, Templeton K, Pennington AM, Reid KA, Boyan BD. Influence of Sex and Gender on Musculoskeletal Conditions and How They Are Reported. J Bone Joint Surg Am 2024; 106:1512-1519. [PMID: 38954642 PMCID: PMC11338726 DOI: 10.2106/jbjs.24.00194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
ABSTRACT There is increasing evidence that musculoskeletal tissues are differentially regulated by sex hormones in males and females. The influence of sex hormones, in addition to other sex-based differences such as in anatomical alignment and immune-system function, impact the prevalence and severity of disease as well as the types of injuries that affect the musculoskeletal system and the outcomes of prevention measures and treatment. Literature specifically addressing sex differences related to the musculoskeletal system is limited, underscoring the imperative for both basic and clinical research on this topic. This review highlights areas of research that have implications for bone and cartilage health, including growth and development, sports injuries, osteoarthritis, osteoporosis, and bone frailty. It is clear that important aspects of the musculoskeletal system have been understudied. Consideration of how sex hormone therapy will affect musculoskeletal tissues in prepuberty, during puberty, and in adults is vital, yet little is known. The purpose of this article is to foster awareness and interest in advancing our understanding of how sex differences influence orthopaedic practice.
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Affiliation(s)
- Laura L Tosi
- Division of Pediatric Orthopaedics and Sports Medicine, Children's National Hospital, Washington, DC
| | | | - Andrew M Pennington
- Division of Pediatric Orthopaedics and Sports Medicine, Children's National Hospital, Washington, DC
| | - Kendall A Reid
- Division of Pediatric Orthopaedics and Sports Medicine, Children's National Hospital, Washington, DC
| | - Barbara D Boyan
- Institute for Engineering and Medicine, College of Engineering, Virginia Commonwealth University, Richmond, Virginia
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6
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Hawkins D, Thomas K, Landsbergis P. Occupational inequalities in mortality from cardiovascular disease, 2020-2021. Am J Ind Med 2024. [PMID: 39105628 DOI: 10.1002/ajim.23643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 07/26/2024] [Accepted: 07/29/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND In recent years previous declines in cardiovascular disease (CVD) have stalled. There are occupational risk factors for CVD mortality. This study seeks to examine inequalities in CVD mortality for working-age adults in the United States by occupation. METHODS Death certificate data for CVD deaths were obtained from the National Center for Health Statistics. Occupation data from these death certificates were coded to major occupation groups. Using information about the number of workers employed in these occupations obtained from the American Community Survey, we calculated mortality rates and rate ratios (RRs), adjusted for covariates associated with CVD mortality. RESULTS After adjusting for age, sex, race/ethnicity, and educational attainment, workers in 11 occupations had significantly elevated RRs: food preparation and serving; construction and extraction; arts, design, entertainment, sports, and media; life, physical, and social science; farming, fishing, and forestry; legal; protective services; building and grounds cleaning and maintenance; healthcare practitioners and technical; personal care and service; and community and social services. CONCLUSIONS Occupation appears to be a significant predictor of CVD mortality. Further research is needed to assess how occupational risk factors contribute to changing trends for CVD mortality. Interventions are needed to address workplace risk factors for CVD.
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Affiliation(s)
- Devan Hawkins
- Public Health Program, School of Arts and Sciences, MCPHS University, Boston, Massachusetts, USA
| | - Karina Thomas
- Pre-Medical Health Studies, School of Arts and Sciences, MCPHS University, Boston, Massachusetts, USA
| | - Paul Landsbergis
- Department of Environmental and Occupational Health Sciences, SUNY-Downstate School of Public Health, Brooklyn, New York, USA
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Singh K. Transactional Care and the Looming Glaucoma Public Health Crisis. Ophthalmology 2024; 131:877-879. [PMID: 39029979 DOI: 10.1016/j.ophtha.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 07/21/2024] Open
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Blosnich JR. Commentary on "Mental Health Diagnoses and Suicidality Among Transgender Youth in Hospital Settings," by Nunes-Moreno et al. LGBT Health 2024. [PMID: 39012941 DOI: 10.1089/lgbt.2024.0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Affiliation(s)
- John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
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Bulaj G, Coleman M, Johansen B, Kraft S, Lam W, Phillips K, Rohaj A. Redesigning Pharmacy to Improve Public Health Outcomes: Expanding Retail Spaces for Digital Therapeutics to Replace Consumer Products That Increase Mortality and Morbidity Risks. PHARMACY 2024; 12:107. [PMID: 39051391 PMCID: PMC11270305 DOI: 10.3390/pharmacy12040107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/26/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
United States healthcare outcomes, including avoidable mortality rates, are among the worst of high-income countries despite the highest healthcare spending per capita. While community pharmacies contribute to chronic disease management and preventive medicine, they also offer consumer products that increase mortality risks and the prevalence of cardiovascular diseases, diabetes, cancer, and depression. To resolve these contradictions, our perspective article describes opportunities for major pharmacy chains (e.g., CVS Pharmacy and Walgreens) to introduce digital health aisles dedicated to prescription and over-the-counter digital therapeutics (DTx), together with mobile apps and wearables that support disease self-management, wellness, and well-being. We provide an evidence-based rationale for digital health aisles to replace spaces devoted to sugar-sweetened beverages and other unhealthy commodities (alcohol, tobacco) that may increase risks for premature death. We discuss how digital health aisles can serve as marketing and patient education resources, informing customers about commercially available DTx and other technologies that support healthy lifestyles. Since pharmacy practice requires symbiotic balancing between profit margins and patient-centered, value-based care, replacing health-harming products with health-promoting technologies could positively impact prevention of chronic diseases, as well as the physical and mental health of patients and caregivers who visit neighborhood pharmacies in order to pick up medicines.
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Affiliation(s)
- Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Melissa Coleman
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Blake Johansen
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Sarah Kraft
- Independent Researcher, Salt Lake City, UT 84112, USA
| | - Wayne Lam
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Katie Phillips
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Aarushi Rohaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- The Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84112, USA
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Halfon N, Russ SA, Counts NZ. Time for a Kids Progress Administration: US Department of the Treasury Stepping Up. JAMA Pediatr 2024; 178:643-644. [PMID: 38767896 DOI: 10.1001/jamapediatrics.2024.1113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
This Viewpoint proposes the creation of a Kids Progress Administration housed under the US Department of the Treasury to address children’s long-term health and well-being.
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Affiliation(s)
- Neal Halfon
- Center for Healthier Children, Families & Communities, MCH Life Course Translational Research Network, Geffen School of Medicine, Fielding School of Public Health, Luskin School of Public Affairs, University of California, Los Angeles
| | - Shirley Ann Russ
- Center for Healthier Children, Families & Communities, MCH Life Course Translational Research Network, University of California, Los Angeles
| | - Nathaniel Z Counts
- New York City Department of Health and Mental Hygiene, Long Island City, New York
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Kolbe LJ. The Future of School Health Education in the United States: An Ontology. THE JOURNAL OF SCHOOL HEALTH 2024; 94:661-673. [PMID: 38268088 DOI: 10.1111/josh.13436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 11/29/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND As summarized in this article, the widespread implementation of modern school health education (SHE) could become one of the most effective means available to improve the well-being of people in the United States and in other nations. However, the development and evolution of SHE largely remains unorganized, underdeveloped, and neglected by health and education agencies, policymakers, and the public. METHODS Essential to the development of any scientific discipline, scientists today use the word ontology to refer to efforts to organize knowledge in particular domains. A useful working definition of a scientific ontology is an explicit, formal specification of a shared conceptualization-a systematic set of shared terms and an explication of their interrelationships. Nine interdependent questions are outlined to help guide the development of an initial, broad, and actionable scientific ontology for SHE. RESULTS Whether and how we respond to these questions arguably will determine the future of SHE research, policy, practice, and equity in the United States. CONCLUSIONS An initial ontology might help conceptualize, inform, and facilitate more systematic and strategic local, state, national, and international deliberations and actions to improve SHE.
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Affiliation(s)
- Lloyd J Kolbe
- Indiana University School of Public Health-Bloomington, c/o 1205 St. George's Lane, Vero Beach, FL, 32967
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12
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Rosenberg PS, Miranda-Filho A. Cancer Incidence Trends in Successive Social Generations in the US. JAMA Netw Open 2024; 7:e2415731. [PMID: 38857048 PMCID: PMC11165384 DOI: 10.1001/jamanetworkopen.2024.15731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/08/2024] [Indexed: 06/11/2024] Open
Abstract
Importance The incidence of some cancers in the US is increasing in younger age groups, but underlying trends in cancer patterns by birth year remain unclear. Objective To estimate cancer incidence trends in successive social generations. Design, Setting, and Participants In this cohort study, incident invasive cancers were ascertained from the Surveillance, Epidemiology, and End Results (SEER) program's 13-registry database (November 2020 submission, accessed August 14, 2023). Invasive cancers diagnosed at ages 35 to 84 years during 1992 to 2018 within 152 strata were defined by cancer site, sex, and race and ethnicity. Exposure Invasive cancer. Main Outcome and Measures Stratum-specific semiparametric age-period-cohort (SAGE) models were fitted and incidence per 100 000 person-years at the reference age of 60 years was calculated for single-year birth cohorts from 1908 through 1983 (fitted cohort patterns [FCPs]). The FCPs and FCP incidence rate ratios (IRRs) were compared by site for Generation X (born between 1965 and 1980) and Baby Boomers (born between 1946 and 1964). Results A total of 3.8 million individuals with invasive cancer (51.0% male; 8.6% Asian or Pacific Islander, 9.5% Hispanic, 10.4% non-Hispanic Black, and 71.5% non-Hispanic White) were included in the analysis. In Generation X vs Baby Boomers, FCP IRRs among women increased significantly for thyroid (2.76; 95% CI, 2.41-3.15), kidney (1.99; 95% CI, 1.70-2.32), rectal (1.84; 95% CI, 1.52-2.22), corpus uterine (1.75; 95% CI, 1.40-2.18), colon (1.56; 95% CI, 1.27-1.92), and pancreatic (1.39; 95% CI, 1.07-1.80) cancers; non-Hodgkins lymphoma (1.40; 95% CI, 1.08-1.82); and leukemia (1.27; 95% CI, 1.03-1.58). Among men, IRRs increased for thyroid (2.16; 95% CI, 1.87-2.50), kidney (2.14; 95% CI, 1.86-2.46), rectal (1.80; 95% CI, 1.52-2.12), colon (1.60; 95% CI, 1.32-1.94), and prostate (1.25; 95% CI, 1.03-1.52) cancers and leukemia (1.34; 95% CI, 1.08-1.66). Lung (IRR, 0.60; 95% CI, 0.50-0.72) and cervical (IRR, 0.71; 95% CI, 0.57-0.89) cancer incidence decreased among women, and lung (IRR, 0.51; 95% CI, 0.43-0.60), liver (IRR, 0.76; 95% CI, 0.63-0.91), and gallbladder (IRR, 0.85; 95% CI, 0.72-1.00) cancer and non-Hodgkins lymphoma (IRR, 0.75; 95% CI, 0.61-0.93) incidence decreased among men. For all cancers combined, FCPs were higher in Generation X than for Baby Boomers because gaining cancers numerically overtook falling cancers in all groups except Asian or Pacific Islander men. Conclusions and Relevance In this model-based cohort analysis of incident invasive cancer in the general population, decreases in lung and cervical cancers in Generation X may be offset by gains at other sites. Generation X may be experiencing larger per-capita increases in the incidence of leading cancers than any prior generation born in 1908 through 1964. On current trajectories, cancer incidence could remain high for decades.
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Affiliation(s)
- Philip S. Rosenberg
- Division of Cancer Epidemiology and Genetics, Biostatistics Branch, National Cancer Institute, Rockville, Maryland
| | - Adalberto Miranda-Filho
- Division of Cancer Epidemiology and Genetics, Biostatistics Branch, National Cancer Institute, Rockville, Maryland
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Woolf SH. Malignant Neglect: Accounting for Public Disinterest in Deteriorating Health Outcomes in the United States. Am J Public Health 2024; 114:580-582. [PMID: 38547491 PMCID: PMC11079841 DOI: 10.2105/ajph.2024.307626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Affiliation(s)
- Steven H Woolf
- Steven H. Woolf is with the Center on Society and Health and Department of Family Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA
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Kelley A, Addie S, Carrington-Lawrence S, Ferrucci L, Jones P, Hadley E, Haim T, Harper J, Kahana S, Kelley M, Kohanski R, Masliah E, McConnell C, Morrison S, Nielsen L, Santora K, Hodes R. National Institute on Aging's 50th anniversary: Advancing aging research and the health and well-being of older adults. J Am Geriatr Soc 2024; 72:1574-1582. [PMID: 38445895 PMCID: PMC11090751 DOI: 10.1111/jgs.18837] [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: 12/21/2023] [Revised: 01/26/2024] [Accepted: 02/07/2024] [Indexed: 03/07/2024]
Abstract
The National Institute on Aging (NIA), part of the National Institutes of Health (NIH), was founded in 1974 to support and conduct research on aging and the health and well-being of older adults. Fifty years ago, the concept of studying aging generated much skepticism. Early NIA-funded research findings helped establish the great value of aging research and provided the foundation for significant science advances that have improved our understanding of the aging process, diseases and conditions associated with aging, and the effects of health inequities, as well as the need to promote healthy aging lifestyles. Today, we celebrate the many important contributions to aging research made possible by NIA, as well as opportunities to continue to make meaningful progress. NIA emphasizes that the broad aging research community must continue to increase and expand our collective efforts to recruit and train a diverse next generation of aging researchers.
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Affiliation(s)
- Amy Kelley
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Siobhan Addie
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Patricia Jones
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Evan Hadley
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Todd Haim
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Jessica Harper
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Shoshana Kahana
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Melinda Kelley
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Ronald Kohanski
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Eliezer Masliah
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Cindy McConnell
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Stephanie Morrison
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisbeth Nielsen
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Kenneth Santora
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Richard Hodes
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
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15
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Fielding JE. Our Catastrophe in Waiting: Climate Change. Am J Public Health 2024; 114:476-478. [PMID: 38452300 PMCID: PMC11008301 DOI: 10.2105/ajph.2024.307575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Affiliation(s)
- Jonathan E Fielding
- Jonathan E. Fielding is professor, Health Policy and Management, Fielding School of Public Health, and professor, Pediatrics, Geffen School of Medicine, University of California, Los Angeles
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Himmelstein KEW, Tsai AC, Venkataramani AS. Wealth Redistribution to Extend Longevity in the US. JAMA Intern Med 2024; 184:311-320. [PMID: 38285594 PMCID: PMC10825783 DOI: 10.1001/jamainternmed.2023.7975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/10/2023] [Indexed: 01/31/2024]
Abstract
Importance The US is unique among wealthy countries in its degree of wealth inequality and its poor health outcomes. Wealth is known to be positively associated with longevity, but little is known about whether wealth redistribution might extend longevity. Objective To examine the association between wealth and longevity and estimate the changes in longevity that could occur with simulated wealth distributions that were perfectly equal, similar to that observed in Japan (among the most equitable of Organisation for Economic Co-operation and Development [OECD] countries), generated by minimum inheritance proposals, and produced by baby bonds proposals. Design, Setting, and Participants This longitudinal cohort study analyzed the association between wealth and survival among participants in the Health and Retirement Study (1992-2018), a nationally representative panel study of middle-aged and older (≥50 years) community-dwelling, noninstitutionalized US adults. The data analysis was performed between November 15, 2022, and September 24, 2023. Exposure Household wealth on study entry, calculated as the sum of all assets minus the value of debts and classified into deciles. Main Outcomes and Measures Weibull survival models were used to estimate the association between per-person wealth decile and survival, adjusting for age, sex, marital status, household size, and race and ethnicity. Changes in longevity that might occur under alternative wealth distributions were then estimated. Results The sample included 35 164 participants (mean [SE] age at study entry, 59.1 [0.1] years; 50.1% female and 49.9% male [weighted]). The hazard of death generally decreased with increasing wealth, wherein participants in the highest wealth decile had a hazard ratio of 0.59 for death (95% CI, 0.53-0.66) compared with those in the lowest decile, corresponding to a 13.5-year difference in survival. A simulated wealth distribution of perfect equality would increase populationwide median longevity by 2.2 years (95% CI, 2.2-2.3 years), fully closing the mortality gap between the US and the OECD average. A simulated minimum inheritance proposal would increase populationwide median longevity by 1.7 years; a simulated wealth distribution similar to Japan's would increase populationwide median longevity by 1.2 years; and a simulated baby bonds proposal would increase populationwide median longevity by 1.0 year. Conclusions and Relevance These findings suggest that wealth inequality in the US is associated with significant inequities in survival. Wealth redistribution policies may substantially reduce those inequities and increase population longevity.
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Affiliation(s)
- Kathryn E. W. Himmelstein
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Alexander C. Tsai
- Harvard Medical School, Boston, Massachusetts
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Atheendar S. Venkataramani
- Division of Health Policy, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Polizzi A, Dowd JB. Working-age mortality is still an important driver of stagnating life expectancy in the United States. Proc Natl Acad Sci U S A 2024; 121:e2318276121. [PMID: 38227659 PMCID: PMC10823174 DOI: 10.1073/pnas.2318276121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Affiliation(s)
- Antonino Polizzi
- Department of Sociology, University of Oxford, OxfordOX1 1JD, United Kingdom
- Leverhulme Centre for Demographic Science, University of Oxford, OxfordOX1 1JD, United Kingdom
- Nuffield College, University of Oxford, OxfordOX1 1NF, United Kingdom
- Nuffield Department of Population Health, University of Oxford, OxfordOX3 7LF, United Kingdom
| | - Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, University of Oxford, OxfordOX1 1JD, United Kingdom
- Nuffield College, University of Oxford, OxfordOX1 1NF, United Kingdom
- Nuffield Department of Population Health, University of Oxford, OxfordOX3 7LF, United Kingdom
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Liang R, Kiang MV, Grant P, Jackson C, Rehkopf DH. Associations between county-level public health expenditures and community health planning activities with COVID-19 incidence and mortality. Prev Med Rep 2023; 36:102410. [PMID: 37732021 PMCID: PMC10507150 DOI: 10.1016/j.pmedr.2023.102410] [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: 03/30/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 09/22/2023] Open
Abstract
The COVID-19 pandemic has revealed consequences of past defunding of the U.S. public health system, but the extent to which public health infrastructure is associated with COVID-19 burden is unknown. We aimed to determine whether previous county-level public health expenditures and community health planning activities are associated with COVID-19 cases and deaths. We examined 3050 of 3143 U.S. counties and county equivalents from March 1, 2020 to February 28, 2022. Multivariable-adjusted linear regression and generalized additive models were used to estimate associations between county-level public health expenditures and completion of community health planning activities by a county health department with outcomes of county-level COVID-19 cases and deaths per 100,000 population. After adjusting for county-level covariates, counties in the highest tertile of public health expenditures per capita had on average 542 fewer COVID-19 cases per 100,000 population (95% CI, -1004 to -81) and 21 fewer deaths per 100,000 population (95% CI, -32 to -10) than counties in the lowest tertile. For analyses of community health planning activities, adjusted estimates of association remained negative for COVID-19 deaths, but confidence intervals included negative and positive values. In conclusion, higher levels of local public health expenditures and community health planning activities were associated with fewer county-level COVID-19 deaths, and to a lesser extent, cases. Future public health funding should be aligned with evidence for the value of county health departments programs and explore further which types of spending are most cost effective.
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Affiliation(s)
- Richard Liang
- Stanford University School of Medicine, Department of Epidemiology and Population Health, Alway Building, 300 Pasteur Drive, Stanford, CA 94305, United States
| | - Mathew V. Kiang
- Stanford University School of Medicine, Department of Epidemiology and Population Health, Alway Building, 300 Pasteur Drive, Stanford, CA 94305, United States
| | - Philip Grant
- Stanford University School of Medicine, Department of Medicine – Infectious Diseases, 300 Pasteur Drive, Lane Building 134, Stanford, CA 94305, United States
| | - Christian Jackson
- Stanford University School of Medicine, Department of Epidemiology and Population Health, Alway Building, 300 Pasteur Drive, Stanford, CA 94305, United States
| | - David H. Rehkopf
- Stanford University School of Medicine, Department of Epidemiology and Population Health, Alway Building, 300 Pasteur Drive, Stanford, CA 94305, United States
- Stanford University School of Medicine, Division of Primary Care and Population Health, 1265 Welch Road, Stanford, CA 94305, United States
- Stanford University, Department of Sociology, 450 Jane Stanford Way, Building 120, Room 160, Stanford, CA 94305, United States
- Stanford University, Center for Population Health Sciences, 1701 Page Mill Road, Palo Alto, CA 94304, United States
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Gosliner W, Ritchie LD. Bold Action Needed for Equitable Access to Nutrition Assistance by All. Am J Public Health 2023; 113:S202-S205. [PMID: 38118095 PMCID: PMC10733885 DOI: 10.2105/ajph.2023.307483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 12/22/2023]
Affiliation(s)
- Wendi Gosliner
- Wendi Gosliner and Lorrene D. Ritchie are with the Nutrition Policy Institute, University of California Agriculture and Natural Resources, Oakland, CA
| | - Lorrene D Ritchie
- Wendi Gosliner and Lorrene D. Ritchie are with the Nutrition Policy Institute, University of California Agriculture and Natural Resources, Oakland, CA
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Fiscella K, Epstein RM. Why the United States needs a multifaceted definition of health. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad048. [PMID: 38756742 PMCID: PMC10986254 DOI: 10.1093/haschl/qxad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/09/2023] [Accepted: 09/18/2023] [Indexed: 05/18/2024]
Abstract
How health is conceived and operationalized is an unrecognized contributor to poor health outcomes in the United States. The United States lacks an explicit definition of health, yielding a de facto, implicit biomedical definition in research and in health care that contrasts with how many people define health for themselves. This biomedical conceptualization has led to the development of lifesaving drugs, vaccines, and procedures, but has also resulted in critical underinvestment in people across their lives, beginning in early childhood, in behavioral, environmental, and social determinants. This underinvestment across the entire lifespan in people's health traps the United States in a vicious cycle of chronic disease and unsustainable health care costs. A movement towards holistic definitions of health represents an escape by defining health in more meaningful terms that reflect people's early development, agency, functioning, adaptive capacity, well-being, and lifelong development-that is, the capability for every person to thrive. Adopting and implementing a multifaceted, holistic health definition by federal research and health agencies could transform and humanize health in the United States and advance health equity.
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Affiliation(s)
- Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY 14620, United States
| | - Ronald M Epstein
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY 14620, United States
- Department of Oncology, University of Rochester School of Medicine and Dentistry,Rochester, NY 14620, United States
- Department of Medicine (Palliative Care), University of Rochester School of Medicine and Dentistry,Rochester, NY 14620, United States
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