Ailing
Physical Symptom Reporting Is Associated With a Tendency to Experience Somatosensory Distortion
Richard Brown et al.
Psychosomatic Medicine, July 2012, Pages 648-655
Objective: Theory suggests that a tendency to experience distortions in somatosensory awareness is associated with physical symptom reporting (i.e., somatization) but empirical evidence for this is lacking. This article describes research designed to test this hypothesis.
Methods: Somatosensory distortion was operationalized as the frequency of illusory touch experiences (i.e., false alarm rate) on the Somatic Signal Detection Task. Two studies correlated false alarms on this task with physical symptom reporting on the 15-item Patient Health Questionnaire, the first using a nonclinical sample (n = 35), the second using a clinical sample of endoscopy patients who were identified as having either medically explained (n = 25) or medically unexplained symptoms (n = 30).
Results: Scores on the 15-item Patient Health Questionnaire were positively correlated with false alarm rate in both studies (r = 0.288-0.506), even after controlling for trait anxiety, depression, anxiety (standardized β range = 0.793-0.932, all p < .0001) and (in Study 2) somatosensory amplification and hypochondriacal worry (standardized β range = 0.345-0.375, both p < .05). There was no difference in false alarm rate between patients with medically explained and medically unexplained symptoms (medically explained median range = 6.8 [3.7] to 6.8 [4.0] versus medically unexplained median range = 4.3 [3.9] to 5.6 [3.1], both p > .1).
Conclusions: There seems to be a robust link between physical symptom reporting and the tendency to experience somatosensory distortion, consistent with recent cognitive theories. It may be possible to reduce the impact of somatization by developing treatments that target this tendency.
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Donorcycles: Motorcycle Helmet Laws and the Supply of Organ Donors
Stacy Dickert-Conlin, Todd Elder & Brian Moore
Journal of Law and Economics, November 2011, Pages 907-935
Abstract:
Traffic safety mandates are typically designed to reduce the harmful externalities of risky behaviors. We consider whether motorcycle helmet laws also reduce a beneficial externality by decreasing the supply of viable organ donors. Our central estimates show that organ donations resulting from fatal motor vehicle accidents increase by 10 percent when states repeal helmet laws. Two features of this association suggest that it is causal: first, nearly all of it is concentrated among men, who account for over 90 percent of all motorcyclist deaths, and second, helmet laws are unrelated to the supply of donors who die in circumstances other than motor vehicle accidents. The estimates imply that every death of a helmetless motorcyclist prevents or delays as many as .33 death among individuals on organ transplant waiting lists.
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Does Childhood Misfortune Increase Cancer Risk in Adulthood?
Patricia Morton, Markus Schafer & Kenneth Ferraro
Journal of Aging and Health, forthcoming
Objective: To address the inconsistent findings on whether childhood misfortune increases adult cancer occurrence.
Methods: This study uses longitudinal data from the National Survey of Midlife Development in the United States (MIDUS) that first sampled 3,032 respondents aged 25 to 74 during 1995-1996. A series of logistic regressions were estimated separately for men and women to test whether the effect of childhood misfortune on adult cancer was largely cumulative or specific to the type or profile of misfortune.
Results: For men, additive childhood misfortune, physical abuse by father, and frequent abuse by either parent increased cancer risk. For women, physical abuse by mother and frequent abuse by either parent increased cancer risk.
Discussion: Analyses reveal the importance of examining alternative specifications of childhood misfortune for men and women. Additive childhood misfortune predicted cancer for men only, whereas child abuse by parent of the same sex predicted cancer for men and women.
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Routes of Infection: Exports and HIV Incidence in Sub-Saharan Africa
Emily Oster
Journal of the European Economic Association, forthcoming
Abstract:
This paper estimates whether exports affect the incidence of HIV in Africa. This relationship has implications for HIV prevention policy as well as for the consequences of trade increases in Africa. I estimate this impact using two sources of data on HIV incidence, one generated based on UNAIDS estimates and the other based on observed HIV mortality. These data are combined with data on export value and volume. I find a fairly consistent positive relationship between exports and new HIV infections: doubling exports leads to a 10%-70% increase in new HIV infections. Consistent with theory, this relationship is larger in areas with higher baseline HIV prevalence. I interpret the result as suggesting that increased exports increase the movement of people (trucking), which increases sexual contacts. Consistent with this interpretation, the effect is larger for export growth than for income growth per se and is larger in areas with more extensive road networks.
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Unemployment and Mortality: A Comparative Study of Germany and the United States
Christopher McLeod et al.
American Journal of Public Health, August 2012, Pages 1542-1550
Objectives: We examined the relationship between unemployment and mortality in Germany, a coordinated market economy, and the United States, a liberal market economy.
Methods: We followed 2 working-age cohorts from the German Socio-economic Panel and the US Panel Study of Income Dynamics from 1984 to 2005. We defined unemployment as unemployed at the time of survey. We used discrete-time survival analysis, adjusting for potential confounders.
Results: There was an unemployment-mortality association among Americans (relative risk [RR] = 2.4; 95% confidence interval [CI] = 1.7, 3.4), but not among Germans (RR = 1.4; 95% CI = 1.0, 2.0). In education-stratified models, there was an association among minimum-skilled (RR = 2.6; 95% CI = 1.4, 4.7) and medium-skilled (RR = 2.4; 95% CI = 1.5, 3.8) Americans, but not among minimum- and medium-skilled Germans. There was no association among high-skilled Americans, but an association among high-skilled Germans (RR = 3.0; 95% CI = 1.3, 7.0), although this was limited to those educated in East Germany. Minimum- and medium-skilled unemployed Americans had the highest absolute risks of dying.
Conclusions: The higher risk of dying for minimum- and medium-skilled unemployed Americans, not found among Germans, suggests that the unemployment-mortality relationship may be mediated by the institutional and economic environment.
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Facial disfigurement is treated like an infectious disease
Stephen Ryan et al.
Evolution and Human Behavior, forthcoming
Abstract:
The behavioral avoidance of people with facial disfigurement is well documented, but its psychological basis is poorly understood. Based upon a disease avoidance account of stigmatization, we conducted the first empirical test of whether facial disfigurement - naevus flammeus (a port wine stain) here - can trigger the same set of emotional and behavioral responses as a contagious disease (influenza). Ninety-eight participants contacted props, which they had seen used either by a healthy confederate or by a confederate simulating medical conditions affecting the face - birthmark and influenza. Behavioral avoidance (e.g., willingness to handle the prop) and facial display of disgust were recorded across five levels of prop contact varying from no contact to contact with the mouth. Behavioral avoidance and disgust displays, especially with oral contact, were equivalent in the birthmark and influenza conditions, with both significantly exceeding reactions to the healthy confederate. These results support the theory that humans have an evolved predisposition to avoid individuals with disease signs, which is mediated by the emotion of disgust. This implicit avoidance occurs even when they know explicitly that such signs - the birthmark here - result from a noncontagious condition.
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Yukie Shiratori & Kristin Samuelson
Journal of Psychosomatic Research, August 2012, Pages 122-125
Objective: The heightened prevalence rates of respiratory problems and posttraumatic stress disorder (PTSD) among New York area residents following the World Trade Center disaster on September 11, 2001, have received national attention. Although there is some evidence suggesting that PTSD is associated with increased risk for asthma, this relationship has not been well documented in this population at high risk for both disorders. There is also a need to examine this relationship while controlling for notable confounds, including dust exposure and smoking.
Method: This study examined the association between symptoms indicative of probable PTSD and the diagnosis of asthma following 9/11 among the individuals who participated in the World Trade Center Health Registry (WTCHR) baseline study between September 2003 and November 2004. A total of 71,437 participants enrolled in this study and completed questionnaires pertaining to exposure, physical health symptoms before and after 9/11, and self-reported PTSD symptoms.
Results: Logistic regression revealed that, compared to participants without probable PTSD, individuals with probable PTSD were 1.65 times more likely to be diagnosed with asthma following 9/11, which was significant after controlling for the effects of gender, ethnicity, income, smoking status, dust exposure, and nonspecific psychological distress [Wald χ2 (1)=52.375, P<.001].
Conclusion: These results suggest that PTSD symptoms are associated with the development of asthma following 9/11 and that this relationship is not explained by sociodemographic, environmental, and lifestyle factors.
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The Smell of Age: Perception and Discrimination of Body Odors of Different Ages
Susanna Mitro et al.
PLoS ONE, May 2012
Abstract:
Our natural body odor goes through several stages of age-dependent changes in chemical composition as we grow older. Similar changes have been reported for several animal species and are thought to facilitate age discrimination of an individual based on body odors, alone. We sought to determine whether humans are able to discriminate between body odor of humans of different ages. Body odors were sampled from three distinct age groups: Young (20-30 years old), Middle-age (45-55), and Old-age (75-95) individuals. Perceptual ratings and age discrimination performance were assessed in 41 young participants. There were significant differences in ratings of both intensity and pleasantness, where body odors from the Old-age group were rated as less intense and less unpleasant than body odors originating from Young and Middle-age donors. Participants were able to discriminate between age categories, with body odor from Old-age donors mediating the effect also after removing variance explained by intensity differences. Similarly, participants were able to correctly assign age labels to body odors originating from Old-age donors but not to body odors originating from other age groups. This experiment suggests that, akin to other animals, humans are able to discriminate age based on body odor alone and that this effect is mediated mainly by body odors emitted by individuals of old age.
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Education, Genetic Ancestry, and Blood Pressure in African Americans and Whites
Amy Non, Clarence Gravlee & Connie Mulligan
American Journal of Public Health, August 2012, Pages 1559-1565
Objectives: We assessed the relative roles of education and genetic ancestry in predicting blood pressure (BP) within African Americans and explored the association between education and BP across racial groups.
Methods: We used t tests and linear regressions to examine the associations of genetic ancestry, estimated from a genomewide set of autosomal markers, and education with BP variation among African Americans in the Family Blood Pressure Program. We also performed linear regressions in self-identified African Americans and Whites to explore the association of education with BP across racial groups.
Results: Education, but not genetic ancestry, significantly predicted BP variation in the African American subsample (b = -0.51 mm Hg per year additional education; P = .001). Although education was inversely associated with BP in the total population, within-group analyses showed that education remained a significant predictor of BP only among the African Americans. We found a significant interaction (b = 3.20; P = .006) between education and self-identified race in predicting BP.
Conclusions: Racial disparities in BP may be better explained by differences in education than by genetic ancestry. Future studies of ancestry and disease should include measures of the social environment.
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Examining the Gender Gap in Life Expectancy: A Cross-National Analysis, 1980-2005
Rob Clark & Mitchell Peck
Social Science Quarterly, forthcoming
Objectives: This study examines predictors of the gender gap in life expectancy across a large cross-national sample.
Methods: We employ random effects and fixed effects models of the gender difference (female-male) and gender ratio (female/male) in life expectancy during the 1980-2005 period.
Results: Women's status, traditional male hazards, and development/modernization processes tend to widen the gender gap in life expectancy. In addition, income inequality expands the gender gap, while female representation in parliament reduces it. We argue that these latter effects are a function of (1) the steeper socioeconomic gradient for men in predicting mortality and (2) the protection of economically vulnerable groups by female parliamentarians, which provides greater health returns to males.
Conclusion: Advances in gender equity along economic, political, and cultural lines appear to exert countervailing effects, both expanding and reducing the gender gap in mortality.
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Epigenetic transgenerational inheritance of altered stress responses
David Crews et al.
Proceedings of the National Academy of Sciences, 5 June 2012, Pages 9143-9148
Abstract:
Ancestral environmental exposures have previously been shown to promote epigenetic transgenerational inheritance and influence all aspects of an individual's life history. In addition, proximate life events such as chronic stress have documented effects on the development of physiological, neural, and behavioral phenotypes in adulthood. We used a systems biology approach to investigate in male rats the interaction of the ancestral modifications carried transgenerationally in the germ line and the proximate modifications involving chronic restraint stress during adolescence. We find that a single exposure to a common-use fungicide (vinclozolin) three generations removed alters the physiology, behavior, metabolic activity, and transcriptome in discrete brain nuclei in descendant males, causing them to respond differently to chronic restraint stress. This alteration of baseline brain development promotes a change in neural genomic activity that correlates with changes in physiology and behavior, revealing the interaction of genetics, environment, and epigenetic transgenerational inheritance in the shaping of the adult phenotype. This is an important demonstration in an animal that ancestral exposure to an environmental compound modifies how descendants of these progenitor individuals perceive and respond to a stress challenge experienced during their own life history.
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Does Donor Assistance for HIV Respond to Media Pressure?
Fabrizio Carmignani, Grace Lordan & Kam Ki Tang
Health Economics, June 2012, Pages 18-32
Abstract:
HIV/AIDS is a heavily mediatised disease. In this article, we test whether media attention is affecting donors' disbursement of aid for HIV to African countries. We use information available on the number of articles and press documents on HIV issues and other health concerns published in donor countries to construct a proxy of media coverage. This proxy is then included as an explanatory variable in a regression of aid for HIV to Africa. After controlling for several donor characteristics, we find that greater media coverage increases aid disbursement. This may be good news for the HIV campaign but may result in displacement effects to the extent that other diseases that cause greater mortality and morbidity receive less media coverage than HIV and thus less health aid.
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Mortality and economic fluctuations: Evidence from wavelet analysis for Sweden 1800-2000
Mikael Svensson & Niclas Krüger
Journal of Population Economics, October 2012, Pages 1215-1235
Abstract:
Using wavelet methods, this paper analyzes the relationship between the age-adjusted, infant, and cause-specific mortality rates and the business cycle in Sweden over the period 1800-2000 (1911-1996 for cause-specific mortality). For the period 1800-2000, an increase in GDP by 1% decreased mortality by 0.7%. This overall relationship is due to a strong counter-cyclical relationship in the nineteenth century, which disappeared in the twentieth century. In contrast, in the twentieth century higher mortality in economic upturns is found for mortality caused by circulatory diseases (including stroke) and accidents.
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Does living by the coast improve health and wellbeing?
Benedict Wheeler et al.
Health & Place, forthcoming
Abstract:
It is often assumed that spending time by the coast leads to better health and wellbeing, but there is strikingly little evidence regarding specific effects or mechanisms to support such a view. We analysed small-area census data for the population of England, which indicate that good health is more prevalent the closer one lives to the coast. We also found that, consistent with similar analyses of greenspace accessibility, the positive effects of coastal proximity may be greater amongst more socio-economically deprived communities. We hypothesise that these effects may be due to opportunities for stress reduction and increased physical activity.
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Predicting Mortality From Human Faces
Dominika Dykiert et al.
Psychosomatic Medicine, July 2012, Pages 560-566
Objective: To investigate whether and to what extent mortality is predictable from facial photographs of older people.
Methods: High-quality facial photographs of 292 members of the Lothian Birth Cohort 1921, taken at the age of about 83 years, were rated in terms of apparent age, health, attractiveness, facial symmetry, intelligence, and well-being by 12 young-adult raters. Cox proportional hazards regression was used to study associations between these ratings and mortality during a 7-year follow-up period.
Results: All ratings had adequate reliability. Concurrent validity was found for facial symmetry and intelligence (as determined by correlations with actual measures of fluctuating asymmetry in the faces and Raven Standard Progressive Matrices score, respectively), but not for the other traits. Age as rated from facial photographs, adjusted for sex and chronological age, was a significant predictor of mortality (hazard ratio = 1.36, 95% confidence interval = 1.12-1.65) and remained significant even after controlling for concurrent, objectively measured health and cognitive ability, and the other ratings. Health as rated from facial photographs, adjusted for sex and chronological age, significantly predicted mortality (hazard ratio = 0.81, 95% confidence interval = 0.67-0.99) but not after adjusting for rated age or objectively measured health and cognition. Rated attractiveness, symmetry, intelligence, and well-being were not significantly associated with mortality risk.
Conclusions: Rated age of the face is a significant predictor of mortality risk among older people, with predictive value over and above that of objective or rated health status and cognitive ability.
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Julia Boehm & Laura Kubzansky
Psychological Bulletin, July 2012, Pages 655-691
Abstract:
This review investigates the association between positive psychological well-being (PPWB) and cardiovascular disease (CVD). We also consider the mechanisms by which PPWB may be linked with CVD, focusing on the health behaviors (e.g., smoking, alcohol consumption, physical activity, sleep quality and quantity, and food consumption) and biological functions (e.g., cardiovascular, inflammatory, and metabolic processes) that are most relevant for cardiovascular health. Because PPWB is a broad concept, not all aspects of PPWB may be associated with cardiovascular health. Thus, we distinguish between eudaimonic well-being, hedonic well-being, optimism, and other measures of well-being when reviewing the literature. Findings suggest that PPWB protects consistently against CVD, independently of traditional risk factors and ill-being. Specifically, optimism is most robustly associated with a reduced risk of cardiovascular events. In general, PPWB is also positively associated with restorative health behaviors and biological function and inversely associated with deteriorative health behaviors and biological function. Cardiovascular health is more consistently associated with optimism and hedonic well-being than with eudaimonic well-being, although this could be due in part to more limited evidence being available concerning eudaimonic well-being. Some similarities were also evident across different measures of PPWB, which is likely due to measurement overlap. A theoretical context for this research is provided, and suggestions for future research are given, including the need for additional prospective investigations and research that includes multiple constructs of psychological well-being and ill-being.
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Physical Health, Affect, and Personality: A Longitudinal Latent Variable Analysis
John Finch et al.
Journal of Research in Personality, forthcoming
Abstract:
This study used structural equation modeling to examine longitudinal relations among physical health, personality and mood in a sample of 360 college students. Research focused on the longitudinal associations among physical health and mood and their systematic relations with the Big Five personality dimensions of Extraversion and Neuroticism. Longitudinal analyses over successive one-month intervals revealed lagged reciprocal effects between physical health and negative affect. After controlling for the effect of negative affect, physical health influenced subsequent positive affect, but positive affect did not influence subsequent physical health. Implications of these findings for subsequent research on health, personality, and emotions are discussed.
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Uncorrected Distance Visual Impairment Among Adolescents in the United States
Alex Kemper et al.
Journal of Adolescent Health, June 2012, Pages 645-647
Purpose: To describe uncorrected distance visual impairment (VI).
Methods: We conducted an analysis of the 3,555 adolescents aged 12 through 21 years who participated in the 2005-2008 National Health and Nutrition Examination Survey. Distance VI was defined as 20/40 or worse in the better-seeing eye. Data were weighted to represent the civilian noninstitutionalized population.
Results: Overall, 12.3% (95% confidence interval [CI]: 10.7%-14.1%) had distance VI, which was correctable to 20/30 or better in both eyes in 86.1% (95% CI: 83.6%-89.5%). The prevalence was higher among those who reported not having corrective lenses available (44.3%) compared with those who reported that they did not need them (8.5%) or who had them available (5.2%; p < .001). After adjusting for potential confounders, those who were 12 or 13 years of age had 2.27 (95% CI: 1.32-3.90) greater odds of distance VI than older adolescents, and the odds of distance VI were greater among non-Hispanic blacks (1.66 [95% CI: 1.11-2.48]), Hispanics (1.96 [95% CI: 1.35-2.84]), or other race/ethnicities (2.06 [95% CI: 1.19-3.57]) than among non-Hispanic whites.
Conclusions: More than 1 in 10 adolescents had uncorrected distance VI. To address this, interventions should address case detection, access to eye care, and adherence with corrective lenses.
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Tetine Sentell
Race and Social Problems, June 2012, Pages 112-120
Abstract:
Quantify the relationships between adolescent self-reported health and college intention in a diverse sample including Asians. Data were used from 3,737 adolescents ages 12-17 who completed the 2003 California Health Interview Survey. Self-reported intention to attend college/university was compared to other plans. Multivariate logistic models predicting college intention by health status (poor/fair, good, or very good/excellent) were performed with the entire sample and for each race/ethnicity separately. Age, poverty, gender, rural residence, and parental college education were controlled. Participants were 44 % white, 36 % Hispanic, 11 % Asian, and 9 % black. Overall, 10 % reported poor/fair health, 30 % good health, and 60 % very good/excellent health. Whites were the most likely to report very good/excellent health and Hispanics least likely (χ2(6) = 11.85; p < 0.01). Eighty-one percent had college plans, which also varied by race/ethnicity with Asians most likely to report college intentions and Hispanics least likely (χ2(3) = 3.97; p < 0.05). In the overall multivariate model, adolescents in poor/fair health (OR: 0.53; 95 % CI: 0.34-0.83) and good health (OR: 0.59; 95 % CI: 0.45-0.78) were significantly less likely to plan on college compared to those in very good/excellent health. Variation was seen by racial/ethnic group. For whites and blacks, only good health significantly predicted less college intention (compared to very good/excellent health) while only poor/fair health significantly predicted less college intention for Hispanics and Asians. Very good/excellent health in adolescence was associated with greater college intention compared to both fair/poor health and good health, but this relationship varied by race/ethnicity.
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Vaccine-Type Human Papillomavirus and Evidence of Herd Protection After Vaccine Introduction
Jessica Kahn et al.
Pediatrics, forthcoming
Objectives: The aims of this study were to compare prevalence rates of human papillomavirus (HPV) in young women before and after HPV vaccine introduction to determine the following: (1) whether vaccine-type HPV infection decreased, (2) whether there was evidence of herd protection, and (3) whether there was evidence for type-replacement (increased prevalence of nonvaccine-type HPV).
Methods: Young women 13 to 26 years of age who had had sexual contact were recruited from 2 primary care clinics in 2006-2007 for a prevaccination surveillance study (N = 368, none were vaccinated) and 2009-2010 for a postvaccination surveillance study (N = 409, 59% were vaccinated). Participants completed a questionnaire and were tested for cervicovaginal HPV DNA. HPV prevalence rates were compared in the pre- versus postsurveillance studies by using χ2 tests. Propensity score weighting was used to balance differences in covariates between the 2 surveillance studies.
Results: The mean age was ∼19 years for both groups of participants and most were African American and non-Hispanic. After propensity score weighting, the prevalence rate for vaccine-type HPV decreased substantially (31.7%-13.4%, P < .0001). The decrease in vaccine-type HPV not only occurred among vaccinated (31.8%-9.9%, P < .0001) but also among unvaccinated (30.2%-15.4%, P < .0001) postsurveillance study participants. Nonvaccine-type HPV increased (60.7%-75.9%, P < .0001) for vaccinated postsurveillance study participants.
Conclusions: Four years after licensing of the quadrivalent HPV vaccine, there was a substantial decrease in vaccine-type HPV prevalence and evidence of herd protection in this community. The increase in nonvaccine-type HPV in vaccinated participants should be interpreted with caution but warrants further study.
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Work-Related Exhaustion and Telomere Length: A Population-Based Study
Kirsi Ahola et al.
PLoS ONE, July 2012
Background: Psychological stress is suggested to accelerate the rate of biological aging. We investigated whether work-related exhaustion, an indicator of prolonged work stress, is associated with accelerated biological aging, as indicated by shorter leukocyte telomeres, that is, the DNA-protein complexes that cap chromosomal ends in cells.
Methods: We used data from a representative sample of the Finnish working-age population, the Health 2000 Study. Our sample consisted of 2911 men and women aged 30-64. Work-related exhaustion was assessed using the Maslach Burnout Inventory - General Survey. We determined relative leukocyte telomere length using a quantitative real-time polymerase chain reaction (PCR) -based method.
Results: After adjustment for age and sex, individuals with severe exhaustion had leukocyte telomeres on average 0.043 relative units shorter (standard error of the mean 0.016) than those with no exhaustion (p = 0.009). The association between exhaustion and relative telomere length remained significant after additional adjustment for marital and socioeconomic status, smoking, body mass index, and morbidities (adjusted difference 0.044 relative units, standard error of the mean 0.017, p = 0.008).
Conclusions: These data suggest that work-related exhaustion is related to the acceleration of the rate of biological aging. This hypothesis awaits confirmation in a prospective study measuring changes in relative telomere length over time.
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Does Information Improve the Health Behavior of Adults Targeted by a Conditional Transfer Program?
Ciro Avitabile
Journal of Human Resources, Summer 2012, Pages 785-825
Abstract:
We use data from the evaluation sample of Mexico's Food Assistance Program (PAL) to study whether including the attendance at health and nutrition classes among the requirements for receiving a transfer affects the health behavior of adults living in localities targeted by the program. The experimental trial has four different treatment types, randomly assigned to four groups of localities, one of which receives the in-kind transfer without the requirement to attend any health or nutrition sessions. Adult women living in localities where the in-kind transfer is conditional on class attendance display a significantly better health behavior than those living in localities where it is not. There is no significant evidence of changes in health outcomes among men.
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Sandy Tubeuf, Florence Jusot & Damien Bricard
Health Economics, June 2012, Pages 129-150
Abstract:
The paper focuses on the long-term effects of early-life conditions with comparison to lifestyles and educational attainment on health status in a cohort of British people born in 1958. Using the longitudinal follow-up data at age 23, 33, 42 and 46, we build a dynamic model to investigate the influence of each determinant on health and the mediating role of education and lifestyles in the relationship between early-life conditions and later health. Direct and indirect effects of early-life conditions on adult health are explored using auxiliary linear regressions of education and lifestyles and panel Probit specifications of self-assessed health with random effects addressing individual unexplained heterogeneity. Our study shows that early-life conditions are important parameters for adult health accounting for almost 20% of explained health inequality when mediating effects are identified. The contribution of lifestyles reduces from 32% down to 25% when indirect effects of early-life conditions and education are distinguished. Noticeably, the absence of father at the time of birth and experience of financial hardships represent the lead factors for direct effects on health. The absence of obesity at 16 influences health both directly and indirectly working through lifestyles.
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A. Renton, M. Wall & J. Lintott
Public Health, July 2012, Pages 551-560
Objectives: The 1999 World Bank Report claimed that growth in gross domestic product (GDP) between 1960 and 1990 only accounted for 15% of concomitant growth in life expectancy in developing countries. These findings were used repeatedly by the World Health Organization (WHO) to support a policy shift away from promoting social and economic development, towards vertical technology-driven programmes. This paper updates the 1999 World Bank Report using the World Bank's 2005 dataset, providing a new assessment of the relative contribution of economic growth.
Study design: Time-series analysis.
Methods: Cross-sectional time-series regression analysis using a random effect model of associations between GDP, education and technical progress and improved health outcomes. The proportion of improvement in health indicators between 1970 and 2000 associated with changes in GDP, education and technical progress was estimated.
Results: In 1970, a 1% difference in GDP between countries was associated with 6% difference in female (LEBF) and 5% male (LEBM) life expectancy at birth. By 2000, these values had increased to 14% and 12%, explaining most of the observed health gain. Excluding Europe and Central Asia, the proportion of the increase in LEBF and LEBM attributable to increased GDP was 31% and 33% in the present analysis, vs 17% and 14%, respectively, estimated by the World Bank. In the poorest countries, higher GDPs were required in 2000 than in 1970 to achieve the same health outcomes.
Conclusions: In the poorest countries, socio-economic change is likely to be a more important source of health improvement than technical progress. Technical progress, operating by increasing the size of the effect of a unit of GDP on health, is likely to benefit richer countries more than poorer countries, thereby increasing global health inequalities.
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The epidemiology of ‘bewitchment' as a lay-reported cause of death in rural South Africa
Edward Fottrell et al.
Journal of Epidemiology & Community Health, August 2012, Pages 704-709
Background: Cases of premature death in Africa may be attributed to witchcraft. In such settings, medical registration of causes of death is rare. To fill this gap, verbal autopsy (VA) methods record signs and symptoms of the deceased before death as well as lay opinion regarding the cause of death; this information is then interpreted to derive a medical cause of death. In the Agincourt Health and Demographic Surveillance Site, South Africa, around 6% of deaths are believed to be due to ‘bewitchment' by VA respondents.
Methods: Using 6874 deaths from the Agincourt Health and Socio-Demographic Surveillance System, the epidemiology of deaths reported as bewitchment was explored, and using medical causes of death derived from VA, the association between perceptions of witchcraft and biomedical causes of death was investigated.
Results: The odds of having one's death reported as being due to bewitchment is significantly higher in children and reproductive-aged women (but not in men) than in older adults. Similarly, sudden deaths or those following an acute illness, deaths occurring before 2001 and those where traditional healthcare was sought are more likely to be reported as being due to bewitchment. Compared with all other deaths, deaths due to external causes are significantly less likely to be attributed to bewitchment, while maternal deaths are significantly more likely to be.
Conclusions: Understanding how societies interpret the essential factors that affect their health and how health seeking is influenced by local notions and perceived aetiologies of illness and death could better inform sustainable interventions and health promotion efforts.