For good or ill
Increasing Disparities in Mortality by Socioeconomic Status
Barry Bosworth
Annual Review of Public Health, 2018, Pages 237-251
Abstract:
This review focuses on the widening disparities in death rates by socioeconomic class. In recent years, there has been a major increase in the availability of data linking mortality risk and measures of socioeconomic status. The result has been a virtual explosion of new empirical research showing not only the existence of large inequities in the risk of death between those at the top and those at the bottom of the socioeconomic distribution, but also that the gaps have been growing. This assessment of the empirical research finds a consistent pattern of growing disparities within the United States. However, this widening gap in death rates does appear to be a uniquely American phenomenon, as the disparities by socioeconomic class appear to be stable or even declining in Europe and Canada.
Association of a Negative Wealth Shock With All-Cause Mortality in Middle-aged and Older Adults in the United States
Lindsay Pool et al.
Journal of the American Medical Association, 3 April 2018, Pages 1341-1350
Design, Setting, and Participants: The Health and Retirement Study, a nationally representative prospective cohort study of US adults aged 51 through 61 years at study entry. The study population included 8714 adults, first assessed for a negative wealth shock in 1994 and followed biennially through 2014 (the most recent year of available data).
Exposures: Experiencing a negative wealth shock, defined as a loss of 75% or more of total net worth over a 2-year period, or asset poverty, defined as 0 or negative total net worth at study entry.
Main Outcomes and Measures: Mortality data were collected from the National Death Index and postmortem interviews with family members. Marginal structural survival methods were used to account for the potential bias due to changes in health status that may both trigger negative wealth shocks and act as the mechanism through which negative wealth shocks lead to increased mortality.
Results: There were 8714 participants in the study sample (mean [SD] age at study entry, 55 [3.2] years; 53% women), 2430 experienced a negative wealth shock during follow-up, 749 had asset poverty at baseline, and 5535 had continuously positive wealth without shock. A total of 2823 deaths occurred during 80 683 person-years of follow-up. There were 30.6 vs 64.9 deaths per 1000 person-years for those with continuously positive wealth vs negative wealth shock (adjusted hazard ratio [HR], 1.50; 95% CI, 1.36-1.67). There were 73.4 deaths per 1000 person-years for those with asset poverty at baseline (adjusted HR, 1.67; 95% CI, 1.44-1.94; compared with continuously positive wealth).
Is 60 the New 50? Examining Changes in Biological Age Over the Past Two Decades
Morgan Levine & Eileen Crimmins
Demography, April 2018, Pages 387–402
Abstract:
Increasing life expectancy has been interpreted as improving health of a population. However, mortality is not always a reliable proxy for the pace of aging and could instead reflect achievement in keeping ailing people alive. Using data from NHANES III (1988–1994) and NHANES IV (2007–2010), we examined how biological age, relative to chronological age, changed in the United States between 1988 and 2010, while estimating the contribution of changes in modifiable health behaviors. Results suggest that biological age is lower for more recent periods; however, the degree of improvement varied across age and sex groups. Overall, older adults experienced the greatest improvement or decreases in biological age. Males, especially those in the youngest and oldest groups, experienced greater declines in biological age than females. These differences were partially explained by age- and sex-specific changes in behaviors, such as smoking, obesity, and medication use. Slowing the pace of aging, along with increasing life expectancy, has important social and economic implications; thus, identifying modifiable risk factors that contribute to cohort differences in health and aging is essential.
County-Level Trends in Suicide Rates in the U.S., 2005–2015
Lauren Rossen et al.
American Journal of Preventive Medicine, forthcoming
Methods: Using National Vital Statistics Underlying Cause of Death Files (2005–2015), hierarchical Bayesian models were used to estimate suicide rates for 3,140 counties. Model-based suicide rate estimates were mapped to explore geographic and temporal patterns and examine urban–rural differences. Analyses were conducted in 2016–2017.
Results: Posterior predicted mean county-level suicide rates increased by >10% from 2005 to 2015 for 99% of counties in the U.S., with 87% of counties showing increases of >20%. Counties with the highest model-based suicide rates were consistently located across the western and northwestern U.S., with the exception of southern California and parts of Washington. Compared with more urban counties, more rural counties had the highest estimated suicide rates from 2005 to 2015, and also the largest increases over time.
Information, education, and health behaviors: Evidence from the MMR vaccine autism controversy
Lenisa Chang
Health Economics, forthcoming
Abstract:
In the wake of strong, although later refuted, claims of a link between autism and the measles‐mumps‐rubella (MMR) vaccine, I examine whether fewer parents immunized or delayed vaccinations for their children and if there was a differential response by mother's education level. Using various controls and a differencing strategy that compares in MMR take‐up with other vaccines, I find that the MMR–autism controversy led to a decline in the immediate years and that there were negative spillovers onto other vaccines. I also find evidence that more highly educated mothers responded more strongly to the controversy either by not immunizing their children altogether or, to a lesser degree, delaying vaccination. Moreover, the educational gap was greater in states where there was greater media attention devoted to the controversy. This is consistent with the health allocative efficiency hypothesis whereby part of the education gradient in health outcomes is due to more‐educated individuals absorbing and responding to health information more quickly. However, unlike in the United Kingdom, where previous studies find that the gap was eliminated after the link was refuted, the evidence for the United States suggests that the educational gap persisted.
Pauvreté, Egalité, Mortalité: Mortality (In)Equality in France and the United States
Janet Currie, Hannes Schwandt & Josselin Thuilliez
NBER Working Paper, May 2018
Abstract:
We develop a method to compare levels and trends in inequality in mortality in the United States and France in a similar framework. The comparison shows that while income inequality has increased in both the United States and France, inequality in mortality in France remained remarkably low and stable. In the United States, inequality in mortality increased for older groups (especially women) while it decreased for children and young adults. These patterns highlight the fact that despite the strong cross-sectional relationship between income and health, there is no necessary connection between changes in income inequality and changes in health inequality.
The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States
The US Burden of Disease Collaborators
Journal of the American Medical Association, 10 April 2018, Pages 1444-1472
Objective: To use the results of the Global Burden of Disease Study (GBD) to report trends in the burden of diseases, injuries, and risk factors at the state level from 1990 to 2016.
Design and Setting: A systematic analysis of published studies and available data sources estimates the burden of disease by age, sex, geography, and year.
Main Outcomes and Measures: Prevalence, incidence, mortality, life expectancy, healthy life expectancy (HALE), years of life lost (YLLs) due to premature mortality, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 333 causes and 84 risk factors with 95% uncertainty intervals (UIs) were computed.
Results: Between 1990 and 2016, overall death rates in the United States declined from 745.2 (95% UI, 740.6 to 749.8) per 100 000 persons to 578.0 (95% UI, 569.4 to 587.1) per 100 000 persons. The probability of death among adults aged 20 to 55 years declined in 31 states and Washington, DC from 1990 to 2016. In 2016, Hawaii had the highest life expectancy at birth (81.3 years) and Mississippi had the lowest (74.7 years), a 6.6-year difference. Minnesota had the highest HALE at birth (70.3 years), and West Virginia had the lowest (63.8 years), a 6.5-year difference. The leading causes of DALYs in the United States for 1990 and 2016 were ischemic heart disease and lung cancer, while the third leading cause in 1990 was low back pain, and the third leading cause in 2016 was chronic obstructive pulmonary disease. Opioid use disorders moved from the 11th leading cause of DALYs in 1990 to the 7th leading cause in 2016, representing a 74.5% (95% UI, 42.8% to 93.9%) change. In 2016, each of the following 6 risks individually accounted for more than 5% of risk-attributable DALYs: tobacco consumption, high body mass index (BMI), poor diet, alcohol and drug use, high fasting plasma glucose, and high blood pressure. Across all US states, the top risk factors in terms of attributable DALYs were due to 1 of the 3 following causes: tobacco consumption (32 states), high BMI (10 states), or alcohol and drug use (8 states).
The dynamic relationships between economic status and health measures among working‐age adults in the United States
Abdulkarim Meraya et al.
Health Economics, forthcoming
Abstract:
We examine the dynamic relationships between economic status and health measures using data from 8 waves of the Panel Study of Income Dynamics from 1999 to 2013. Health measures are self‐rated health (SRH) and functional limitations; economic status measures are labor income (earnings), family income, and net wealth. We use 3 different types of models: (a) ordinary least squares regression, (b) first‐difference, and (c) system‐generalized method of moment (GMM). Using ordinary least squares regression and first difference models, we find that higher levels of economic status are associated with better SRH and functional status among both men and women, although declines in income and wealth are associated with a decline in health for men only. Using system‐GMM estimators, we find evidence of a causal link from labor income to SRH and functional status for both genders. Among men only, system‐GMM results indicate that there is a causal link from net wealth to SRH and functional status. Results overall highlight the need for integrated economic and health policies, and for policies that mitigate the potential adverse health effects of short‐term changes in economic status.
Part-time employment and worker health in the United States
Youngmin Cho
Social Science Journal, June 2018, Pages 97–107
Abstract:
A growing body of research has highlighted the consequences of part-time employment for workers’ health and well-being. However, these studies have yielded inconsistent results and relied on cross-sectional data. In addition, relatively little empirical research has explored whether the effect of working part-time on health varies by gender, particularly in the United States. Using longitudinal data from three waves of the General Social Survey panel (2010–2012–2014), our study examined the association between part-time employment and perceived health among U.S employees, and whether this association varied by gender. The results showed that part-time workers were less likely to report poor self-rated health than full-time workers, especially among males. The pattern of results was consistent across empirical approaches—including generalized estimating equations and random effects models, with an extensive set of covariates. Taken together, these findings suggest that for U.S. employees, working part-time appears to be beneficial or at least not detrimental to perceived health, which warrants further investigation.
Parental Socioeconomic Instability and Child Obesity
Antwan Jones
Biodemography and Social Biology, Spring 2018, Pages 15-29
Abstract:
Using data from the 1986 to 2010 National Longitudinal Study of Youth (NLSY) and the NLSY Child and Young Adult Supplement, this research explores how changes in parental socioeconomic status relate to child obesity over time. Results from linear mixed-effects models indicate that maternal educational gains and maternal employment transitions significantly increased their child’s body mass index (BMI). This finding suggests that mothers who work may have less time to devote to monitoring their child’s food intake and physical activity, which places their children at higher risks of becoming overweight or obese over time. Conversely, father’s work transitions and educational gains contribute to decreases in child’s BMI. Thus, work instability and increasing educational attainment for the traditional breadwinner of the household corresponds to better child weight outcomes. Results also suggest that there are racial differences in child BMI that remain after adjusting for changes in socioeconomic status, which indicate that the same structural disadvantages that operate to keep minorities in lower social class standings in society also work to hinder minorities from advancing among and out of their social class. Policy implications related to curbing child obesity are discussed.
Deposition of Bacteria and Bacterial Spores by Bathroom Hot Air Hand Dryers
Luz del Carmen Huesca-Espitia et al.
Applied and Environmental Microbiology, forthcoming
Abstract:
Hot air hand dryers in multiple men's and women's bathrooms in 3 basic science research areas in an academic health center were screened for their deposition on plates of: i) total bacteria, some of which were identified; and ii) a kanamycin resistant Bacillus subtilis strain, PS533, spores of which are produced in large amounts in one basic science research laboratory. Plates exposed to hand dryer air for 30 seconds averaged 18-60 colonies/plate but interior hand dryer nozzle surfaces had minimal bacterial levels, plates exposed to bathroom air for 2 minutes with hand dryers off averaged ≤1 colony, and plates exposed to bathroom air moved by a small fan for 20 minutes had averages of 15 and 12 colonies/plate in two buildings tested. Retrofitting hand dryers with HEPA filters reduced bacterial deposition by hand dryers ∼4-fold, and potential human pathogens were recovered from plates exposed to hand dryer air whether or not a HEPA filter was present, and from bathroom air moved by a small fan. Spore-forming colonies, identified as B. subtilis PS533 averaged ∼2.5-5% of bacteria deposited by hand dryers throughout basic research areas examined regardless of distance from the spore forming laboratory, and these were almost certainly deposited as spores. Comparable results were obtained when bathroom air was sampled for spores. These results indicate that many kinds of bacteria, including potential pathogens and spores, can be deposited on hands exposed to bathroom hand dryers, and that spores could be dispersed throughout buildings and deposited on hands by hand dryers.
Vaccination Patterns in Children After Autism Spectrum Disorder Diagnosis and in Their Younger Siblings
Ousseny Zerbo et al.
JAMA Pediatrics, forthcoming
Design, Setting, and Participants: This investigation was a retrospective matched cohort study. The setting was 6 integrated health care delivery systems across the United States within the Vaccine Safety Datalink. Participants were children born between January 1, 1995, and September 30, 2010, and their younger siblings born between January 1, 1997, and September 30, 2014. The end of follow-up was September 30, 2015.
Results: The study included 3729 children with ASD (676 [18.1%] female), 592 907 children without ASD, and their respective younger siblings. Among children without ASD, 250 193 (42.2%) were female. For vaccines recommended between ages 4 and 6 years, children with ASD were significantly less likely to be fully vaccinated compared with children without ASD (adjusted rate ratio, 0.87; 95% CI, 0.85-0.88). Within each age category, vaccination rates were significantly lower among younger siblings of children with ASD compared with younger siblings of children without ASD. The adjusted rate ratios varied from 0.86 for siblings younger than 1 year to 0.96 for those 11 to 12 years old. Parents who had a child with ASD were more likely to refuse at least 1 recommended vaccine for that child’s younger sibling and to limit the number of vaccines administered during the younger sibling’s first year of life.
Conclusions and Relevance: Children with ASD and their younger siblings were undervaccinated compared with the general population. The results of this study suggest that children with ASD and their younger siblings are at increased risk of vaccine-preventable diseases.
Misleading Health Consumers Through Violations of Communicative Norms: A Case Study of Online Diabetes Education
Derek Powell et al.
Psychological Science, forthcoming
Abstract:
Communication is a cooperative endeavor that goes well beyond decoding sentences’ literal meaning. Listeners actively construe the meaning of utterances from both their literal meanings and the pragmatic principles that govern communication. When communicators make pragmatically infelicitous statements, the effects can be similar to paltering — misleading speech that evokes false inferences from true statements. The American Diabetes Association’s (ADA’s) “Diabetes Myths” website provides a real-world case study in such misleading communications. Calling something a myth implies that it is clearly false. Instead, the ADA’s “myths” are false only because of some technicality or uncharitable reading. We compared participants’ baseline knowledge of diabetes with that of participants who read either the ADA’s myths or the myths rewritten as questions that do not presuppose the statement is false. As predicted, exposure to the ADA’s “myths,” but not to the rephrased questions, reduced basic knowledge of diabetes. Our findings underscore the need to consider psycholinguistic principles in mass communications.
Patterns of plant and animal protein intake are strongly associated with cardiovascular mortality: The Adventist Health Study-2 cohort
Marion Tharrey et al.
International Journal of Epidemiology, forthcoming
Methods: We selected 81 337 men and women from the Adventist Health Study-2. Diet was assessed between 2002 and 2007, by using a validated food frequency questionnaire. Dietary patterns based on the participants’ protein consumption were derived by factor analysis. Cox regression analysis was used to estimate multivariate-adjusted hazard ratios (HRs) adjusted for sociodemographic and lifestyle factors and dietary components.
Results: There were 2276 cardiovascular deaths during a mean follow-up time of 9.4 years. The HRs for cardiovascular mortality were 1.61 [98.75% confidence interval (CI), 1.12 2.32; P-trend < 0.001] for the ‘Meat’ protein factor and 0.60 (98.75% CI, 0.42 0.86; P-trend < 0.001) for the ‘Nuts & Seeds’ protein factor (highest vs lowest quintile of factor scores). No significant associations were found for the ‘Grains’, ‘Processed Foods’ and ‘Legumes, Fruits & Vegetables’ protein factors. Additional adjustments for the participants’ vegetarian dietary pattern and nutrients related to cardiovascular disease outcomes did not change the results.
Deposition rates of viruses and bacteria above the atmospheric boundary layer
Isabel Reche et al.
ISME Journal, April 2018, Pages 1154–1162
Abstract:
Aerosolization of soil-dust and organic aggregates in sea spray facilitates the long-range transport of bacteria, and likely viruses across the free atmosphere. Although long-distance transport occurs, there are many uncertainties associated with their deposition rates. Here, we demonstrate that even in pristine environments, above the atmospheric boundary layer, the downward flux of viruses ranged from 0.26 × 109 to >7 × 109 m−2 per day. These deposition rates were 9–461 times greater than the rates for bacteria, which ranged from 0.3 × 107 to >8 × 107 m−2 per day. The highest relative deposition rates for viruses were associated with atmospheric transport from marine rather than terrestrial sources. Deposition rates of bacteria were significantly higher during rain events and Saharan dust intrusions, whereas, rainfall did not significantly influence virus deposition. Virus deposition rates were positively correlated with organic aerosols <0.7 μm, whereas, bacteria were primarily associated with organic aerosols >0.7 μm, implying that viruses could have longer residence times in the atmosphere and, consequently, will be dispersed further. These results provide an explanation for enigmatic observations that viruses with very high genetic identity can be found in very distant and different environments.