Frailty
Health, Human Capital Formation and Knowledge Production: Two Centuries of International Evidence
Jakob Madsen
NBER Working Paper, October 2012
Abstract:
Recent medical research shows that health is highly influential for learning and the ability to think laterally; however, past economic studies have failed to empirically examine the influence of health on learning, schooling, and ideas production; the main drivers of growth in endogenous growth models. This paper constructs a measure of health-adjusted educational attainment among the working age population based on their health status during the time they did their education. Using annual data for 21 OECD countries over the past two centuries it is shown that health has been highly influential for the quantity and quality of schooling, innovations and growth.
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Leading Causes of Unintentional and Intentional Injury Mortality: United States, 2000-2009
Ian Rockett et al.
American Journal of Public Health, November 2012, Pages e84-e92
Objectives: We have described national trends for the 5 leading external causes of injury mortality.
Methods: We used negative binomial regression and annual underlying cause-of-death data for US residents for 2000 through 2009.
Results: Mortality rates for unintentional poisoning, unintentional falls, and suicide increased by 128%, 71%, and 15%, respectively. The unintentional motor vehicle traffic crash mortality rate declined 25%. Suicide ranked first as a cause of injury mortality, followed by motor vehicle traffic crashes, poisoning, falls, and homicide. Females had a lower injury mortality rate than did males. The adjusted fall mortality rate displayed a positive age gradient. Blacks and Hispanics had lower adjusted motor vehicle traffic crash and suicide mortality rates and higher adjusted homicide rates than did Whites, and a lower unadjusted total injury mortality rate.
Conclusions: Mortality rates for suicide, poisoning, and falls rose substantially over the past decade. Suicide has surpassed motor vehicle traffic crashes as the leading cause of injury mortality. Comprehensive traffic safety measures have successfully reduced the national motor vehicle traffic crash mortality rate. Similar efforts will be required to diminish the burden of other injury.
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Early childhood poverty, immune-mediated disease processes, and adult productivity
Kathleen Ziol-Guest et al.
Proceedings of the National Academy of Sciences, forthcoming
Abstract:
This study seeks to understand whether poverty very early in life is associated with early-onset adult conditions related to immune-mediated chronic diseases. It also tests the role that these immune-mediated chronic diseases may play in accounting for the associations between early poverty and adult productivity. Data (n = 1,070) come from the US Panel Study of Income Dynamics and include economic conditions in utero and throughout childhood and adolescence coupled with adult (age 30-41 y) self-reports of health and economic productivity. Results show that low income, particularly in very early childhood (between the prenatal and second year of life), is associated with increases in early-adult hypertension, arthritis, and limitations on activities of daily living. Moreover, these relationships and particularly arthritis partially account for the associations between early childhood poverty and adult productivity as measured by adult work hours and earnings. The results suggest that the associations between early childhood poverty and these adult disease states may be immune-mediated.
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The 20-Year Public Health Impact and Direct Cost of Testosterone Deficiency in U.S. Men
Daniel Moskovic et al.
Journal of Sexual Medicine, forthcoming
Introduction: Testosterone deficiency (TD) imposes a substantial public health burden in the U.S. We modeled the costs associated with TD-related sequelae including cardiovascular disease (CVD), diabetes mellitus (DM), and osteoporosis-related fractures (ORFs).
Aim: To quantify the incremental cost burden imposed by TD's cardiometabolic sequelae.
Method: Incidence, prevalence, and mortality of these conditions were collected for men ages 45-74 from six national databases and large cross-sectional studies. Relative risk (RR) rates were determined for these sequelae in patients with T < 300 ng/dL. The prevalence of TD was determined for this cohort of men.
Main Outcome Measures: Adjusted incidence and prevalence were determined. Annual costs for the three TD-related sequelae were inflated at a real rate of 3% for 20 years.
Results: Actual and adjusted (normalized for T deficiency) rates of CVD, DM, and ORFs in U.S. men aged 45-74 assuming a TD prevalence of 13.4% were calculated. We determined that, over a 20-year period, T deficiency is projected to be involved in the development of approximately 1.3 million new cases of CVD, 1.1 million new cases of DM, and over 600,000 ORFs. In year 1, the attributed cost burden of these diseases was approximately $8.4 billion. Over the entire 20-year period, T deficiency may be directly responsible for approximately $190-$525 billion in inflation-adjusted U.S. health care expenditures.
Conclusion: TD may be a significant contributor to adverse public health. Further study is needed to definitively describe the whether TD is a modifiable risk factor for CVD, DM, and ORFs. This may represent an opportunity for nationwide public health initiatives aimed at preventive care.
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Recessions, Older Workers, and Longevity: How Long Are Recessions Good For Your Health?
Courtney Coile, Phillip Levine & Robin McKnight
NBER Working Paper, September 2012
Abstract:
This paper examines the impact of exposure to higher unemployment rates in the pre-retirement years on subsequent mortality. Although past research has found that recessions reduce contemporaneous mortality, these short-term effects may reverse over time, particularly for older workers. If workers experience an economic downturn in their late 50s, they may face several years of reduced employment and earnings before "retiring" when they reach Social Security eligibility at age 62. They also may experience lost health insurance, and therefore higher financial barriers to health care, through age 65, when Medicare becomes available. All of these experiences could contribute to weaker long-term health outcomes. To examine these hypotheses, we use Vital Statistics mortality data between 1969 and 2008 to generate age-specific cohort survival probabilities at older ages. We then link these survival probabilities to labor market conditions at earlier ages. We also use data from the 1980-2010 March Current Population Surveys and the 1991-2010 Behavioral Risk Factor Surveillance System surveys to explore potential mechanisms for this health effect. Our results indicate that experiencing a recession in one's late 50s leads to a reduction in longevity. We also find that this exposure leads to several years of reduced employment, health insurance coverage, and health care utilization which may contribute to the lower long-term likelihood of survival.
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Child Health in the United States: Recent Trends in Racial/Ethnic Disparities
Neil Mehta, Hedwig Lee & Kelly Ylitalo
Social Science & Medicine, forthcoming
Abstract:
In the United States, race and ethnicity are considered key social determinants of health because of their enduring association with social and economic opportunities and resources. An important policy and research concern is whether the U.S. is making progress toward reducing racial/ethnic inequalities in health. While race/ethnic disparities in infant and adult outcomes are well documented, less is known about patterns and trends by race/ethnicity among children. Our objective was to determine the patterns of and progress toward reducing racial/ethnic disparities in child health. Using nationally representative data from 1998-2009, we assessed 17 indicators of child health, including overall health status, disability, measures of specific illnesses, and indicators of the social and economic consequences of illnesses. We examined disparities across five race/ethnic groups (non-Hispanic white, non-Hispanic black, Hispanic, non-Hispanic Asian, and non-Hispanic other). We found important racial/ethnic disparities across nearly all of the indicators of health we examined, adjusting for socioeconomic status, nativity, and access to health care. Importantly, we found little evidence that racial/ethnic disparities in child health have changed over time. In fact, for certain illnesses such as asthma, black-white disparities grew significantly larger over time. In general, black children had the highest reported prevalence across the health indicators and Asian children had the lowest reported prevalence. Hispanic children tended to be more similar to whites compared to the other race/ethnic groups, but there was considerable variability in their relative standing.
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Educational Attainment and Late Life Telomere Length in the Health, Aging and Body Composition Study
Nancy Adler et al.
Brain, Behavior, and Immunity, forthcoming
Abstract:
Morbidity and mortality are greater among socially disadvantaged racial/ethnic groups and those of lower socioeconomic status (SES). Greater chronic stress exposure in disadvantaged groups may contribute to this by accelerating cellular aging, indexed by shorter age-adjusted telomere length. While studies consistently relate shorter leukocyte telomere length (LTL) to stress, the few studies, mostly from the UK, examining associations of LTL with SES have been mixed. The current study examined associations between educational attainment and LTL among 2,599 high-functioning black and white adults age 70-79 from the Health, Aging and Body Composition Study. Multiple regression analyses tested associations of race/ethnicity, educational attainment and income with LTL, adjusting for potential confounders. Those with only a high school education had significantly shorter mean LTL (4806 basepairs) than those with post-high school education (4926 basepairs; B=125, SE= 47.6, p = .009). A significant interaction of race and education (B = 207.8, SE = 98.7, p = .035) revealed more beneficial effects of post-high school education for blacks than for whites. Smokers had shorter LTL than non-smokers, but the association of education and LTL remained significant when smoking was covaried (B = 119.7, SE = 47.6, p = .012). While higher income was associated with longer LTL, the effect was not significant (p > .10). This study provides the first demonstration of an association between educational attainment and LTL in a US population where higher education appears to have a protective effect against telomere shortening, particularly in blacks.
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Local Legal Infrastructure and Population Health
Julia Costich & Dana Patton
American Journal of Public Health, October 2012, Pages 1936-1941
Objectives: We explored the association between the legal infrastructure of local public health, as expressed in the exercise of local fiscal and legislative authority, and local population health outcomes.
Methods: Our unit of analysis was public health jurisdictions with at least 100 000 residents. The dependent variable was jurisdiction premature mortality rates obtained from the Mobilize Action Toward Community Health (MATCH) database. Our primary independent variables represented local public health's legal infrastructure: home rule status, board of health power, county government structure, and type of public health delivery system. Several control variables were included. We used a regression model to test the relationship between the varieties of local public health legal infrastructure identified and population health status.
Results: The analyses suggested that public health legal infrastructure, particularly reformed county government, had a significant effect on population health status as a mediator of social determinants of health.
Conclusions: Because states shape the legal infrastructure of local public health through power-sharing arrangements, our findings suggested recommendations for state legislation that positions local public health systems for optimal impact. Much more research is needed to elucidate the complex relationships among law, social capital, and population health status.
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Cumulative Neighborhood Risk of Psychosocial Stress and Allostatic Load in Adolescents
Katherine Theall, Stacy Drury & Elizabeth Shirtcliff
American Journal of Epidemiology, 1 October 2012, Pages S164-S174
Abstract:
The authors examined the impact of cumulative neighborhood risk of psychosocial stress on allostatic load (AL) among adolescents as a mechanism through which life stress, including neighborhood conditions, may affect health and health inequities. They conducted multilevel analyses, weighted for sampling and propensity score-matched, among adolescents aged 12-20 years in the National Health and Nutrition Examination Survey (1999-2006). Individuals (first level, n = 11,886) were nested within families/households (second level, n = 6,696) and then census tracts (third level, n = 2,191) for examination of the contextual effect of cumulative neighborhood risk environment on AL. Approximately 35% of adolescents had 2 or more biomarkers of AL. A significant amount of variance in AL was explained at the neighborhood level. The likelihood of having a high AL was approximately 10% higher for adolescents living in medium-cumulative-risk neighborhoods (adjusted odds ratio (OR) = 1.09, 95% confidence interval (CI): 1.08, 1.09), 28% higher for those living in high-risk neighborhoods (adjusted OR = 1.28, 95% CI: 1.27, 1.30), and 69% higher for those living in very-high-risk neighborhoods (adjusted OR = 1.69, 95% CI: 1.68, 1.70) as compared with adolescents living in low-risk areas. Effect modification was observed by both individual- and neighborhood-level sociodemographic factors. These findings offer support for the hypothesis that neighborhood risks may culminate in a range of biologically mediated negative health outcomes detectable in adolescents.
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Renée Boynton-Jarrett, Elizabeth Hair & Barry Zuckerman
Social Science & Medicine, forthcoming
Abstract:
Turbulent social environments are associated with health and developmental risk, yet mechanisms have been understudied. Guided by a life course framework and stress theory, this study examined the association between turbulent life transitions (including frequent residential mobility, school transitions, family structure disruptions, and homelessness) and exposure to violence during adolescence and high school completion, mental health, and health risk behaviors in young adulthood. Participants (n=4,834) from the U.S. National Longitudinal Survey of Youth, 1997 cohort were followed prospectively from age 12-14 years for 10 years. We used structural equation models to investigate pathways between turbulence and cumulative exposure to violence (CEV), to high school completion, mental health, and health risk behaviors, while accounting for early life socio-demographics, family processes, and individual characteristics. Results indicated that turbulence index was associated with cumulative exposure to violence in adolescence. Both turbulence index and cumulative exposure to violence were positively associated with higher health risk behavior, poorer mental health, and inversely associated with high school completion. These findings highlight the importance of considering the cumulative impact of turbulent and adverse social environments when developing interventions to optimize health and developmental trajectory for adolescents transitioning into adulthood.
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Stephanie Broyles et al.
PLoS ONE, September 2012
Background: Childhood socioeconomic status is linked to adult cardiovascular disease and disease risk. One proposed pathway involves inflammation due to exposure to a stress-inducing neighborhood environment. Whether CRP, a marker of systemic inflammation, is associated with stressful neighborhood conditions among children is unknown.
Methods and Results: The sample included 385 children 5-18 years of age from 255 households and 101 census tracts. Multilevel logistic regression analyses compared children and adolescents with CRP levels >3 mg/L to those with levels ≤3 mg/L across neighborhood environments. Among children living in neighborhoods (census tracts) in the upper tertile of poverty or crime, 18.6% had elevated CRP levels, in contrast to 7.9% of children living in neighborhoods with lower levels of poverty and crime. Children from neighborhoods with the highest levels of either crime or poverty had 2.7 (95% CI: 1.2-6.2) times the odds of having elevated CRP levels when compared to children from other neighborhoods, independent of adiposity, demographic and behavioral differences.
Conclusions: Children living in neighborhoods with high levels of poverty or crime had elevated CRP levels compared to children from other neighborhoods. This result is consistent with a psychosocial pathway favoring early development of cardiovascular risk that involves chronic stress from exposure to socially- and physically-disordered neighborhoods characteristic of poverty.
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Neighborhood disadvantage and adolescent stress reactivity
Daniel Hackman et al.
Frontiers in Human Neuroscience, October 2012
Abstract:
Lower socioeconomic status (SES) is associated with higher levels of life stress, which in turn affect stress physiology. SES is related to basal cortisol and diurnal change, but it is not clear if SES is associated with cortisol reactivity to stress. To address this question, we examined the relationship between two indices of SES, parental education and concentrated neighborhood disadvantage, and the cortisol reactivity of African-American adolescents to a modified version of the Trier Social Stress Test (TSST). We found that concentrated disadvantage was associated with cortisol reactivity and this relationship was moderated by gender, such that higher concentrated disadvantage predicted higher cortisol reactivity and steeper recovery in boys but not in girls. Parental education, alone or as moderated by gender, did not predict reactivity or recovery, while neither education nor concentrated disadvantage predicted estimates of baseline cortisol. This finding is consistent with animal literature showing differential vulnerability, by gender, to the effects of adverse early experience on stress regulation and the differential effects of neighborhood disadvantage in adolescent males and females. This suggests that the mechanisms underlying SES differences in brain development and particularly reactivity to environmental stressors may vary across genders.
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John Stogner, Chris Gibson & Mitchell Miller
Justice Quarterly, forthcoming
Abstract:
The correlation between health and offending is typically regarded as the result of confounding factors such as socioeconomic status and drug use, with little consideration given to the plausibility of reciprocal effects. Using two waves of data collected on 14,738 adolescents from the National Longitudinal Study of Adolescent Health (Add Health), a simultaneous structural equations modeling approach was used to determine whether there is a symbiotic relationship between health and violence. Findings indicate that minor health problems have delayed effects on violence and that involvement in violence also negatively affects future health. Discussion centers on this reciprocal relationship, implications for future research, and public health and delinquency prevention policy.
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Samuel Preston et al.
NBER Working Paper, September 2012
Abstract:
We project the effects of declining smoking and increasing obesity on mortality in the United States over the period 2010-2040. Data on cohort behavioral histories are integrated into these projections. Future distributions of body mass indices are projected using transition matrices applied to the initial distribution in 2010. In addition to projections of current obesity, we project distributions of obesity when cohorts were age 25. To these distributions we apply death rates by current and age-25 obesity status observed in the National Health and Nutrition Examination Survey, 1988-2006. Projections of the effects of smoking are based on observed relations between cohort smoking patterns and cohort death rates from lung cancer. We find that both changes in smoking and in obesity are expected to have large effects on mortality. For males, the reductions in smoking have larger effects than the rise in obesity throughout the projection period. By 2040, male life expectancy at age 40 is expected to have gained 0.92 years from the combined effects. Among women, however, the two sets of effects largely offset one another throughout the projection period, with a small gain of 0.26 years expected by 2040.
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To Flourish or Not: Positive Mental Health and All-Cause Mortality
Corey Keyes & Eduardo Simoes
American Journal of Public Health, November 2012, Pages 2164-2172
Objectives: We investigated whether positive mental health predicts all-cause mortality.
Methods: Data were from the Midlife in the United States (MIDUS) study (n = 3032), which at baseline in 1995 measured positive mental health (flourishing and not) and past-year mental illness (major depressive episode, panic attacks, and generalized anxiety disorders), and linked respondents with National Death Index records in a 10-year follow-up ending in 2005. Covariates were age, gender, race, education, any past-year mental illness, smoking, physical inactivity, physical diseases, and physical disease risk factors.
Results: A total of 6.3% of participants died during the study period. The final and fully adjusted odds ratio of mortality was 1.62 (95% confidence interval [CI] = 1.00, 2.62; P = .05) for adults who were not flourishing, relative to participants with flourishing mental health. Age, gender, race, education, smoking, physical inactivity, cardiovascular disease, and HIV/AIDS were significant predictors of death during the study period.
Conclusions: The absence of positive mental health increased the probability of all-cause mortality for men and women at all ages after adjustment for known causes of death.
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Life-Threatening Disparities: The Treatment of Black and White Cancer Patients
Louis Penner et al.
Journal of Social Issues, June 2012, Pages 328-357
Abstract:
Cancer mortality and survival rates are much poorer for Black patients than for White patients. We argue that Black-White treatment disparities are a major reason for these disparities. We examine three specific kinds of Black-White treatment disparities: disparities in information exchange in oncology interactions, disparities in the treatment of breast cancer, and disparities in the treatment of clinically localized prostate cancer. In the final section, we discuss possible causes of these disparities, with a primary focus on communication within medical interactions and the role that race-related attitudes and beliefs may play in the quality of communication in these interactions.
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The ‘trendiness' of sleep: An empirical investigation into the cyclical nature of sleep time
Pierre Brochu, Catherine Deri Armstrong & Louis-Philippe Morin
Empirical Economics, October 2012, Pages 891-913
Abstract:
Using Canadian time use data, we exploit variation in local unemployment rates to investigate the cyclical nature of sleep time and show that for both men and women, sleep time decreases when the economy is doing relatively better. Our results suggest that in a recession Canadians sleep an average of 3 h more per week, or 26 min more per day. Given the importance of even small changes in sleep time on measures of cognitive functioning such as reaction time and concentration, our findings may help explain the countercyclical nature of mortality. Further, as we find that sleep is affected by the same economic variables (notably the unemployment rate) that affect market work time, our results also contribute to the limited literature that shows that sleep time should not be treated as exogenously determined, but, like any other resource, determined by its relative cost.
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Motorcycle fatalities among out-of-state riders and the role of universal helmet laws
Michael French, Gulcin Gumus & Jenny Homer
Social Science & Medicine, November 2012, Pages 1855-1863
Abstract:
Several studies have demonstrated that universal helmet laws (UHLs) and other motor vehicle policies are effective in reducing fatal and non-fatal motorcycle injuries. Although state policies can improve traffic safety overall, very little is known about how they affect different segments of motorcycle riders. In this paper, we investigate the differential effectiveness of such policies by license state of the rider (i.e., in-state versus out-of-state). From a policy perspective, this information gap is noteworthy because variations in state regulations may influence where individuals choose to ride. We use state-level longitudinal (1988-2008) data on motorcycle fatalities in the United States from the Fatality Analysis Reporting System (FARS). Our results reconfirm the effectiveness of UHLs and offer new evidence suggesting that states without such policies may attract more risky riders from out-of-state. In particular, not having a UHL increases out-of-state rider fatalities by 18 percent and this effect is more pronounced for out-of-state riders who reside in a UHL state. These findings have important implications regarding unintended spillover effects of state-specific motor vehicle policies.
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Emily Williams et al.
PLoS ONE, September 2012
Background: To compare disability prevalence rates in the major ethnic groups in the UK and understand the risk factors contributing to differences identified. It was hypothesised that Indian Asian and African Caribbean people would experience higher rates of disability compared with Europeans.
Methods: Data was collected from 888 European, 636 Indian Asian and 265 African Caribbean men and women, aged 58-88 years at 20-year follow-up of community-based cohort study, based in West London. Disability was measured using a performance-based locomotor function test and self-reported questionnaires on functional limitation, and instrumental (IADL) and basic activities of daily living (ADL).
Results: The mean (SD) age of participants at follow-up was 69.6 (6.2) years. Compared with Europeans, Indian Asian people were significantly more likely to experience all of the disability outcomes than Europeans; this persisted after adjustment for socioeconomic, behavioural, adiposity and chronic disease risk factors measured at baseline (locomotor dysfunction: adjusted odds ratio (OR) 2.20, 95% CI 1.56-3.11; functional limitation: OR 2.77, 2.01-3.81; IADL impairment: OR 3.12, 2.20-4.41; ADL impairment: OR 1.58, 1.11-2.24). In contrast, a modest excess risk of disability was observed in African Caribbeans, which was abolished after adjustment (e.g. locomotor dysfunction: OR 1.37, 0.90-1.91); indeed a reduced risk of ADL impairment appeared after multivariable adjustment (OR from 0.99, 0.68-1.45 to 0.59, 0.38-0.93), compared with Europeans.
Conclusions: Substantially elevated risk of disability was observed among Indian Asian participants, unexplained by known factors. A greater understanding of determinants of disability and normative functional beliefs of healthy aging is required in this population to inform intervention efforts to prevent disability.
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Craig Trumbo
Mass Communication and Society, September/October 2012, Pages 718-738
Abstract:
The effect that newspapers had on patients visiting physicians for influenza was examined for 2002 to 2008. The basis for this investigation rests on theories of media effects drawn from agenda setting, media hype, and the Social Amplification of Risk Framework. It was hypothesized that controlling for the rate of influenza, a positive relationship exists in which increases and decreases of newspaper attention to influenza precede increases and decreases in the percentage of patients visiting physicians for flu symptoms. The percentage of visits and the percentage of positive flu tests are taken from the Centers for Disease Control's flu report. Media attention was located through the Lexis/Nexis database as words per week in stories having flu in the headline in 32 newspapers. Time series analysis shows that controlling for autoregressive and seasonal effects, and the actual rate of disease present, news attention in the previous week accounts for a statistically significant portion of the increase and decrease in the number of individuals who go to their physician reporting influenza-like symptoms. Reverse causality was examined. It was shown that controlling for autoregressive and seasonal effects, patient visits did not predict news coverage, whereas the rate of the flu in the previous 3 weeks did.
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Disease Politics and Medical Research Funding: Three Ways Advocacy Shapes Policy
Rachel Kahn Best
American Sociological Review, October 2012, Pages 780-803
Abstract:
In the 1980s and 1990s, single-disease interest groups emerged as an influential force in U.S. politics. This article explores their effects on federal medical research priority-setting. Previous studies of advocacy organizations' political effects focused narrowly on direct benefits for constituents. Using data on 53 diseases over 19 years, I find that in addition to securing direct benefits, advocacy organizations have aggregate effects and can systemically change the culture of policy arenas. Disease advocacy reshaped funding distributions, changed the perceived beneficiaries of policies, promoted metrics for commensuration, and made cultural categories of worth increasingly relevant to policymaking.
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Elizabeth Myers et al.
Academic Medicine, forthcoming
Purpose: The medical community currently has no detailed source of information on philanthropic research funding. The authors sought to identify trends in research funding by members of the Health Research Alliance (HRA), a consortium of nonprofit funders of biomedical research, and compare findings with research support from the federal government.
Method: Thirty-two HRA members uploaded information about grants with start dates in 2006, 2007, and 2008. Data were collected about each grant, investigator, and recipient institution. Disease categorization codes were assigned by a computer process similar to that used by the National Institutes of Health (NIH).
Results: In the three years under study, HRA members awarded 9,934 grants, totaling $2,712,418,254 in research and training support. Grant funding increased by 26% between 2006 and 2008. In contrast, NIH research spending increased by only 3% over the same time. Fifty-six percent of HRA grant dollars supported research projects, whereas 30% supported career development and training. During the same period, more than two-thirds of NIH grant dollars supported research projects, although NIH invested proportionally less in career development and training (7%). The largest proportion of HRA grant dollars addressed cancer, followed by diabetes and genetics. Sixty-three percent of HRA-supported investigators were men and 36% were women; 66% of investigators were white, 32% Asian, and fewer than 2% black.
Conclusions: These results indicate that nonprofit organizations play an important role in developing careers and advancing research in significant disease areas such as cancer and diabetes, and in basic science areas such as genetics.
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Sunil Shah et al.
American Journal of Epidemiology, forthcoming
Abstract:
An increased risk of death in persons who have suffered spousal bereavement has been described in many populations. The impact of modifying factors, such as chronic disease and material circumstances, is less well understood. The authors followed 171,120 couples 60 years of age or older in a United Kingdom primary care database between 2005 and 2010 for an average of 4 years. A total of 26,646 (15.5%) couples experienced bereavement, with mean follow up after bereavement of 2 years. In a model adjusted for age, sex, comorbid conditions at baseline, material deprivation based on area of residence, season, and smoking status, the hazard ratio for mortality in the first year after bereavement was 1.25 (95% confidence interval: 1.18, 1.33). Further adjustment for changes in comorbid conditions throughout follow up did not alter the hazard ratio for bereavement (hazard ratio = 1.27, 95% confidence interval: 1.19, 1.35). The association was strongest in individuals with no significant chronic comorbid conditions throughout follow up (hazard ratio = 1.50, 95% confidence interval: 1.28, 1.77) and in more affluent couples (P = 0.035). In the first year after bereavement, the association between bereavement and death is not primarily mediated through worsening or new onset of chronic disease. Good health and material circumstances do not protect individuals from increased mortality rates after bereavement.
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Trends in US Older Adult Disability: Exploring Age, Period, and Cohort Effects
Shih-Fan Lin et al.
American Journal of Public Health, November 2012, Pages 2157-2163
Objectives: We elucidated how US late-life disability prevalence has changed over the past 3 decades.
Methods: We examined activities of daily living (ADL) and instrumental activities of daily living (IADL) disability trends by using age-period-cohort (APC) models among older adults aged 70 years or older who responded to the National Health Interview Survey between 1982 and 2009. We fitted logistic regressions for ADL and IADL disabilities and for each of the 3 APC trends with 2 models: unadjusted and fully adjusted for age, period, cohort, and sociodemographic variables.
Results: The unadjusted and adjusted period trends showed a substantial decline in IADL disability, and ADL disability remained stable across time. Unadjusted cohort trends for both outcomes also showed continual declines across successive cohorts; however, increasing cohort trends were evident in the adjusted models.
Conclusions: More recent cohorts of US older adults are becoming more disabled, net of aging and period effects. The net upward cohort trends in ADL and IADL disabilities remain unexplained. Further studies should explore cohort-specific determinants contributing to the increase of cohort-based disability among US older adults.
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Offering Pharmaceutical Samples: The Role of Physician Learning and Patient Payment Ability
Ram Bala, Pradeep Bhardwaj & Yuxin Chen
Marketing Science, forthcoming
Abstract:
Physicians may learn about prescription drug effectiveness directly from the firm via detailing or from patient experience. Patient-mediated learning is aided by the use of free drug samples. The effective use of samples is hampered by a lack of understanding of its exact return on investment implications. We seek to fill this gap by incorporating the physician's sample allocation behavior in the firm's decision making. We uncover the following implications for firms as well as policy makers. First, we find that the optimal sampling level for a drug category is a nonmonotonic function of patient payment ability and the price of the drug. Second, an increase in the cost of samples can lead to an increase in sampling and a decrease in detailing when the physician's propensity to provide sample subsidies is high. Third, when future market growth is expected to be high (early stage product life cycle and/or chronic drugs) and sampling efficiency is low, the use of sampling is profitable for the firm but leads to lower market coverage than when sampling is disallowed.
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Tracy Richmond, Courtney Walls & S.V. Subramanian
Economics & Human Biology, forthcoming
Abstract:
Numerous studies have demonstrated the association of childhood socioeconomic position and adult height. Many have suggested the use of adult height as a marker of overall childhood well-being. However, few studies have examined the relationship between child/adolescent socioeconomic position and adult height in a racially/ethnically diverse cohort. Using the National Longitudinal Study of Adolescent Health, we examined the association of child/adolescent SEP (maternal education and maternal report of household income) and measured adult height in a diverse cohort of US adolescents/young adults. We found a positive gradient effect of maternal education on height in the overall population and in White and Mixed race males and females; no such gradient existed in Hispanic, Asian, or Black males or females. Only in Mixed race females was household income positively associated with height. These findings emphasize the need to recognize differential effects of socioeconomic status on height in different racial/ethnic and gender subpopulations.
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Body Height and Socioeconomic Status of Females at Different Life Stages
Iwona Wronka
Journal of Biosocial Science, forthcoming
Abstract:
Adult height reflects long-term nutritional status and exposure to infectious diseases, both of which are influenced by socioeconomic factors. Very little research has been done on these inequalities from a longitudinal perspective. This paper explores the links between body height at different life stages and socioeconomic characteristics. Data were obtained from 1008 Polish schoolgirls aged 16-18 years for whom earlier data on height were available. The height of each subject was measured. Socioeconomic status and age at menarche were assessed based on information received from the surveyed girls. Girls' heights in early life were ascertained from medical records. All girls were measured by trained school nurses at 7, 9 and 14 years of age. Socioeconomic status was found to be related to body height, but not to the rate of height gain during childhood and adolescence. Girls of a higher socioeconomic status were taller than girls of a lower socioeconomic status. On dividing the research material into homogeneous groups by maturity status, the same relationship was observed. No significant relationships were found between socioeconomic status and rate of height gain between ages 7 and 16, 17, 18 years. The findings suggest that socioeconomic variation in height is the result of living conditions during the first years of life.
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Omega-3 fatty acids, oxidative stress, and leukocyte telomere length: A randomized controlled trial
Janice Kiecolt-Glaser et al.
Brain, Behavior, and Immunity, forthcoming
Abstract:
Shorter telomeres have been associated with poor health behaviors, age-related diseases, and early mortality. Telomere length is regulated by the enzyme telomerase, and is linked to exposure to proinflammatory cytokines and oxidative stress. In our recent randomized controlled trial, omega-3 (n-3) polyunsaturated fatty acid (PUFA) supplementation lowered the concentration of serum proinflammatory cytokines. This study assessed whether n-3 PUFA supplementation also affected leukocyte telomere length, telomerase, and oxidative stress. In addition to testing for group differences, changes in the continuous n-6:n-3 PUFA ratio were assessed to account for individual differences in adherence, absorption, and metabolism. The double-blind four-month trial included 106 healthy sedentary overweight middle-aged and older adults who received (1) 2.5 g/day n-3 PUFAs, (2) l.25 g/day n-3 PUFAs, or (3) placebo capsules that mirrored the proportions of fatty acids in the typical American diet. Supplementation significantly lowered oxidative stress as measured by F2-isoprostanes (p = 0.02). The estimated geometric mean log-F2-isoprostanes values were 15% lower in the two supplemented groups compared to placebo. Although group differences for telomerase and telomere length were nonsignificant, changes in the n-6:n-3 PUFA plasma ratios helped clarify the intervention's impact: telomere length increased with decreasing n-6:n-3 ratios, p = 0.02. The data suggest that lower n-6:n-3 PUFA ratios can impact cell aging. The triad of inflammation, oxidative stress, and immune cell aging represents important pre-disease mechanisms that may be ameliorated through nutritional interventions. This translational research broadens our understanding of the potential impact of the n-6:n-3 PUFA balance.
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Kouta Ito et al.
Health Services Research, forthcoming
Objective: To evaluate the comparative cost-effectiveness of interventions to improve adherence to evidence-based medications among postmyocardial infarction (MI) patients.
Data Sources/Study Setting: Cost-effectiveness analysis.
Study Design: We developed a Markov model simulating a hypothetical cohort of 65-year-old post-MI patients who were prescribed secondary prevention medications. We evaluated mailed education, disease management, polypill use, and combinations of these interventions. The analysis was performed from a societal perspective over a lifetime horizon. The main outcome was an incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life year (QALY) gained.
Data Collection/Extraction Methods: Model inputs were extracted from published literature.
Principal Findings: Compared with usual care, only mailed education had both improved health outcomes and reduced spending. Mailed education plus disease management, disease management, polypill use, polypill use plus mailed education, and polypill use plus disease management cost were $74,600, $69,200, $133,000, $113,000, and $142,900 per QALY gained, respectively. In an incremental analysis, only mailed education had an ICER of less than $100,000 per QALY and was therefore the optimal strategy. Polypill use, particularly when combined with mailed education, could be cost effective, and potentially cost saving if its price decreased to less than $100 per month.
Conclusions: Mailed education and a polypill, once available, may be the cost-saving strategies for improving post-MI medication adherence.