Health Risk
The “double jeopardy” of midlife and old age mortality trends in the United States
Leah Abrams, Mikko Myrskylä & Neil Mehta
Proceedings of the National Academy of Sciences, 17 October 2023
Abstract:
Since 2010, US life expectancy growth has stagnated. Much research on US mortality has focused on working-age adults given adverse trends in drug overdose deaths, other external causes of death, and cardiometabolic deaths in midlife. We show that the adverse mortality trend at retirement ages (65+ y) has in fact been more consequential to the US life expectancy stagnation since 2010, as well as excess deaths and years of life lost in 2019, than adverse mortality trends at working ages. These results reveal that the United States is experiencing a “double jeopardy” that is driven by both mid-life and older-age mortality trends, but more so by older-age mortality. Understanding and addressing the causes behind the worsening mortality trend in older ages will be essential to returning to the pace of life expectancy improvements that the United States had experienced for decades.
Historical narratives about the COVID-19 pandemic are motivationally biased
Philipp Sprengholz et al.
Nature, forthcoming
Abstract:
How people recall the SARS-CoV-2 pandemic is likely to prove crucial in future societal debates on pandemic preparedness and appropriate political action. Beyond simple forgetting, previous research suggests that recall may be distorted by strong motivations and anchoring perceptions on the current situation. Here, using 4 studies across 11 countries (total n = 10,776), we show that recall of perceived risk, trust in institutions and protective behaviours depended strongly on current evaluations. Although both vaccinated and unvaccinated individuals were affected by this bias, people who identified strongly with their vaccination status -- whether vaccinated or unvaccinated -- tended to exhibit greater and, notably, opposite distortions of recall. Biased recall was not reduced by providing information about common recall errors or small monetary incentives for accurate recall, but was partially reduced by high incentives. Thus, it seems that motivation and identity influence the direction in which the recall of the past is distorted. Biased recall was further related to the evaluation of past political action and future behavioural intent, including adhering to regulations during a future pandemic or punishing politicians and scientists. Together, the findings indicate that historical narratives about the COVID-19 pandemic are motivationally biased, sustain societal polarization and affect preparation for future pandemics. Consequently, future measures must look beyond immediate public-health implications to the longer-term consequences for societal cohesion and trust.
Geographic Variation, Economic Activity, and Labor Market Characteristics in Trajectories of Suicide in the United States, 2008 to 2020
Katherine Keyes et al.
American Journal of Epidemiology, forthcoming
Abstract:
Suicide rates have increased in the U.S. over the past 15 years with substantial geographic variation in these increases; yet there have been few attempts to cluster counties by the magnitude of suicide rate changes by intercept and slope or to identify the economic precursors of increases. We used Vital Statistics data and growth mixture models to identify clusters of counties by their magnitude of suicide growth from 2008 to 2020 and examined associations with county economic and labor indices. Our models identified five clusters, each differentiated by intercept and slope magnitude, with the highest rate cluster (4% of counties) mainly in sparsely populated areas in the West and Alaska, starting the time series at 25.4 suicides/100,000, and exhibiting the steepest increase in slope (0.69/100,000 per year). There was no cluster for which the suicide rate was stable or declining. Counties in the highest rate cluster were more likely to have agriculture and service economies, and less likely to have urban professional economies. Given the increased burden of suicide, with no clusters of counties improving over time, additional policy and prevention efforts are needed, particularly targeted at rural areas in the West.
Economic Benefits and Social Costs of Legalizing Recreational Marijuana
Jason Brown, Elior Cohen & Alison Felix
Federal Reserve Working Paper, September 2023
Abstract:
We analyze the effects of legalizing recreational marijuana on state economic and social outcomes (2000–20) using difference-in-differences estimation robust to staggered timing and heterogeneity of treatment. We find moderate economic gains and accompanied by some social costs. Post-legalization, average state income grew by 3 percent, house prices by 6 percent, and population by 2 percent. However, substance use disorders, chronic homelessness, and arrests increased by 17, 35, and 13 percent, respectively. Although some of our estimates are noisy, our findings suggest that the economic benefits of legalization are broadly distributed, while the social costs may be more concentrated among individuals who use marijuana heavily. States that legalized early experienced similar social costs but larger economic gains, implying a potential first-mover advantage.
Frailty and survival in the 1918 influenza pandemic
Amanda Wissler & Sharon DeWitte
Proceedings of the National Academy of Sciences, 17 October 2023
Abstract:
One of the most well-known yet least understood aspects of the 1918 influenza pandemic is the disproportionately high mortality among young adults. Contemporary accounts further describe the victims as healthy young adults, which is contrary to the understanding of selective mortality, which posits that individuals with the highest frailty within a group are at the greatest risk of death. We use a bioarchaeological approach, combining individual-level information on health and stress gleaned from the skeletal remains of individuals who died in 1918 to determine whether healthy individuals were dying during the 1918 pandemic or whether underlying frailty contributed to an increased risk of mortality. Skeletal data on tibial periosteal new bone formation were obtained from 369 individuals from the Hamann–Todd documented osteological collection in Cleveland, Ohio. Skeletal data were analyzed alongside known age at death using Kaplan–Meier survival and Cox proportional hazards analysis. The results suggest that frail or unhealthy individuals were more likely to die during the pandemic than those who were not frail. During the flu, the estimated hazards for individuals with periosteal lesions that were active at the time of death were over two times higher compared to the control group. The results contradict prior assumptions about selective mortality during the 1918 influenza pandemic. Even among young adults, not everyone was equally likely to die -- those with evidence of systemic stress suffered greater mortality. These findings provide time depth to our understanding of how variation in life experiences can impact morbidity and mortality even during a pandemic caused by a novel pathogen.
No phenotypic or genotypic evidence for a link between sleep duration and brain atrophy
Anders Fjell et al.
Nature Human Behaviour, forthcoming
Abstract:
Short sleep is held to cause poorer brain health, but is short sleep associated with higher rates of brain structural decline? Analysing 8,153 longitudinal MRIs from 3,893 healthy adults, we found no evidence for an association between sleep duration and brain atrophy. In contrast, cross-sectional analyses (51,295 observations) showed inverse U-shaped relationships, where a duration of 6.5 (95% confidence interval, (5.7, 7.3)) hours was associated with the thickest cortex and largest volumes relative to intracranial volume. This fits converging evidence from research on mortality, health and cognition that points to roughly seven hours being associated with good health. Genome-wide association analyses suggested that genes associated with longer sleep for below-average sleepers were linked to shorter sleep for above-average sleepers. Mendelian randomization did not yield evidence for causal impacts of sleep on brain structure. The combined results challenge the notion that habitual short sleep causes brain atrophy, suggesting that normal brains promote adequate sleep duration -- which is shorter than current recommendations.
The association between playing professional American football and longevity
John Robert Warren & Gina Rumore
Proceedings of the National Academy of Sciences, 7 November 2023
Abstract:
Recent research concludes that professional American football players (hereafter, “football players”) live longer than American men in general, despite experiencing higher rates of chronic traumatic encephalopathy (CTE) and cardiovascular disease (CVD). This suggests that the longevity-enhancing benefits of playing football (e.g., physical fitness, money) outweigh the costs associated with CTE, CVD, and other longevity detriments of playing football. However, these surprising results may be the consequence of flawed research design. To investigate, we conducted two analyses. In analysis 1, we compared a) all professional American football players whose first season was 1986 or between 1988 and 1995 to b) a random sample of same-age American men observed as part of the National Health Interview Surveys in those same years selected on good health, at least 3 y of college, and not being poor. The exposure consists of playing one or more games of professional football; the outcome is risk of death within 25 y. In analysis 2, we use data on 1,365 men drafted to play in the (American) National Football League in the 1950s -- 906 of whom ultimately played professional football, and 459 of whom never played a game in any professional league. We estimate the association between playing football and survival through early 2023. In both analyses, we investigate differences between linemen and other position players. In contrast to most prior research, in both analyses, we find that linemen died earlier than otherwise similar men; men who played other positions died no earlier (or later).
Advertising and stocking at small retailers: A sweetened beverage excise tax in Philadelphia
Matthew Lee et al.
American Journal of Preventive Medicine, forthcoming
Introduction: In 2017, Philadelphia enacted a $0.015/oz excise tax on sweetened beverages (SBs) that covered both sugar-sweetened beverages and artificially sweetened beverages, which reduced purchasing and consumption. This study assessed whether the tax also changed beverage advertising or stocking practices that could influence consumer behavior, among stores in Philadelphia, Baltimore, and Philadelphia-adjacent counties not subject to a tax.
Methods: Using a longitudinal difference-in-differences approach, beverage advertising and availability changes were evaluated from 4-months pre-tax to 6-, 12-, and 24-months post-implementation in small independent stores in Philadelphia (n=34) and Philadelphia-adjacent counties (n=38) versus Baltimore (n=43), a demographically similar city without a tax. Mixed effects models tested whether beverage advertising/availability increased in Philadelphia and surrounding counties post-implementation vs. Baltimore, included store-level random intercepts, and were stratified by beverage tax status, type, size, and store zip-code income. Data were collected from 2016-18, and analyses performed in 2022-23.
Results: SB advertising increased post-tax in Philadelphia (6-months: +1.04 ads/store [95%CI:0.27-1.80]; 12-months: +1.54 [0.57-2.52]; 24-months: +0.91 [0.09-1.72]) relative to Baltimore. This was driven by increased advertising of SBs in low-income zip-codes. Marketing of SBs increased significantly in Philadelphia-adjacent counties relative to Baltimore. While SB availability in Philadelphia did not change, it increased in surrounding county stores (6-months: +0.20 [0.15-0.25]; 12-months: +0.08 [0.03-0.12]) relative to Baltimore.