Trends in Health and Mortality

Kevin Lewis

December 08, 2009

Personality, Socioeconomic Status, and All-Cause Mortality in the United States

Benjamin Chapman, Kevin Fiscella, Ichiro Kawachi & Paul Duberstein
American Journal of Epidemiology, forthcoming

The authors assessed the extent to which socioeconomic status (SES) and the personality factors termed the "big 5" (neuroticism, extraversion, openness to experience, agreeableness, conscientiousness) represented confounded or independent risks for all-cause mortality over a 10-year follow-up in the Midlife Development in the United States (MIDUS) cohort between 1995 and 2004. Adjusted for demographics, the 25th versus 75th percentile of SES was associated with an odds ratio of 1.43 (95% confidence interval (CI): 1.11, 1.83). Demographic-adjusted odds ratios for the 75th versus 25th percentile of neuroticism were 1.38 (95% CI: 1.10, 1.73) and 0.63 (95% CI: 0.47, 0.84) for conscientiousness, the latter evaluated at high levels of agreeableness. Modest associations were observed between SES and the big 5. Adjusting each for the other revealed that personality explained roughly 20% of the SES gradient in mortality, while SES explained 8% of personality risk. Portions of SES and personality risk were explained by health behaviors, although some residual risk remained unexplained. Personality appears to explain some between-SES strata differences in mortality risk, as well as some individual risk heterogeneity within SES strata. Findings suggest that both sociostructural inequalities and individual disposition hold public health implications. Future research and prevention aimed at ameliorating SES health disparities may benefit from considering the risk clustering of social disadvantage and dispositional factors.


Taking time to be healthy: Predicting health behaviors with delay discounting and time perspective

James Daugherty & Gary Brase
Personality and Individual Differences, January 2010, Pages 202-207

Delay discounting, a willingness to postpone receiving an immediate reward in order to gain additional benefits in the future, is conceptually related to time perspective, the cognitive processes which filter temporal information and influence behavior. One measure of delay discounting (Money Choice Questionnaire) and two measures of time perspective (Consideration of Future Consequences Scale and Zimbardo Time Perspective Inventory) were compared in this study to each other and to self-reported health behaviors with 467 undergraduates. Delay discounting and time perspective significantly improved the incremental prediction of tobacco, alcohol, and drug use, exercise frequency, eating breakfast, wearing a safety belt, estimated longevity, health concerns, and sociosexual orientation above and beyond sex and Big Five traits. These results further suggest that delay discounting and time perspective are indeed similar but also non-redundant constructs that are not reducible to global personality.


How Four Once Common Diseases Were Eliminated From The American South

Margaret Humphreys
Health Affairs, November/December 2009, Pages 1734-1744

Four major diseases stigmatized the American South in the nineteenth and twentieth centuries: yellow fever, malaria, hookworm, and pellagra. Each disease contributed to the inhibition of economic growth in the South, and the latter three severely affected children's development and adult workers' productivity. However, all four had largely disappeared from the region by 1950. This paper analyzes the reasons for this disappearance. It describes the direct effects of public health interventions and the indirect effects of prosperity and other facets of economic development. It also offers insights into the invaluable benefits that could be gained if today's neglected diseases were also eliminated.


Aversive Racism and Medical Interactions with Black Patients: A Field Study

Louis Penner, John Dovidio, Tessa West, Samuel Gaertner, Terrance Albrecht, Rhonda Dailey & Tsveti Markova Journal of Experimental Social Psychology, forthcoming

Medical interactions between Black patients and nonBlack physicians are usually less positive and productive than same-race interactions. We investigated the role that physician explicit and implicit biases play in shaping physician and patient reactions in racially discordant medical interactions. We hypothesized that whereas physicians' explicit bias would predict their own reactions, physicians' implicit bias, in combination with physician explicit (self-reported) bias, would predict patients' reactions. Specifically, we predicted that patients would react most negatively when their physician fit the profile of an aversive racist (i.e., low explicit-high implicit bias). The hypothesis about the effects of explicit bias on physicians' reactions was partially supported. The aversive racism hypothesis received support. Black patients had less positive reactions to medical interactions with physicians relatively low in explicit but relatively high in implicit bias than to interactions with physicians who were either (a) low in both explicit and implicit bias, or (b) high in both explicit and implicit bias.


Mortality Predictors in a 60-Year Follow-Up of Adolescent Males: Exploring Delinquency, Socioeconomic Status, IQ, High-School Drop-Out Status, and Personality

Susan Trumbetta, Benjamin Seltzer, Irving Gottesman & Kathleen McIntyre
Psychosomatic Medicine, forthcoming

Objective: To examine whether socioeconomic status (SES), high school (HS) completion, IQ, and personality traits that predict delinquency in adolescence also could explain men's delinquency-related (Dq-r) mortality risk across the life span.

Methods: Through a 60-year Social Security Death Index (SSDI) follow-up of 1812 men from Hathaway's adolescent normative Minnesota Multiphasic Personality Inventory (MMPI) sample, we examined mortality risk at various ages and at various levels of prior delinquency severity. We examined SES (using family rent level), HS completion, IQ, and MMPI indicators simultaneously as mortality predictors and tested for SES (rent level) interactions with IQ and personality.

Results: We ascertained 418 decedents. Dq-r mortality peaked between ages 45 years to 64 years and continued through age 75 years, with high delinquency severity showing earlier and higher mortality risk. IQ and rent level failed to explain Dq-r mortality. HS completion robustly conferred mortality protection through ages 55 years and 75 years, explained IQ and rent level-related risk, but did not fully explain Dq-r risk. Dq-r MMPI scales, Psychopathic Deviate, and Social Introversion, respectively, predicted risk for and protection from mortality by age 75 years, explaining mortality risk otherwise attributable to delinquency. Wiggins' scales also explained Dq-r mortality risk, as Authority Conflict conferred risk for and Social Maladjustment and Hypomania conferred protection from mortality by age 75 years.

Conclusions: HS completion robustly predicts mortality by ages 55 years and 75 years. Dq-r personality traits predict mortality by age 75 years, accounting, in part, for Dq-r mortality.


Absolute Change in Cause-Specific Infant Mortality for Blacks and Whites in the US: 1983-2002

Daniel Powers & Seung-Eun Song
Population Research and Policy Review, December 2009, Pages 817-851

This paper examines absolute change in infant mortality from 5 leading causes of death for whites and blacks over a 20 year period. Change in infant mortality varies by cause, race, and birth weight. Absolute decline in mortality from respiratory distress syndrome (RDS) and sudden infant death syndrome (SIDS) in the overall study population has been more rapid for black infants during the period after specific technological innovations were approved and behavioral practices were recommended for these conditions. For low birth weight infants, blacks experienced greater decline in mortality from SIDS and whites experienced greater decline in RDS mortality. Despite remarkable declines in mortality from these causes, relative racial disparities have increased over this time period. For the overall study population, blacks and whites experienced similar rates of mortality decline from congenital anomalies. Mortality decline from this cause among low birth weight infants occurred at a faster pace for whites. Mortality from causes for which no specific innovations were developed increased for blacks but remained relatively constant for whites. An analysis of absolute change complements the relative disparities approach by revealing the dynamics of change, thus providing a more complete understanding of changing racial disparities in infant mortality.


The possible macroeconomic impact on the UK of an influenza pandemic

Marcus Keogh-Brown, Simon Wren-Lewis, John Edmunds, Philippe Beutels & Richard Smith
Health Economics, forthcoming

Little is known about the possible impact of an influenza pandemic on a nation's economy. We applied the UK macroeconomic model COMPACT to epidemiological data on previous UK influenza pandemics, and extrapolated a sensitivity analysis to cover more extreme disease scenarios. Analysis suggests that the economic impact of a repeat of the 1957 or 1968 pandemics, allowing for school closures, would be short-lived, constituting a loss of 3.35 and 0.58% of GDP in the first pandemic quarter and year, respectively. A more severe scenario (with more than 1% of the population dying) could yield impacts of 21 and 4.5%, respectively. The economic shockwave would be gravest when absenteeism (through school closures) increases beyond a few weeks, creating policy repercussions for influenza pandemic planning as the most severe economic impact is due to policies to contain the pandemic rather than the pandemic itself. Accounting for changes in consumption patterns made in an attempt to avoid infection worsens the potential impact. Our mild disease scenario then shows first quarter/first year reductions in GDP of 9.5/2.5%, compared with our severe scenario reductions of 29.5/6%. These results clearly indicate the significance of behavioural change over disease parameters.


Material Resources and Population Health: Disadvantages in Health Care, Housing, and Food Among Adults Over 50 Years of Age

Dawn Alley, Beth Soldo, José Pagán, John McCabe,Madeleine deBlois, Samuel Field, David Asch & Carolyn Cannuscio
American Journal of Public Health, November 2009, Pages S693-S701

Objectives: We examined associations between material resources and late-life declines in health.
Methods: We used logistic regression to estimate the odds of declines in self-rated health and incident walking limitations associated with material disadvantages in a prospective panel representative of US adults aged 51 years and older (N = 15 441).

Results: Disadvantages in health care (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.23, 1.58), food (OR = 1.69; 95% CI = 1.29, 2.22), and housing (OR = 1.20; 95% CI = 1.07, 1.35) were independently associated with declines in self-rated health, whereas only health care (OR = 1.43; 95% CI = 1.29, 1.58) and food (OR = 1.64; 95% CI = 1.31, 2.05) disadvantage predicted incident walking limitations. Participants experiencing multiple material disadvantages were particularly susceptible to worsening health and functional decline. These effects were sustained after we controlled for numerous covariates, including baseline health status and comorbidities. The relations between health declines and non-Hispanic Black race/ethnicity, poverty, marital status, and education were attenuated or eliminated after we controlled for material disadvantage.

Conclusions: Material disadvantages, which are highly policy relevant, appear related to health in ways not captured by education and poverty. Policies to improve health should address a range of basic human needs, rather than health care alone.


Do we believe the tobacco industry lied to us? Association with smoking behavior in a military population

Robert Klesges, Deborah Sherrill-Mittleman, Margaret DeBon, Wayne Talcott & Robert Vanecek
Health Education Research, December 2009, Pages 909-921

Despite the dangers of smoking, tobacco companies continue to impede tobacco control efforts through deceptive marketing practices. Media campaigns that expose these practices have been effective in advancing anti-industry attitudes and reducing smoking initiation among young people, yet the association between knowledge of industry practices and smoking cessation and relapse has not been studied. In a large military sample entering Air Force Basic Military Training (BMT), where tobacco use is prohibited, we investigated (i) the prevalence of agreement with a statement that tobacco companies have misled the public about the health consequences of smoking and (ii) the association of this acknowledgement with smoking status upon entry into BMT (N = 36 013). At baseline, 56.6% agreed that tobacco companies have been deceptive, and agreement was a strong predictor of smoking status [smokers less likely to agree, odds ratio (OR) = 0.39, P < 0.01]. At 12-month follow-up, we examined the association between industry perception at baseline and current smoking status (N = 20 672). Recruits who had been smoking upon entry into BMT and who had acknowledged industry deception were less likely to report current smoking (OR = 0.84, P = 0.01). These findings suggest that anti-industry attitudes may affect smoking relapse following cessation.


Globus Sensation and Psychopathology in Men: The Vietnam Experience Study

Catharine Gale, Janet Wilson & Ian Deary
Psychosomatic Medicine, November/December 2009, Pages 1026-1031

Objective: To assess whether globus is associated with psychopathology in men. Globus - a persistent sensation of having a lump in the throat with no detectable physical cause - has long been thought a predominantly female disorder. Several small studies, based wholly or largely on women, suggested that globus is associated with higher levels of depression, anxiety, and somatic concern.

Methods: Participants were 4240 male U.S. veterans who underwent detailed medical and psychological examinations in middle age. Psychological health was assessed by structured diagnostic interview and the clinical scales of the Minnesota Multiphasic Personality Inventory (MMPI). The MMPI includes an item on the presence of globus.

Results: The prevalence of globus was 6.4%. Men with globus had an increased risk of being diagnosed with somatization disorder, odds ratio (OR) = 5.92, 95% Confidence Interval (CI) = 3.22, 10.9l; major depression, OR = 4.98, 95% CI = 3.63, 6.67; generalized anxiety disorder, OR = 3.70, 95% CI = 2.75, 4.90; posttraumatic stress disorder, OR = 3.50, 95% CI = 2.54, 4.76; and drug abuse or dependence, OR = 1.89, 95% CI = 1.15, 3.13; and they scored significantly higher on nine of the ten MMPI clinical scales. Globus was also associated with lower cognitive ability, socioeconomic and educational disadvantage, a higher pulse rate, and increased likelihood of being on antihypertensive medication.

Conclusions: Globus is linked with a wide range of psychopathology in men, notably depression and somatization disorder. Men presenting with globus might have developed that particular symptom to "represent" other, related and treatable psychopathology, which should also be investigated.


Labor Markets and Health Benefits: The Offer and Restrictions on It

Nan Maxwell
Contemporary Economic Policy, January 2008, Pages 73-88

This study argues that a multidimensional health benefit offer (i.e., offers of medical, dental, sick leave, or vision benefits) and the hours or tenure restrictions placed on it are affected by the relative demand for workers in the local labor market. Using the Bay Area Longitudinal Surveys (BALS), a database of low-skilled jobs, we show that an excess labor demand for workers' skills increases the firm's offer of health benefits and reduces the restrictions on them, while an excess labor supply increases restrictions. These findings suggest that research assessing the correlation between wages, skills, and whether or not a firm offers health insurance might understate the plight of the low-skilled worker since health care access may also be restricted by a failure to receive an array of health benefits and by the restrictions placed on the offer. Furthermore, public policies might place the issues of uninsurance of low-wage workers within the context of a lack of marketable skills since low-skilled workers might be able to enhance their ability to secure jobs that offer an array of health benefits if they acquire skills in short supply in the local labor market.


Rising U.S. income inequality, gender and individual self-rated health, 1972-2004

Hui Zheng
Social Science & Medicine, November 2009, Pages 1333-1342

The effect of income inequality on health has been a contested topic among social scientists. Most previous research is based on cross-sectional comparisons rather than temporal comparisons. Using data from the General Social Survey and the U.S. Census Bureau, this study examines how rising income inequality affects individual self-rated health in the U.S. from 1972 to 2004. Data are analyzed using hierarchical generalized linear models. The findings suggest a significant association between income inequality and individual self-rated health. The dramatic increase in income inequality from 1972 to 2004 increases the odds of worse self-rated health by 9.4 percent. These findings hold for three measures of income inequality: the Gini coefficient, the Atkinson Index, and the Theil entropy index. Results also suggest that overall income inequality and gender-specific income inequality harm men's, but not women's, self-rated health. These findings also hold for the three measures of income inequality. These findings suggest that inattention to gender composition may explain apparent discrepancies across previous studies.


Did Vietnam Veterans Get Sicker in the 1990s? The Complicated Effects of Military Service on Self-Reported Health

Joshua Angrist, Stacey Chen & Brigham Frandsen
NBER Working Paper, March 2009

The veterans disability compensation (VDC) program, which provides a monthly stipend to disabled veterans, is the third largest American disability insurance program. Since the late 1990s, VDC growth has been driven primarily by an increase in claims from Vietnam veterans, raising concerns about costs as well as health. We use the draft lottery to study the long-term effects of Vietnam-era military service on health and work in the 2000 Census. These estimates show no significant overall effects on employment or work-related disability status, with a small effect on non-work-related disability for whites. On the other hand, estimates for white men with low earnings potential show a large negative impact on employment and a marked increase in non-work-related disability rates. The differential impact of Vietnam-era service on low-skill men cannot be explained by more combat or war-theatre exposure for the least educated, leaving the relative attractiveness of VDC for less skilled men and the work disincentives embedded in the VDC system as a likely explanation.


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