Sick of it
Recessions, Job Loss, and Mortality Among Older US Adults
Clemens Noelke & Jason Beckfield
American Journal of Public Health, November 2014, Pages e126-e134
Objectives: We analyzed how recessions and job loss jointly shape mortality risks among older US adults.
Methods: We used data for 50 states from the Health and Retirement Study and selected individuals who were employed at ages 45 to 66 years during 1992 to 2011. We assessed whether job loss affects mortality risks, whether recessions moderate the effect of job loss on mortality, and whether individuals who do and do not experience job loss are differentially affected by recessions.
Results: Compared with individuals not experiencing job loss, mortality risks among individuals losing their job in a recession were strongly elevated (hazard ratio = 1.6; 95% confidence interval = 1.1, 2.3). Job loss during normal times or booms is not associated with mortality. For employed workers, we found a reduction in mortality risks if local labor market conditions were depressed, but this result was not consistent across different model specifications.
Conclusions: Recessions increase mortality risks among older US adults who experience job loss. Health professionals and policymakers should target resources to this group during recessions. Future research should clarify which health conditions are affected by job loss during recessions and whether access to health care following job loss moderates this relation.
----------------------
Is There a Link Between Foreclosure and Health?
Janet Currie & Erdal Tekin
American Economic Journal: Economic Policy, forthcoming
Abstract:
We investigate the relationship between foreclosures and hospital visits using data on all foreclosures and all hospital and emergency room visits from four states that were among the hardest hit by the foreclosure crisis. We find that living in a neighborhood with a spike in foreclosures is associated with significant increases in urgent unscheduled visits, including increases in visits for preventable conditions. The estimated relationships cannot be accounted for by increasing unemployment, declines in housing prices, migration, or by people switching from out-patient providers to hospitals.
----------------------
A hidden cost of war: The impact of mobilizing reserve troops on emergency response times
Christopher Coyne et al.
Public Choice, forthcoming
Abstract:
This paper analyzes a hidden cost of war: the effect of the mass mobilization of reserve troops on the response times of domestic emergency services to accidents. We provide a statistical examination of this linkage following the US invasion of Iraq in 2003 and find that mobilization significantly increases response times to accidents in the United States. These mobilization-related costs are exacerbated by both legal restrictions and issues of replacing highly specialized human capital.
----------------------
Maternal Intake of Supplemental Iron and Risk of Autism Spectrum Disorder
Rebecca Schmidt et al.
American Journal of Epidemiology, 1 November 2014, Pages 890-900
Abstract:
Iron deficiency affects 40%–50% of pregnancies. Iron is critical for early neurodevelopmental processes that are dysregulated in autism spectrum disorder (ASD). We examined maternal iron intake in relation to ASD risk in California-born children enrolled in a population-based case-control study (the Childhood Autism Risks from Genetics and the Environment (CHARGE) Study) from 2003 to 2009 with a diagnosis of ASD (n = 520) or typical development (n = 346) that was clinically confirmed using standardized assessments. Mean maternal daily iron intake was quantified on the basis of frequency, dose, and brands of supplements and cereals consumed each month from 3 months before pregnancy through the end of pregnancy and during breastfeeding (the index period), as reported in parental interviews. Mothers of cases were less likely to report taking iron-specific supplements during the index period (adjusted odds ratio = 0.63, 95% confidence interval: 0.44, 0.91), and they had a lower mean daily iron intake (51.7 (standard deviation, 34.0) mg/day) than mothers of controls (57.1 (standard deviation, 36.6) mg/day; P = 0.03). The highest quintile of iron intake during the index period was associated with reduced ASD risk compared with the lowest (adjusted odds ratio = 0.49, 95% confidence interval: 0.29, 0.82), especially during breastfeeding. Low iron intake significantly interacted with advanced maternal age and metabolic conditions; combined exposures were associated with a 5-fold increased ASD risk. Further studies of this link between maternal supplemental iron and ASD are needed to inform ASD prevention strategies.
----------------------
Second Trimester Sunlight and Asthma: Evidence from Two Independent Studies
Nils Wernerfelt, David Slusky & Richard Zeckhauser
NBER Working Paper, October 2014
Abstract:
One in twelve Americans suffers from asthma and its annual costs are estimated to exceed $50 billion. Simultaneously, the root causes of the disease remain unknown. A recent hypothesis speculates that maternal vitamin D levels during pregnancy affect the probability the fetus later develops asthma. In two large-scale studies, we test this hypothesis using a natural experiment afforded by historical variation in sunlight, a major source of vitamin D. Specifically, holding the birth location and month fixed, we see how exogenous within-location variation in sunlight across birth years affects the probability of asthma onset. We show that this measurement of sunlight correlates with actual exposure, and consistent with pre-existing results from the fetal development literature, we find substantial and highly significant evidence in both datasets that increased sunlight during the second trimester lowers the subsequent probability of asthma. Our results suggest policies designed to augment vitamin D levels in pregnant women, the large majority of whom are vitamin D insufficient, could be very cost-effective.
----------------------
Artificial sweeteners induce glucose intolerance by altering the gut microbiota
Jotham Suez et al.
Nature, 9 October 2014, Pages 181–186
Abstract:
Non-caloric artificial sweeteners (NAS) are among the most widely used food additives worldwide, regularly consumed by lean and obese individuals alike. NAS consumption is considered safe and beneficial owing to their low caloric content, yet supporting scientific data remain sparse and controversial. Here we demonstrate that consumption of commonly used NAS formulations drives the development of glucose intolerance through induction of compositional and functional alterations to the intestinal microbiota. These NAS-mediated deleterious metabolic effects are abrogated by antibiotic treatment, and are fully transferrable to germ-free mice upon faecal transplantation of microbiota configurations from NAS-consuming mice, or of microbiota anaerobically incubated in the presence of NAS. We identify NAS-altered microbial metabolic pathways that are linked to host susceptibility to metabolic disease, and demonstrate similar NAS-induced dysbiosis and glucose intolerance in healthy human subjects. Collectively, our results link NAS consumption, dysbiosis and metabolic abnormalities, thereby calling for a reassessment of massive NAS usage.
----------------------
The prevalence of periodontal disease in a Romano-British population c. 200-400 AD
T. Raitapuro-Murray, T.I. Molleson & F.J. Hughes
British Dental Journal, October 2014, Pages 459-466
Subjects and methods: 303 skulls from a Romano-British burial site in Poundbury, Dorset were examined for evidence of dental disease.
Results: The overall prevalence of moderate to severe periodontitis was just greater than 5%. The prevalence rate remained nearly constant between ages 20 to 60, after which it rose to around 10%. The number of affected teeth increased with age. Horizontal bone loss was generally minor. Caries was seen in around 50% of the cohort, and evidence of pulpal and apical pathology was seen in around 25%.
Conclusions: The prevalence of moderate to severe periodontitis was markedly decreased when compared to the prevalence in modern populations, underlining the potential importance of risk factors such as smoking and diabetes in determining susceptibility to progressive periodontitis in modern populations.
----------------------
Shona Fang et al.
Journal of Epidemiology & Community Health, forthcoming
Background: Sleep plays an important role in health and varies by social determinants. Little is known, however, about geographic variations in sleep and the role of individual-level and neighbourhood-level factors.
Methods: We used a multilevel modelling approach to quantify neighbourhood variation in self-reported sleep duration (very short <5 h; short 5–6.9 h; normative 7–8.9 h; long ≥9 h) among 3591 participants of the Boston Area Community Health Survey. We determined whether geographic variations persisted with control for individual-level demographic, socioeconomic status (SES) and lifestyle factors. We then determined the role of neighbourhood SES (nSES) in geographic variations. Additional models considered individual health factors.
Results: Between neighbourhood differences accounted for a substantial portion of total variability in sleep duration. Neighbourhood variation persisted with control for demographics, SES and lifestyle factors. These characteristics accounted for a portion (6–20%) of between-neighbourhood variance in very short, short and long sleep, while nSES accounted for the majority of the remaining between-neighbourhood variances. Low and medium nSES were associated with very short and short sleep (eg, very short sleep OR=2.08; 95% CI 1.38 to 3.14 for low vs high nSES), but not long sleep. Further inclusion of health factors did not appreciably increase the amount of between-neighbourhood variance explained nor did it alter associations.
Conclusions: Sleep duration varied by neighbourhood in a diverse urban setting in the northeastern USA. Individual-level demographics, SES and lifestyle factors explained some geographic variability, while nSES explained a substantial amount. Mechanisms associated with nSES should be examined in future studies to help understand and reduce geographic variations in sleep.
----------------------
The Socioeconomic Gradient in Physical Inactivity: Evidence from One Million Adults in England
Lisa Farrell et al.
Social Science & Medicine, forthcoming
Abstract:
Understanding the socioeconomic gradient in physical inactivity is essential for effective health promotion. This paper exploits data on over one million individuals (1,002,216 people aged 16 and over) in England drawn from the Active People Survey (2004-11). We identify the separate associations between a variety of measures of physical inactivity with education and household income. We find high levels of physical inactivity. Further, both education and household income are strongly associated with inactivity even when controlling for local area deprivation, the availability of physical recreation and sporting facilities, the local weather and regional geography. Moreover, the gap in inactivity between those living in high and low income households is already evident in early adult life and increases up until about age 85. Overall, these results suggest that England is building up a large future health problem and one that is heavily socially graded.
----------------------
Markus Jokela
American Journal of Epidemiology, 15 October 2014, Pages 776-784
Abstract:
People who live in disadvantaged neighborhoods tend to have poor physical and mental health, but this might be due to selective residential mobility rather than causal neighborhood effects. As a test of social causation, I examined whether persons were less healthy when they were living in disadvantaged neighborhoods than at other times when they were living in more advantaged neighborhoods. Data were taken from the 10-year Household, Income and Labour Dynamics in Australia (HILDA) prospective cohort study, which had annual follow-up waves between 2001 and 2010 (n = 112,503 person-observations from 20,012 persons). Neighborhood disadvantage was associated with poorer self-rated health, mental health, and physical functioning, higher probability of smoking, and less frequent physical activity. However, these associations were almost completely due to between-person differences; the associations were not replicated in within-person analyses that compared the same persons living in different neighborhoods over time. Results were similar when using neighborhood remoteness as the exposure and when focusing only on long-term residence. In contrast, poor health predicted selective residential mobility to less advantaged neighborhoods, which provided evidence of social selection. These findings provide little support for social causation in neighborhood health associations and suggest that correlations between neighborhoods and health may develop via selective residential mobility.
----------------------
Alternating antibiotic treatments constrain evolutionary paths to multidrug resistance
Seungsoo Kim, Tami Lieberman & Roy Kishony
Proceedings of the National Academy of Sciences, 7 October 2014, Pages 14494–14499
Abstract:
Alternating antibiotic therapy, in which pairs of drugs are cycled during treatment, has been suggested as a means to inhibit the evolution of de novo resistance while avoiding the toxicity associated with more traditional combination therapy. However, it remains unclear under which conditions and by what means such alternating treatments impede the evolution of resistance. Here, we tracked multistep evolution of resistance in replicate populations of Staphylococcus aureus during 22 d of continuously increasing single-, mixed-, and alternating-drug treatment. In all three tested drug pairs, the alternating treatment reduced the overall rate of resistance by slowing the acquisition of resistance to one of the two component drugs, sometimes as effectively as mixed treatment. This slower rate of evolution is reflected in the genome-wide mutational profiles; under alternating treatments, bacteria acquire mutations in different genes than under corresponding single-drug treatments. To test whether this observed constraint on adaptive paths reflects trade-offs in which resistance to one drug is accompanied by sensitivity to a second drug, we profiled many single-step mutants for cross-resistance. Indeed, the average cross-resistance of single-step mutants can help predict whether or not evolution was slower in alternating drugs. Together, these results show that despite the complex evolutionary landscape of multidrug resistance, alternating-drug therapy can slow evolution by constraining the mutational paths toward resistance.
----------------------
Community, Family, and Subjective Socioeconomic Status: Relative Status and Adolescent Health
Elizabeth Quon & Jennifer McGrath
Health Psychology, forthcoming
Objective: Relative socioeconomic status (SES) may be an important social determinant of health. The current study aimed to examine how relative SES, as measured by subjective SES, income inequality, and individual SES relative to others in the community, is associated with a wide range of adolescent health outcomes, after controlling for objective family SES.
Method: Adolescents (13–16 years; N = 2,199) from the Quebec Child and Adolescent Health and Social Survey were included. Socioeconomic measures included adolescents’ subjective SES; parental education and household income; community education/employment, income, and poverty rate; and community income inequality. Health outcomes included self-rated health, mental health problems, dietary and exercise health behaviors, substance-related health behaviors, reported physical health, and biomarkers of health. Best-fitting multilevel regression models (participants nested within schools) were used to test associations.
Results: Findings indicated that lower subjective SES was associated with poorer health outcomes. After accounting for family SES, lower community education/employment had an additional negative effect on health, while lower community income had a protective effect for certain health outcomes. There was less evidence for an independent effect of income inequality.
Conclusions: Findings highlight the importance of measures of relative SES that span across a number of levels and contexts, and provide further understanding into the socioeconomic gradient in adolescence.
----------------------
John Thompson et al.
PLoS ONE, September 2014
Objective: Our aim was to replicate and extend the recently found association between acetaminophen use during pregnancy and ADHD symptoms in school-age children.
Methods: Participants were members of the Auckland Birthweight Collaborative Study, a longitudinal study of 871 infants of European descent sampled disproportionately for small for gestational age. Drug use during pregnancy (acetaminophen, aspirin, antacids, and antibiotics) were analysed in relation to behavioural difficulties and ADHD symptoms measured by parent report at age 7 and both parent- and child-report at 11 years of age. The analyses included multiple covariates including birthweight, socioeconomic status and antenatal maternal perceived stress.
Results: Acetaminophen was used by 49.8% of the study mothers during pregnancy. We found significantly higher total difficulty scores (Strengths and Difficulty Questionnaire parent report at age 7 and child report at age 11) if acetaminophen was used during pregnancy, but there were no significant differences associated with any of the other drugs. Children of mothers who used acetaminophen during pregnancy were also at increased risk of ADHD at 7 and 11 years of age (Conners’ Parent Rating Scale-Revised).
Conclusions: These findings strengthen the contention that acetaminophen exposure in pregnancy increases the risk of ADHD-like behaviours. Our study also supports earlier claims that findings are specific to acetaminophen.
----------------------
Theresa Hastert et al.
Journal of Epidemiology & Community Health, forthcoming
Background: Disparities in cancer incidence and mortality have been observed by measures of area-level socioeconomic status (SES); however, the extent to which these disparities are explained by individual SES is unclear.
Methods: Participants included 60 756 men and women in the VITamins And Lifestyle (VITAL) study cohort, aged 50–76 years at baseline (2000–2002) and followed through 2010. We constructed a block group SES index using the 2000 US Census and fit Cox proportional hazards models to estimate the association between area-level SES (by quintile) and total and site-specific cancer incidence and total cancer mortality, with and without household income and individual education in the models.
Results: Lower area-level SES was weakly associated with higher total cancer incidence and lower prostate cancer risk, but was not associated with risk of breast cancer. Compared with the highest-SES areas, living in the lowest-SES areas was associated with higher lung (HR: 2.21, 95% CI 1.69 to 2.90) and colorectal cancer incidence (HR: 1.52, 95% CI 1.11 to 2.09) and total cancer mortality (HR: 1.68, 95% CI 1.47 to 1.93). Controlling for individual education and household income weakened the observed associations, but did not eliminate them (lung cancer HR: 1.43, 95% CI 1.07 to 1.91; colorectal cancer HR: 1.35, 95% CI 0.97 to 1.88; cancer mortality HR: 1.28, 95% CI 1.11 to 1.48).
Conclusions: Area-level socioeconomic disparities exist for several cancer outcomes. These differences are not fully explained by individual SES, suggesting area-level factors may play a role.