Well being
Chirag Patel et al.
American Journal of Epidemiology, 1 February 2015, Pages 171-179
Abstract:
A fuller understanding of the social epidemiology of disease requires an extended description of the relationships between social factors and health indicators in a systematic manner. In the present study, we investigated the correlations between income and 330 indicators of physiological, biochemical, and environmental health in participants in the US National Health and Nutrition Examination Survey (NHANES) (1999–2006). We combined data from 3 survey waves (n = 249–23,649 for various indicators) to search for linear and nonlinear (quadratic) correlates of income, and we validated significant (P < 0.00015) correlations in an independent testing data set (n = 255–7,855). We validated 66 out of 330 factors, including infectious (e.g., hepatitis A), biochemical (e.g., carotenoids, high-density lipoprotein cholesterol), physiological (e.g., upper leg length), and environmental (e.g., lead, cotinine) measures. We found only a modest amount of association modification by age, race/ethnicity, and gender, and there was no association modification for blacks. The present study is descriptive, not causal. We have shown in our systematic investigation the crucial place income has in relation to health risk factors. Future research can use these correlations to better inform theory and studies of pathways to disease, as well as utilize these findings to understand when confounding by income is most likely to introduce bias.
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On the Beginning of Mortality Acceleration
Giambattista Salinari & Gustavo De Santis
Demography, forthcoming
Abstract:
Physiological senescence is characterized by the increasing limitation of capabilities of an organism resulting from the progressive accumulation of molecular damage, which at group (cohort) level translates into, among other things, an increase in mortality risks with age. Physiological senescence is generally thought to begin at birth, if not earlier, but models of demographic aging (i.e., an increase in mortality risks) normally start at considerably later ages. This apparent inconsistency can be solved by assuming the existence of two mortality regimes: “latent” and “manifest” aging. Up to a certain age, there is only latent aging: physiological senescence occurs, but its low level does not trigger any measurable increase in mortality. Past a certain level (and age), molecular damage is such that mortality risks start to increase. We first discuss why this transition from latent to manifest aging should exist at all, and then we turn to the empirical estimation of the corresponding threshold age by applying Bai’s approach to the estimation of breakpoints in time series. Our analysis, which covers several cohorts born between 1850 and 1938 in 14 of the countries included in the Human Mortality Database, indicates that an age at the onset of manifest aging can be identified. However, it has not remained constant: it has declined from about 43 and 47 years, respectively, for males and females at the beginning of the period (cohorts born in 1850–1869) to about 31 for both males and females toward its end (cohorts born in 1920–1938). A discussion of why this may have happened ensues.
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Rates of Psychiatrists’ Participation in Health Insurance Networks
Janet Cummings
Journal of the American Medical Association, 13 January 2015, Pages 190-191
Objective: To describe recent trends in acceptance of insurance by psychiatrists compared with physicians in other specialties.
Design, Setting, and Participants: We used data from a national survey of office-based physicians in the United States to calculate rates of acceptance of private noncapitated insurance, Medicare, and Medicaid by psychiatrists vs physicians in other specialties and to compare characteristics of psychiatrists who accepted insurance and those who did not.
Results: The percentage of psychiatrists who accepted private noncapitated insurance in 2009-2010 was significantly lower than the percentage of physicians in other specialties (55.3% [95% CI, 46.7%-63.8%] vs 88.7% [86.4%-90.7%]; P < .001) and had declined by 17.0% since 2005-2006. Similarly, the percentage of psychiatrists who accepted Medicare in 2009-2010 was significantly lower than that for other physicians (54.8% [95% CI, 46.6%-62.7%] vs 86.1% [84.4%-87.7%]; P < .001) and had declined by 19.5% since 2005-2006. Psychiatrists’ Medicaid acceptance rates in 2009-2010 were also lower than those for other physicians (43.1% [95% CI, 34.9%-51.7%] vs 73.0% [70.3%-75.5%]; P < .001) but had not declined significantly from 2005-2006. Psychiatrists in the Midwest were more likely to accept private noncapitated insurance (85.1%) than those in the Northeast (48.5%), South (43.0%), or West (57.8%) (P = .02).
Conclusions and Relevance: Acceptance rates for all types of insurance were significantly lower for psychiatrists than for physicians in other specialties. These low rates of acceptance may pose a barrier to access to mental health services.
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Gene-Environment Interaction in the Intergenerational Transmission of Health
Owen Thompson
University of Wisconsin Working Paper, January 2015
Abstract:
Researchers have found strong linkages between parent and child health, but the mechanisms underlying intergenerational health transmission are not well understood. Motivated by biomedical research that has increasingly focused on interactions between genetic and environmental health determinants, I investigate how the importance of genetic health transmission mechanisms vary by environmental conditions in the case of pediatric asthma, the single most common chronic health condition among American children. Using a sample of approximately 2,000 adoptees and a matched sample of biological families, I find that the relative importance of genetic transmission differs strongly by SES. Specifically, in high SES families, parent-child asthma associations are approximately 75% weaker among adoptees than biological children, suggesting a dominant role for genetic transmission. In contrast, among lower SES families, parent-child asthma associations are virtually identical across biological and adoptive children, suggesting a negligible role for genetic transmission. Potential explanations for these differences are discussed.
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Age at Menarche: 50-Year Socioeconomic Trends Among US-Born Black and White Women
Nancy Krieger et al.
American Journal of Public Health, February 2015, Pages 388-397
Objectives: We investigated 50-year US trends in age at menarche by socioeconomic position (SEP) and race/ethnicity because data are scant and contradictory.
Methods: We analyzed data by income and education for US-born non-Hispanic Black and White women aged 25 to 74 years in the National Health Examination Survey (NHES) I (1959–1962), National Health Examination and Nutrition Surveys (NHANES) I–III (1971–1994), and NHANES 1999–2008.
Results: In NHES I, average age at menarche among White women in the 20th (lowest) versus 80th (highest) income percentiles was 0.26 years higher (95% confidence interval [CI] = −0.09, 0.61), but by NHANES 2005–2008 it had reversed and was −0.33 years lower (95% CI = −0.54, −0.11); no socioeconomic gradients occurred among Black women. The proportion with onset at younger than 11 years increased only among women with low SEP, among Blacks and Whites (P for trend < .05), and high rates of change occurred solely among Black women (all SEP strata) and low-income White women who underwent menarche before 1960.
Conclusions: Trends in US age at menarche vary by SEP and race/ethnicity in ways that pose challenges to several leading clinical, public health, and social explanations for early age at menarche and that underscore why analyses must jointly include data on race/ethnicity and socioeconomic position. Future research is needed to explain these trends.
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The Per Case and Total Annual Costs of Foodborne Illness in the United States
Travis Minor et al.
Risk Analysis, forthcoming
Abstract:
We present an economic welfare-based method to estimate the health costs associated with foodborne illness caused by known viruses, bacteria, parasites, allergens, two marine biotoxins, and unspecified agents. The method generates health costs measured in both quality-adjusted life years and in dollars. We calculate the reduction in quality-adjusted life days caused by the illness and add reductions in quality-adjusted life years from any secondary effects that are estimated to occur. For fatal cases, we calculate the life years lost due to premature death. We add direct medical expenses to the monetary costs as derived from estimates of willingness to pay to reduce health risks. In total, we estimate that foodborne illness represents an annual burden to society of approximately $36 billion, with an average identified illness estimated to reduce quality-adjusted life days by 0.84, which is monetized and included in the average cost burden per illness of $3,630.
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Nutrition and Cognitive Achievement: An Evaluation of the School Breakfast Program
David Frisvold
Journal of Public Economics, forthcoming
Abstract:
This paper investigates the impact of the School Breakfast Program (SBP) on cognitive achievement. The SBP is a federal entitlement program that offers breakfast to any student, including free breakfast for any low-income student, who attends a school that participates in the program. To increase the availability of the SBP, many states mandate that schools participate in the program if the percent of free or reduced-price eligible students in a school exceeds a specific threshold. Using the details of these mandates as a source of identifying variation, I find that the availability of the program increases student achievement.
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Lunch, Recess and Nutrition: Responding to Time Incentives in the Cafeteria
Joseph Price & David Just
Preventive Medicine, February 2015
Objectives: In this study, we evaluate if moving recess before lunch has an effect on the amount of fruits and vegetables elementary school students eat as part of their school-provided lunch.
Methods: Participants were 1st-6th grade students from three schools that switched recess from after to before lunch and four similar schools that continued to hold recess after lunch. We collected data for an average of 14 days at each school (4 days during spring 2011, May 3 through June 1, 2011 and 9 days during fall 2011, occurred September 19 through November 11, 2011. All of the schools were in Orem, UT. Data was collected for all students receiving a school lunch and was based on observational plate waste data.
Results: We find that moving recess before lunch increased consumption of fruits and vegetables by 0.16 servings per child (a 54% increase) and increased the fraction of children eating at least one serving of fruits or vegetables by 10 percentage points (a 45% increase).
Conclusions: Our results show the benefits of holding recess before lunch and suggest that if more schools implement this policy, there would be significant increases in fruit and vegetable consumption among students who eat school lunch as part of the National School Lunch Program.
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Allergy Test: Seasonal Allergens and Performance in School
Dave Marcotte
Journal of Health Economics, forthcoming
Abstract:
Seasonal pollen allergies affect approximately 1 in 5 school age children. Clinical research has established that these allergies result in large and consistent decrements in cognitive functioning, problem solving ability and speed, focus and energy. However, compared to air pollution, the impact of pollen and seasonal allergies on achievement in schools has received less attention from economists. Here, I use data on daily pollen counts merged with school district data to assess whether variation in the airborne pollen that induces seasonal allergies is associated with performance on state reading and math assessments. I find substantial and robust effects: A one standard deviation in ambient pollen levels reduces the percent of 3rd graders passing ELA assessments by between 0.2 and 0.3 standard deviations, and math assessments by between about 0.3 and 0.4 standard deviations. I discuss the empirical limitations as well as policy implications of this reduced-form estimate of pollen levels in a community setting.
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Ruopeng An
Public Health, January 2015, Pages 29–36
Objectives: Obesity and smoking are two leading health risk factors and consume substantial health care resources. This study estimates and tracks annual per-capita health care expenses associated with obesity and smoking among U.S. adults aged 18 years and older from 1998 to 2011.
Methods: Individual-level data came from the National Health Interview Survey 1996–2010 waves and the Medical Expenditure Panel Survey 1998–2011 waves. Annual per-capita health care expenses associated with obesity and smoking were estimated in two-part models, accounting for individual characteristics and sampling design.
Results: Obesity and smoking were associated with an increase in annual per-capita total health care expenses (2011 US$) by $1360 (95% confidence interval: $1134-$1587) and $1046 ($846-$1247), out-of-pocket expenses by $143 ($110-$176) and $70 ($37-$104), hospital inpatient expenses by $406 ($283-$529) and $405 ($291-$519), hospital outpatient expenses by $164 ($119-$210) and $95 ($52-$138), office-based medical provider service expenses by $219 ($157-$280) and $117 ($62-$172), emergency room service expenses by $45 ($28-$63) and $57 ($44-$71), and prescription expenses by $439 ($382-$496) and $251 ($199-$302), respectively. From 1998 to 2011, the estimated per-capita expenses associated with obesity and smoking increased by 25% and 30% for total health care, 41% and 48% for office-based medical provider services, 59% and 66% for emergency room services, and 62% and 70% for prescriptions but decreased by 16% and 15% for out-of-pocket health care expenses, 3% and 0.3% for inpatient care, and 6% and 2% for outpatient care, respectively. Health care expenses associated with obesity and smoking were considerably larger among women, Non-Hispanic whites, and older adults compared with their male, racial/ethnic minority, and younger counterparts.
Conclusions: Health care costs associated with obesity and smoking are substantial and increased noticeably during 1998–2011. They also vary significantly across gender, race/ethnicity and age.
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Joseph Simonetti et al.
JAMA Psychiatry, forthcoming
Objectives: To estimate the prevalence of self-reported in-home firearm access among US adolescents, to quantify the lifetime prevalence of mental illness and suicidality (ie, suicidal ideation, planning, or attempt) among adolescents living with a firearm in the home, and to compare the prevalence of in-home firearm access between adolescents with and without specific mental health risk factors for suicide.
Design, Setting, and Participants: Cross-sectional analysis of data from the National Comorbidity Survey–Adolescent Supplement, a nationally representative survey of 10 123 US adolescents (age range, 13-18 years) who were interviewed between February 2001 and January 2004 (response rate 82.9%).
Results: One in three respondents (2778 [29.1%]) of the weighted survey sample reported living in a home with a firearm and responded to a question about firearm access; 1089 (40.9%) of those adolescents reported easy access to and the ability to shoot that firearm. Among adolescents with a firearm in home, those with access were significantly more likely to be older (15.6 vs 15.1 years), male (70.1% vs 50.9%), of non-Hispanic white race/ethnicity (86.6% vs 78.3%), and living in high-income households (40.0% vs 31.8%), and in rural areas (28.1% vs 22.6%) (P < .05 for all). Adolescents with firearm access also had a higher lifetime prevalence of alcohol abuse (10.1% vs 3.8%, P < .001) and drug abuse (11.4% vs 6.9%, P < .01) compared with those without firearm access. In multivariable analyses, adolescents with a history of mental illness without a history of suicidality (prevalence ratio [PR], 1.13; 95% CI, 0.98-1.29) and adolescents with a history of suicidality with or without a history of mental illness (PR, 1.20; 95% CI, 0.96-1.51) were as likely to report in-home firearm access as those without such histories.
Conclusions and Relevance: Adolescents with risk factors for suicide were just as likely to report in-home firearm access as those without such risk factors. Given that firearms are the second most common means of suicide among adolescents, further attention to developing and implementing evidence-based strategies to decrease firearm access in this age group is warranted.
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Sepideh Modrek, Rita Hamad & Mark Cullen
American Journal of Public Health, February 2015, Pages 304-310
Objectives: We examined the mental health effects of the Great Recession of 2008 to 2009 on workers who remained continuously employed and insured.
Methods: We examined utilization trends for mental health services and medications during 2007 to 2012 among a panel of workers in the 25 largest plants, located in 15 states, of a US manufacturing firm. We used piecewise regression to compare trends from 2007 to 2010 in service and medication use before and after 2009, the year of mass layoffs at the firm and the peak of the recession. Our models accounted for changes in county-level unemployment rates and individual-level fixed effects.
Results: Mental health inpatient and outpatient visits and the yearly supply of mental health–related medications increased among all workers after 2009. The magnitude of the increase in medication usage was higher for workers at plants with more layoffs.
Conclusions: The negative effects of the recession on mental health extend to employed individuals, a group considered at lower risk of psychological distress.
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Hongyu Wu et al.
JAMA Internal Medicine, forthcoming
Objective: To examine the association between dietary whole grain consumption and risk of mortality.
Design, Setting, and Participants: We investigated 74 341 women from the Nurses’ Health Study (1984–2010) and 43 744 men from the Health Professionals Follow-Up Study (1986–2010), 2 large prospective cohort studies. All patients were free of CVD and cancer at baseline.
Results: We documented 26 920 deaths during 2 727 006 person-years of follow-up. After multivariate adjustment for potential confounders, including age, smoking, body mass index, physical activity, and modified Alternate Healthy Eating Index score, higher whole grain intake was associated with lower total and CVD mortality but not cancer mortality: the pooled HRs for quintiles 1 through 5, respectively, of whole grain intake were 1 (reference), 0.99 (95% CI, 0.95-1.02), 0.98 (95% CI, 0.95-1.02), 0.97 (95% CI, 0.93-1.01), and 0.91 (95% CI, 0.88-0.95) for total mortality (P fortrend < .001); 1 (reference), 0.94 (95% CI, 0.88-1.01), 0.94 (95% CI, 0.87-1.01), 0.87 (95% CI, 0.80-0.94), and 0.85 (95% CI, 0.78-0.92) for CVD mortality (P fortrend < .001); and 1 (reference), 1.02 (95% CI, 0.96-1.08), 1.05 (95% CI, 0.99-1.12), 1.04 (95% CI, 0.98-1.11), and 0.97 (95% CI, 0.91-1.04) for cancer mortality (P fortrend = .43). We further estimated that every serving (28 g/d) of whole grain consumption was associated with a 5% (95% CI, 2%-7%) lower total morality or a 9% (95% CI, 4%-13%) lower CVD mortality, whereas the same intake level was nonsignificantly associated with lower cancer mortality (HR, 0.98; 95% CI, 0.94-1.02). Similar inverse associations were observed between bran intake and CVD mortality, with a pooled HR of 0.80 (95% CI, 0.73-0.87; P fortrend < .001), whereas germ intake was not associated with CVD mortality after adjustment for bran intake.
Conclusions and Relevance: These data indicate that higher whole grain consumption is associated with lower total and CVD mortality in US men and women, independent of other dietary and lifestyle factors. These results are in line with recommendations that promote increased whole grain consumption to facilitate disease prevention.
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A new antibiotic kills pathogens without detectable resistance
Losee Ling et al.
Nature, 22 January 2015, Pages 455–459
Abstract:
Antibiotic resistance is spreading faster than the introduction of new compounds into clinical practice, causing a public health crisis. Most antibiotics were produced by screening soil microorganisms, but this limited resource of cultivable bacteria was overmined by the 1960s. Synthetic approaches to produce antibiotics have been unable to replace this platform. Uncultured bacteria make up approximately 99% of all species in external environments, and are an untapped source of new antibiotics. We developed several methods to grow uncultured organisms by cultivation in situ or by using specific growth factors. Here we report a new antibiotic that we term teixobactin, discovered in a screen of uncultured bacteria. Teixobactin inhibits cell wall synthesis by binding to a highly conserved motif of lipid II (precursor of peptidoglycan) and lipid III (precursor of cell wall teichoic acid). We did not obtain any mutants of Staphylococcus aureus or Mycobacterium tuberculosis resistant to teixobactin. The properties of this compound suggest a path towards developing antibiotics that are likely to avoid development of resistance.
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Variation in cancer risk among tissues can be explained by the number of stem cell divisions
Cristian Tomasetti & Bert Vogelstein
Science, 2 January 2015, Pages 78-81
Abstract:
Some tissue types give rise to human cancers millions of times more often than other tissue types. Although this has been recognized for more than a century, it has never been explained. Here, we show that the lifetime risk of cancers of many different types is strongly correlated (0.81) with the total number of divisions of the normal self-renewing cells maintaining that tissue’s homeostasis. These results suggest that only a third of the variation in cancer risk among tissues is attributable to environmental factors or inherited predispositions. The majority is due to “bad luck,” that is, random mutations arising during DNA replication in normal, noncancerous stem cells. This is important not only for understanding the disease but also for designing strategies to limit the mortality it causes.