Looking out for your health

Kevin Lewis

February 07, 2017

Trends in premature mortality in the USA by sex, race, and ethnicity from 1999 to 2014: An analysis of death certificate data

Meredith Shiels et al.

Lancet, forthcoming

Methods: For this analysis, we used cause-of-death and demographic data from death certificates from the US National Center for Health Statistics, and population estimates from the US Census Bureau. We estimated annual percentage changes in mortality using age-period-cohort models. Age-standardised excess deaths were estimated for 2000 to 2014 as observed deaths minus expected deaths (estimated from 1999 mortality rates).

Findings: Between 1999 and 2014, premature mortality increased in white individuals and in American Indians and Alaska Natives. Increases were highest in women and those aged 25–30 years. Among 30-year-olds, annual mortality increases were 2.3% (95% CI 2.1–2.4) for white women, 0.6% (0.5–0.7) for white men, and 4.3% (3.5–5.0) and 1.9% (1.3–2.5), respectively, for American Indian and Alaska Native women and men. These increases were mainly attributable to accidental deaths (primarily drug poisonings), chronic liver disease and cirrhosis, and suicide. Among individuals aged 25–49 years, an estimated 111 000 excess premature deaths occurred in white individuals and 6600 in American Indians and Alaska Natives during 2000–14. By contrast, premature mortality decreased substantially across all age groups in Hispanic individuals (up to 3.2% per year), black individuals (up to 3.9% per year), and Asians and Pacific Islanders (up to 2.6% per year), mainly because of declines in HIV, cancer, and heart disease deaths, resulting in an estimated 112 000 fewer deaths in Hispanic individuals, 311 000 fewer deaths in black individuals, and 34 000 fewer deaths in Asians and Pacific Islanders aged 25–64 years. During 2011–14, American Indians and Alaska Natives had the highest premature mortality, followed by black individuals.

Interpretation: Important public health successes, including HIV treatment and smoking cessation, have contributed to declining premature mortality in Hispanic individuals, black individuals, and Asians and Pacific Islanders. However, this progress has largely been negated in young and middle-aged (25–49 years) white individuals, and American Indians and Alaska Natives, primarily because of potentially avoidable causes such as drug poisonings, suicide, and chronic liver disease and cirrhosis. The magnitude of annual mortality increases in the USA is extremely unusual in high-income countries, and a rapid public health response is needed to avert further premature deaths.


Mental retirement and health selection: Analyses from the U.S. Health and Retirement Study

Sean Clouston & Nicole Denier

Social Science & Medicine, forthcoming

Methods: We draw on data from the Health and Retirement Study (1998–2012) to examine the relationship between cognition and retirement for 18,575 labor force participants. Longitudinal regression discontinuity modeling was used to examine performance and decline in episodic memory. Models differentiated three forms of selection bias: indirect and direct selection as well as reverse causation. To further interrogate the disuse hypothesis, we adjust for confounding from health and socioeconomic sources.

Results: Results revealed that individuals who retired over the course of the panel were substantially different in terms of health, wealth and cognition when compared to those who remained employed. However, accounting for observed selection biases, significant associations were found linking longer retirement with more rapid cognitive decline.

Discussion: This study examined respondents who were in the labor force at baseline and transitioned into retirement. Analyses suggested that those who retired over the course of the panel had worse overall functioning, but also experienced more rapid declines after retirement that increased the rate of aging by two-fold, resulting in yearly losses of 3.7% (95% CI = [3.5, 4.0]) of one standard deviation in functioning attributable to retirement. Results are supportive of the view that retirement was associated with more rapid cognitive aging.


Health, Human Capital and Domestic Violence

Nicholas Papageorge et al.

NBER Working Paper, December 2016

We study the impact of health shocks on domestic violence and illicit drug use. We argue that health is a form of human capital that shifts incentives for risky behaviors, such as drug use, and also changes options outside of violent relationships. To estimate causal effects, we examine chronically ill women before and after a medical breakthrough and exploit differences in these women's health prior to the breakthrough. We show evidence that health improvements induced by the breakthrough reduced domestic violence and illicit drug use. Our findings provide support for the idea that health improvements can have far-reaching implications for costly social problems. The policy relevance of our findings is compounded by the fact that both domestic violence and illicit drug use are social problems often seen as frustratingly impervious to interventions. One possible reason is that the common factors that drive them, such underlying health or labor market human capital, are themselves very persistent over time. Our study provides a unique test of this hypothesis by examining what happens when factors underlying violence or drug use exogenously shift due to a medical technological advancement. Our findings suggest that both violence and drug use could be reduced by improving women's access to better healthcare.


Trends in Personal Belief Exemption Rates Among Alternative Private Schools: Waldorf, Montessori, and Holistic Kindergartens in California, 2000–2014

Julia Brennan et al.

American Journal of Public Health, January 2017, Pages 108-112

Methods: We used California Department of Public Health data on kindergarten PBE rates from 2000 to 2014 to compare annual average increases in PBE rates between schools.

Results. Alternative schools had an average PBE rate of 8.7%, compared with 2.1% among public schools. Waldorf schools had the highest average PBE rate of 45.1%, which was 19 times higher than in public schools (incidence rate ratio = 19.1; 95% confidence interval = 16.4, 22.2). Montessori and holistic schools had the highest average annual increases in PBE rates, slightly higher than Waldorf schools (Montessori: 8.8%; holistic: 7.1%; Waldorf: 3.6%).

Conclusions. Waldorf schools had exceptionally high average PBE rates, and Montessori and holistic schools had higher annual increases in PBE rates. Children in these schools may be at higher risk for spreading vaccine-preventable diseases if trends are not reversed.


Costs And Savings Associated With Community Water Fluoridation In The United States

Joan O’Connell et al.

Health Affairs, December 2016, Pages 2224-2232

The most comprehensive study of US community water fluoridation program benefits and costs was published in 2001. This study provides updated estimates using an economic model that includes recent data on program costs, dental caries increments, and dental treatments. In 2013 more than 211 million people had access to fluoridated water through community water systems serving 1,000 or more people. Savings associated with dental caries averted in 2013 as a result of fluoridation were estimated to be $32.19 per capita for this population. Based on 2013 estimated costs ($324 million), net savings (savings minus costs) from fluoridation systems were estimated to be $6,469 million and the estimated return on investment, 20.0. While communities should assess their specific costs for continuing or implementing a fluoridation program, these updated findings indicate that program savings are likely to exceed costs.


Time Use and the Labor Market: The Wage Returns to Sleep

Matthew Gibson & Jeffrey Shrader

University of California Working Paper, August 2016

We investigate the labor market effects of the single largest use of time — sleep. Motivated by a productive sleep model, we show that sleep is complementary to work in the short run and complementary to home production for non-employed individuals in both the short and long run. Using time use diaries from the United States, we demonstrate in both parametric and non-parametric frameworks that later sunset time reduces worker sleep and wages. After investigating these relationships and ruling out alternative hypotheses, we implement an instrumental variables specification that provides the first causal estimates of the impact of sleep on wages. A one-hour increase in location-average weekly sleep increases wages by 1.3% in the short run and by 5% in the long run.


Reduced Cardiovascular Disease Incidence With a National Lifestyle Change Program

Sandra Jackson et al.

American Journal of Preventive Medicine, forthcoming

Introduction: Lifestyle change programs implemented within healthcare systems could reach many Americans, but their impact on cardiovascular disease (CVD) remains unclear. The MOVE! program is the largest lifestyle change program implemented in a healthcare setting in the U.S. This study aimed to determine whether MOVE! participation was associated with reduced CVD incidence.

Methods: This retrospective cohort study, analyzed in 2013–2015, used national Veterans Health Administration databases to identify MOVE! participants and eligible non-participants for comparison (2005–2012). Patients eligible for MOVE! — obese or overweight with a weight-related health condition, and no baseline CVD — were examined (N=1,463,003). Of these, 169,248 (12%) were MOVE! participants. Patients were 92% male, 76% white, with mean age 52 years and BMI of 32. The main outcome was incidence of CVD (ICD-9 and procedure codes for coronary artery disease, cerebrovascular disease, peripheral vascular disease, and heart failure).

Results: Adjusting for age, race, sex, BMI, statin use, and baseline comorbidities, over a mean 4.9 years of follow-up, MOVE! participation was associated with lower incidence of total CVD (hazard ratio [HR]=0.83, 95% CI=0.80, 0.86); coronary artery disease (HR=0.81, 95% CI=0.77, 0.86); cerebrovascular disease (HR=0.87, 95% CI=0.82, 0.92); peripheral vascular disease (HR=0.89, 95% CI=0.83, 0.94); and heart failure (HR=0.78, 95% CI=0.74, 0.83). The association between MOVE! participation and CVD incidence remained significant when examined across categories of race/ethnicity, BMI, diabetes, hypertension, smoking status, and statin use.

Conclusions: Although participation was limited, MOVE! was associated with reduced CVD incidence in a nationwide healthcare setting.


The Association of Hot Red Chili Pepper Consumption and Mortality: A Large Population-Based Cohort Study

Mustafa Chopan & Benjamin Littenberg

PLoS ONE, January 2017

The evidence base for the health effects of spice consumption is insufficient, with only one large population-based study and no reports from Europe or North America. Our objective was to analyze the association between consumption of hot red chili peppers and mortality, using a population-based prospective cohort from the National Health and Nutritional Examination Survey (NHANES) III, a representative sample of US noninstitutionalized adults, in which participants were surveyed from 1988 to 1994. The frequency of hot red chili pepper consumption was measured in 16,179 participants at least 18 years of age. Total and cause-specific mortality were the main outcome measures. During 273,877 person-years of follow-up (median 18.9 years), a total of 4,946 deaths were observed. Total mortality for participants who consumed hot red chili peppers was 21.6% compared to 33.6% for those who did not (absolute risk reduction of 12%; relative risk of 0.64). Adjusted for demographic, lifestyle, and clinical characteristics, the hazard ratio was 0.87 (P = 0.01; 95% Confidence Interval 0.77, 0.97). Consumption of hot red chili peppers was associated with a 13% reduction in the instantaneous hazard of death. Similar, but statistically nonsignificant trends were seen for deaths from vascular disease, but not from other causes. In this large population-based prospective study, the consumption of hot red chili pepper was associated with reduced mortality. Hot red chili peppers may be a beneficial component of the diet.


Prenatal exposure to famine and the development of hyperglycemia and type 2 diabetes in adulthood across consecutive generations: A population-based cohort study of families in Suihua, China

Jie Li et al.

American Journal of Clinical Nutrition, January 2017, Pages 221-227

Design: A total of 1034 families, including 2068 parents [parental generation (F1)] and 1183 offspring [offspring generation (F2)], were recruited from the Suihua rural area that was affected by the Chinese Famine of 1959–1961. Participants born between 1 October 1959 and 30 September 1961 were defined as famine exposed, and those born between 1 October 1962 and 30 September 1964 were defined as nonexposed. The F2 were classified as having 1) no parent exposed to famine, 2) only a mother exposed to famine, 3) only a father exposed to famine, or 4) both parents exposed to famine. Classical risk factors for T2D as well as fasting-glucose- and oral-glucose-tolerance tests were measured in both the F1 and F2.

Results: Prenatal exposure to famine was associated with elevated risks of hyperglycemia (multivariable-adjusted OR: 1.93; 95% CI: 1.51, 2.48) and T2D (OR: 1.75; 95% CI: 1.20, 2.54) in adulthood in F1. Furthermore, compared with the offspring of nonexposed parents, the F2 with exposed parents — especially both exposed parents — had increased hyperglycemia risk (OR: 2.02; 95% CI: 1.12, 3.66) in adulthood.

Conclusion: Prenatal exposure to famine remarkably increases hyperglycemia risk in 2 consecutive generations of Chinese adults independent of known T2D risk factors, which supports the notion that prenatal nutrition plays an important role in the development of T2D across consecutive generations of Chinese adults.


Wireless Alerts for Extreme Weather and the Impact on Hazard Mitigating Behavior

Jeffrey Ferris & David Newburn

Journal of Environmental Economics and Management, March 2017, Pages 239–255

Wireless alerts delivered through mobile phones are a recent innovation in regulatory efforts toward preparation for extreme weather events including flash floods. In this article, we use difference-in-differences models of the number of car accidents from days with government issued alerts for flash flood events in Virginia. We find that wireless alert messages for flash flood warnings reduced car accidents by 15.9% relative to the counterfactual with non-wireless alert protocols. We also use a regression discontinuity model to analyze hourly traffic volume data immediately before and after a flash flood warning message is issued. We find that traffic volume is reduced by 3.1% immediately following the issuance of a wireless alert relative to before the alert. These results imply that wireless alert messages effectively reduce exposure to hazards associated with extreme weather.


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