Pathological
The Growing Gap in Life Expectancy: Using the Future Elderly Model to Estimate Implications for Social Security and Medicare
Dana Goldman & Peter Orszag
American Economic Review, May 2014, Pages 230-233
Abstract:
Mortality gradients by education and income have been rising in the United States and elsewhere. However, their impact on Social Security progressivity has received relatively little attention, and the impact on Medicare has received effectively none. This paper uses the Future Elderly Model to estimate the effects of increased mortality gaps on the progressivity of Social Security and Medicare for those born between 1928 and 1990. It finds significant reductions in progressivity of both programs if current mortality trends persist and noticeable effects on total program costs. The effects are large enough to warrant more attention from both policy-makers and researchers.
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Childhood Social Disadvantage, Cardiometabolic Risk, and Chronic Disease in Adulthood
Amy Non et al.
American Journal of Epidemiology, forthcoming
Abstract:
Adverse social environments in early life are hypothesized to become biologically embedded during the first few years of life, with potentially far-reaching implications for health across the life course. Using prospective data from a subset of a US birth cohort, the Collaborative Perinatal Project, started in 1959–1966 (n = 566), we examined associations of social disadvantage assessed in childhood with cardiometabolic function and chronic disease status more than 40 years later (in 2005–2007). Social disadvantage was measured with an index that combined information on adverse socioeconomic and family stability factors experienced between birth and age 7 years. Cardiometabolic risk (CMR) was assessed by combining information from 8 CMR biomarkers; an index of chronic disease status was derived by assessing 8 chronic diseases. Poisson models were used to investigate associations between social disadvantage and CMR or chronic disease scores while adjusting for childhood covariates and potential pathway variables. A high level of social disadvantage was significantly associated with both higher CMR (incident rate ratio = 1.69, 95% confidence interval: 1.19, 2.39) and with a higher number of chronic diseases (incident rate ratio = 1.39, 95% confidence interval: 1.00, 1.92) in minimally adjusted models. Associations with CMR persisted even after accounting for childhood and adult covariates.
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Early-Life Socioeconomic Status and Mortality at Three Life Course Stages: An Increasing Within-Cohort Inequality
Tetyana Pudrovska
Journal of Health and Social Behavior, June 2014, Pages 181-195
Abstract:
Using the 1957–2011 data from 10,317 participants in the Wisconsin Longitudinal Study, I examine how socioeconomic status (SES) at age 18 affects all-cause mortality between ages 18 and 72. Integrating fundamental cause theory, gender relations theory, and a life course perspective, I evaluate the cumulative advantage (CA) and age-as-leveler processes as well as gender differences in these processes. Findings indicate that higher early-life SES at age 18 is related to lower mortality over the life course, and the effect of early-life SES is not explained by socioeconomic achievement and health behaviors in adulthood. Consistent with the CA model, early-life SES generates increasing within-cohort inequality with age, and this CA process is stronger for women than men. Results also show that unequal selection by SES obscures the CA process and creates an illusion of the age-as-leveler process. This study calls for a lifelong gendered approach to socioeconomic health disparities.
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The Effects of the Great Recession on Teenagers' Risky Health Behaviors and Time Use
Sabrina Wulff Pabilonia
U.S. Bureau of Labor Statistics Working Paper, May 2014
Abstract:
This paper uses individual-level data from both the 2003-2011 American Time Use Survey and Youth Risk Behavior Survey and state-level unemployment rates to examine the effects of the Great Recession on teenagers' activities. I present results by gender and gender by race/ethnicity. Over the period, I find changes in sexual activity for males associated with changes in time spent with parents; but results vary significantly by race. In addition, Hispanic males gained weight during the recession, due perhaps to a decrease in time spent playing sports. Hispanic females, on the other hand, made greater educational investments while spending less time working. All females significantly decreased TV viewing during the Great Recession. However, there were signs that female teenagers were stressed as they slept less and were more likely to smoke regularly.
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Hurricane Katrina: Behavioral Health and Health Insurance in Non-Impacted Vulnerable Counties
Michael Pesko
Cornell Working Paper, May 2014
Abstract:
I find causal evidence that Hurricane Katrina increased stress, smoking, binge drinking, and health insurance coverage in the non-impacted storm surge region. In this region, Hurricane Katrina increased health insurance coverage by 440,000 young adults, the number of smokers by 930,000, and the number of binge drinkers by 510,000. Results are robust to varying the location and time of Hurricane Katrina, varying the pre-Hurricane Katrina time window, and excluding counties within 400 miles of New Orleans. Findings suggest that disasters are integral to the formation of risk perceptions and affect the demand for behavioral health and health insurance.
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Cumulative Childhood Adversity, Educational Attainment, and Active Life Expectancy Among U.S. Adults
Jennifer Karas Montez & Mark Hayward
Demography, April 2014, Pages 413-435
Abstract:
Studies of the early-life origins of adult physical functioning and mortality have found that childhood health and socioeconomic context are important predictors, often irrespective of adult experiences. However, these studies have generally assessed functioning and mortality as distinct processes and used cross-sectional prevalence estimates that neglect the interplay of disability incidence, recovery, and mortality. Here, we examine whether early-life disadvantages both shorten lives and increase the number and fraction of years lived with functional impairment. We also examine the degree to which educational attainment mediates and moderates the health consequences of early-life disadvantages. Using the 1998–2008 Health and Retirement Study, we examine these questions for non-Hispanic whites and blacks aged 50–100 years using multistate life tables. Within levels of educational attainment, adults from disadvantaged childhoods lived fewer total and active years, and spent a greater portion of life impaired compared with adults from advantaged childhoods. Higher levels of education did not ameliorate the health consequences of disadvantaged childhoods. However, because education had a larger impact on health than did childhood socioeconomic context, adults from disadvantaged childhoods who achieved high education levels often had total and active life expectancies that were similar to or better than those of adults from advantaged childhoods who achieved low education levels.
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Can Education Rescue Genetic Liability for Cognitive Decline?
Justin Cook & Jason Fletcher
Social Science & Medicine, forthcoming
Abstract:
Although there is a vast literature linking education and later health outcomes, the mechanisms underlying these associations are relatively unknown. In the spirit of some medical literature that leverages developmental abnormalities to understand mechanisms of normative functioning, we explore the ability of higher educational attainments to “rescue” biological/genetic liabilities in brain function through inheritance of a variant of the APOE gene shown to lead to cognitive decline, dementia, and Alzheimer’s disease in old age. Deploying a between-sibling design that allows quasi-experimental variation in genotype and educational attainment within a standard gene-environment interaction framework, we show evidence that the genetic effects of the “risky” APOE variant on old-age cognitive decline are absent in individuals who complete college (vs. high school graduates). Auxiliary analyses suggest that the likely mechanisms of education are most consistent through changing brain processes (i.e. “how we think”) and potentially building cognitive reserves, rather than alleviating old age cognitive decline through the channels of higher socioeconomic status and resources over the life course.
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Individual Joblessness, Contextual Unemployment, and Mortality Risk
José Tapia Granados et al.
American Journal of Epidemiology, forthcoming
Abstract:
Longitudinal studies at the level of individuals find that employees who lose their jobs are at increased risk of death. However, analyses of aggregate data find that as unemployment rates increase during recessions, population mortality actually declines. We addressed this paradox by using data from the US Department of Labor and annual survey data (1979–1997) from a nationally representative longitudinal study of individuals — the Panel Study of Income Dynamics. Using proportional hazards (Cox) regression, we analyzed how the hazard of death depended on 1) individual joblessness and 2) state unemployment rates, as indicators of contextual economic conditions. We found that 1) compared with the employed, for the unemployed the hazard of death was increased by an amount equivalent to 10 extra years of age, and 2) each percentage-point increase in the state unemployment rate reduced the mortality hazard in all individuals by an amount equivalent to a reduction of 1 year of age. Our results provide evidence that 1) joblessness strongly and significantly raises the risk of death among those suffering it, and 2) periods of higher unemployment rates, that is, recessions, are associated with a moderate but significant reduction in the risk of death among the entire population.
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What the future held: Childhood psychosocial adversity is associated with health deterioration through adulthood in a cohort of British women
Daniel Nettle
Evolution and Human Behavior, forthcoming
Abstract:
Childhood psychosocial adversity is associated with accelerated onset of reproductive effort in women. Adaptive explanations for this phenomenon are built on the assumption that greater childhood psychosocial adversity is statistically associated with having a shorter period of healthy adult life during which reproduction will be possible. However, this critical assumption is never actually tested using individual-level longitudinal data. In this study, I revisit a large, longitudinally-studied cohort of British women. In an earlier paper, we showed that a simple index of psychosocial adversity in the first seven years of life predicted age at first pregnancy in a dose-dependent manner. Here, I show that the same index of adversity also predicts accelerated deterioration of health across the potentially reproductive period, and increased levels of the inflammatory biomarker c-reactive protein at age 44-46. These associations are robust to controlling for adult socioeconomic position, and do not appear to be solely a consequence of accelerated reproductive schedule. I argue that childhood psychosocial adversity may cause latent somatic damage that will, in adulthood, accelerate age-related physical decline. This provides a compelling adaptive rationale for the accelerated reproductive schedules observed in women who experience childhood psychosocial adversity.
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The Welfare Value of FDA's Mercury-in-Fish Advisory: Dynamic Reanalysis
Christoph Rheinberger & James Hammitt
Journal of Health Economics, September 2014, Pages 113–122
Abstract:
Assessing the welfare impact of consumer health advisories is a thorny task. Recently, Shimshack and Ward (2010) studied how U.S. households responded to FDA's 2001 mercury-in-fish advisory. They found that the average at-risk household reduced fish consumption by 21%, resulting in a 17%-reduction in mercury exposure at the cost of a 21%-reduction in cardioprotective omega-3 fatty acids. Based on a static assessment of the health costs and benefits Shimshack and Ward concluded that the advisory policy resulted in an overall consumer welfare loss. In this note, we propose a dynamic assessment that links the long-term cardiovascular health effects of the advisory to life-cycle consumption. We find that under reasonable assumptions the welfare loss might be much larger than suggested. Our analysis highlights the importance of accounting for dynamic effects when evaluating persistent changes in exposure to environmental health risks.
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Voting for stem cells: How local conditions tempered moral opposition to Proposition 71
Nick Dragojlovic
Science and Public Policy, June 2014, Pages 359-369
Abstract:
A major theme in the debate on Proposition 71, the 2004 California ballot initiative in which voters approved US$3 billion in state funding for stem cell research, was the tension between values-based opposition to the use of embryos in medical research and a focus on the potential health benefits of stem cell therapies. Using a dataset that combines individual-level voting intention data from three Field Poll pre-election surveys and county-level data, the present study finds that moral opposition to Proposition 71 decreased as the local prevalence of chronic diseases and the proportion of elderly residents in respondents’ counties increased. The paper argues that this finding reflects an increase in the salience of the possible benefits of stem cell research that was driven by local conditions, and concludes with a discussion of the implications of this dynamic for the democratic governance of regenerative medicine in the context of an aging society.
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Effects of early-life exposure to allergens and bacteria on recurrent wheeze and atopy in urban children
Susan Lynch et al.
Journal of Allergy and Clinical Immunology, forthcoming
Objective: We sought to examine environmental factors associated with recurrent wheezing in inner-city environments.
Methods: The Urban Environment and Childhood Asthma study examined a birth cohort at high risk for asthma (n = 560) in Baltimore, Boston, New York, and St Louis. Environmental assessments included allergen exposure and, in a nested case-control study of 104 children, the bacterial content of house dust collected in the first year of life. Associations were determined among environmental factors, aeroallergen sensitization, and recurrent wheezing at age 3 years.
Results: Cumulative allergen exposure over the first 3 years was associated with allergic sensitization, and sensitization at age 3 years was related to recurrent wheeze. In contrast, first-year exposure to cockroach, mouse, and cat allergens was negatively associated with recurrent wheeze (odds ratio, 0.60, 0.65, and 0.75, respectively; P ≤ .01). Differences in house dust bacterial content in the first year, especially reduced exposure to specific Firmicutes and Bacteriodetes, was associated with atopy and atopic wheeze. Exposure to high levels of both allergens and this subset of bacteria in the first year of life was most common among children without atopy or wheeze.
Conclusions: In inner-city environments children with the highest exposure to specific allergens and bacteria during their first year were least likely to have recurrent wheeze and allergic sensitization. These findings suggest that concomitant exposure to high levels of certain allergens and bacteria in early life might be beneficial and suggest new preventive strategies for wheezing and allergic diseases.
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Public Bicycle Share Programs and Head Injuries
Janessa Graves et al.
American Journal of Public Health, August 2014, Pages e106-e111
Objectives: We evaluated the effect of North American public bicycle share programs (PBSPs), which typically do not offer helmets with rentals, on the occurrence of bicycle-related head injuries.
Methods: We analyzed trauma center data for bicycle-related injuries from 5 cities with PBSPs and 5 comparison cities. We used logistic regression models to compare the odds that admission for a bicycle-related injury would involve a head injury 24 months before PBSP implementation and 12 months afterward.
Results: In PBSP cities, the proportion of head injuries among bicycle-related injuries increased from 42.3% before PBSP implementation to 50.1% after (P < .01). This proportion in comparison cities remained similar before (38.2%) and after (35.9%) implementation (P = .23). Odds ratios for head injury were 1.30 (95% confidence interval = 1.13, 1.67) in PBSP cities and 0.94 (95% confidence interval = 0.79, 1.11) in control cities (adjusted for age and city) when we compared the period after implementation to the period before.
Conclusions: Results suggest that steps should be taken to make helmets available with PBSPs. Helmet availability should be incorporated into PBSP planning and funding, not considered an afterthought following implementation.
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Does More Education Lead to Better Health Habits? Evidence from the School Reforms in Australia
Jinhu Li & Nattavudh Powdthavee
Social Science & Medicine, forthcoming
Abstract:
The current study provides new empirical evidence on the causal effect of education on health-related behaviors by exploiting historical changes in the compulsory schooling laws in Australia. Since World War II, Australian states increased the minimum school leaving age from 14 to 15 in different years. Using differences in the laws regarding minimum school leaving age across different cohorts and across different states as a source of exogenous variation in education, we show that more education improves people’s diets and their tendency to engage in more regular exercise and drinking moderately, but not necessarily their tendency to avoid smoking and to engage in more preventive health checks. The improvements in health behaviors are also reflected in the estimated positive effect of education on some health outcomes. Our results are robust to alternative measures of education and different estimation methods.
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The impact of changes in county public health expenditures on general health in the population
Timothy Brown, Maria Martinez-Gutierrez & Bahar Navab
Health Economics, Policy and Law, July 2014, Pages 251-269
Abstract:
We estimate the effect of changes in the per capita expenditures of county departments of public health on county-level general health status. Using panel data on 40 counties in California (2001–2009), dynamic panel estimation techniques are combined with the Lewbel instrumental variable technique to estimate an aggregate demand for health function that measures the causal cumulative impact that per capita public health expenditures have on county-level general health status. We find that a $10 long-term increase in per capita public health expenditures would increase the percentage of the population reporting good, very good or excellent health by 0.065 percentage points. Each year expenditures were increased would result in ∼24,000 individuals moving from the ‘poor or fair health’ category to the ‘good, very good or excellent health’ category across these 40 counties. In terms of the overall impact of county public health departments on general health status, at current funding levels, each annual expenditure cycle results in over 207,000 individuals being in the ‘good, very good or excellent’ categories of health status rather than the ‘poor or fair’ categories.
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The Impact of Family Planning Funding Cuts on Preventive Care
Yao Lu & David Jason Gershkoff Slusky
Princeton Working Paper, May 2014
Abstract:
Many women rely on family planning and women’s health organizations as their only recent source of care, including preventive care. Recently, several states have cut public funding for women’s health organizations that are associated with abortion services. This paper is the first to quantify the impact of these funding cuts and resulting clinic closures on the incidence of preventive care, focusing on Texas and Wisconsin during the 2007-2012 period. Using quarterly data on health center street addresses from a national network of women’s health centers and confidential respondent ZIP codes from the Behavioral Risk Factor Surveillance System (BRFSS), we calculate changes in distance to the nearest clinic over time. From a within-ZIP-code analysis, we conclude that an increase of 100 miles to the nearest clinic would result in a decrease in the annual utilization rate of a clinical breast exam by 6 percentage points (pp), a mammogram by 2 pp, and a Pap test by 9 pp. These estimates are generally larger for low-education women: 14 pp, 6 pp, and 8 pp respectively. Future analysis will incorporate 2014 survey data to cover a more recent round of cuts.
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Medical Dramas and Viewer Perception of Health: Testing Cultivation Effects
Jae Eun Chung
Human Communication Research, July 2014, Pages 333–349
Abstract:
By using a national representative sample (N = 11,555), the current study tested cultivation theory and aimed at understanding the relationship between medical drama watching and viewer perception and beliefs related to health. Findings suggest that heavy viewers of medical dramas tend to underestimate the gravity of chronic illnesses such as cancer and cardiovascular disease and undermine the importance of tackling these issues. Heavier viewers of medical dramas, compared to lighter viewers, also tend to take a more fatalistic perspective about cancer. Theoretical implications for cultivation theory and practical implications for health policy makers and drama producers are discussed.
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Impact of Texting Laws on Motor Vehicular Fatalities in the United States
Alva Ferdinand et al.
American Journal of Public Health, August 2014, Pages 1370-1377
Abstract:
Using a panel study design, we examined the effects of different types of texting bans on motor vehicular fatalities. We used the Fatality Analysis Reporting System and a difference-in-differences approach to examine the incidence of fatal crashes in 2000 through 2010 in 48 US states with and without texting bans. Age cohorts were constructed to examine the impact of these bans on age-specific traffic fatalities. Primarily enforced laws banning all drivers from texting were significantly associated with a 3% reduction in traffic fatalities in all age groups, and those banning only young drivers from texting had the greatest impact on reducing deaths among those aged 15 to 21 years. Secondarily enforced restrictions were not associated with traffic fatality reductions in any of our analyses.
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Association Between Cardiorespiratory Fitness and Accelerometer-Derived Physical Activity and Sedentary Time in the General Population
Jacquelyn Kulinski et al.
Mayo Clinic Proceedings, forthcoming
Objective: To determine the association between cardiorespiratory fitness and sedentary behavior, independent of exercise activity.
Patients and Methods: We included 2223 participants (aged 12-49 years; 1053 females [47%]) without known heart disease who had both cardiovascular fitness testing and at least 1 day of accelerometer data from the National Health and Nutrition Examination Survey 2003-2004. From accelerometer data, we quantified bouts of exercise as mean minutes per day for each participant. Sedentary time was defined as less than 100 counts per minute in mean minutes per day. Cardiorespiratory fitness was derived from a submaximal exercise treadmill test. Multivariable-adjusted linear regression analyses were performed with fitness as the dependent variable. Models were stratified by sex, adjusted for age, body mass index, and wear time, and included sedentary and exercise time.
Results: An additional hour of daily exercise activity time was associated with a 0.88 (0.37-1.39; P<.001) metabolic equivalent of task (MET) higher fitness for men and a 1.37 (0.43-2.31; P=.004) MET higher fitness for women. An additional hour of sedentary time was associated with a −0.12 (−0.02 to −0.22; P=.03) and a −0.24 (−0.10 to −0.38; P<.001) MET difference in fitness for men and women, respectively.
Conclusion: After adjustment for exercise activity, sedentary behavior appears to have an inverse association with fitness. These findings suggest that the risk related to sedentary behavior might be mediated, in part, through lower fitness levels.