Divergent Trends in the Effects of Early Life Factors on Adult Health

Unequal but widespread despairs: Social inequalities and self-rated health trends in the United States in 1972-2018

SIGNIFICANCE

Past studies show rising mortality and morbidity among middle-aged white Americans since the 21st century. This research analyses trends in declining self-rated health (SRH) across demographic groups, focusing on shifts in SRH inequalities by gender, race, and socioeconomic status (SES). It sheds light on declining health trends in the United States and deepens our understanding of health inequalities and their dynamics in high-income countries.

METHOD

We analyse 29 waves of cross-sectional data from the General Social Survey (1972-2018, N = 46,133) using Bayesian Hierarchical Age-Period-Cohort Cross-Classified Random Effect models (BHAPC-CCRM) to estimate age, period, and cohort effects, and changes in health gaps over time as interactions between period and race, gender, or SES.

RESULTS

SRH improved until the 21st century but then declined across all gender, race, income, education, and employment groups after controlling for age and cohort effects. The racial health gap has continued since 2000, with a slight erosion of white health privilege. Nonwhite, low-income, non-college-educated, unemployed, and unmarried individuals have seen further declines in SRH. Baby Boomers' health advantage was wiped out after 2000.

INTERPRETATION

In line with the health reversal literature in the U.S. and the U.K., SRH has deteriorated in the 21st century for all racial, gender, and SES groups in the U.S. The diminishing SRH advantage for whites results from a faster decline compared to Blacks and other non-white groups. However, significant racial and SES disparities in SRH persist, with disadvantaged groups experiencing poorer SRH. We discuss the policy implications.

The Long Arm of Prospective Childhood Income for Mature Adult Health in the United States

Pioneering scholarship links retrospective childhood conditions to mature adult health. We distinctively provide critical evidence with prospective state-of-the-art measures of parent income observed multiple times during childhood in the 1970s to 1990s. Using the Panel Study of Income Dynamics, we analyze six health outcomes (self-rated health, heart attack, stroke, life-threatening chronic conditions, non-life-threatening chronic conditions, and psychological distress) among 40- to 65-year-olds. Parent relative income rank has statistically and substantively significant relationships with five of six outcomes. The relationships with heart attack, stroke, and life-threatening chronic conditions are particularly strong. Parent income rank performs slightly better than alternative prospective and retrospective measures. At the same time, we provide novel validation on which retrospective measures (i.e., father's education) perform almost as well as prospective measures. Furthermore, we inform several perennial debates about how relative versus absolute income and other measures of socioeconomic status and social class influence health.