The significance of education for mortality compression in the United States

The Role of Estrogen in Brain MicroRNAs Regulation

Purpose

This review aims to elucidate the role of estrogen-sensitive microRNAs (miRNAs) in modulating brain functions and disorders, highlighting the protective effects of estrogen on the central nervous system.

Methods

A comprehensive literature review was conducted, examining the relationship between estrogen, miRNAs, and cognitive health. The study focused on experimental data comparing cognitive impairments between genders and the mechanisms of estrogen's effects on brain function.

Results

Cognitive impairments are less prevalent in women of reproductive age compared to men, indicating estrogen's neuroprotective role. Estrogen modulates gene expression through specific receptors, while miRNAs regulate approximately 30% of protein-coding genes in mammals. These miRNAs play critical roles in synaptic plasticity and neuronal survival. The review identifies several estrogen-sensitive miRNAs and their potential involvement in brain disorders.

Conclusion

The interplay between estrogen and miRNAs offers valuable insights into the molecular mechanisms underlying cognitive health and disease. Understanding these relationships may lead to novel therapeutic strategies for addressing various brain disorders, particularly those associated with hormonal changes and aging.

Trends in socioeconomic inequalities in life expectancy and lifespan variation in Chile

Background

Socioeconomic disparities in life expectancy are well-documented in various contexts, including Chile. However, there is a lack of research examining trends in life expectancy inequalities and lifespan variation over time. Addressing these gaps can provide crucial insights into the dynamics of health inequalities.

Methods

This study utilizes data from census records, population surveys, and death certificates to compare the life expectancy and the lifespan variation at age 26 of individuals according to their rank in the distribution of years of education within their own birth cohort. The analysis spans three periods (1991, 2002, and 2017) and focuses on two educational groups: individuals in the first (lowest) quintile and tenth (highest) decile of educational attainment. Changes in life expectancy are disaggregated by major causes of death to elucidate their contributions to overall trends.

Results

Consistent with existing literature, our findings confirm that individuals with lower education levels experience lower life expectancy and higher lifespan variation compared to their more educated counterparts. Notably, by 2017, life expectancy for individuals in the lowest quintile of education has caught up with that of the top decile in 1991, albeit with contrasting trends between genders. Among women, the gap has reduced, while it has increased for males. Moreover, lifespan variation decreased (increased) over time for individuals in the tenth decile (first quintile). The leading causes of death that explain the increase in life expectancy in women and men in the tenth decile as well as women in the first quintile are cardiovascular, cancer, respiratory and digestive diseases. In the case of males in the first quintile, few gains have been made in life expectancy resulting from cancer and a negative contribution is associated with digestive conditions.

Conclusions

This study underscores persistent socioeconomic disparities in life expectancy in Chile, emphasizing the importance of ongoing monitoring of health inequalities across different demographic segments. The gender-specific and educational gradient trends highlight areas for targeted interventions aimed at reducing health disparities and improving overall population health outcomes. Further research is warranted to delve into specific causes of death driving life expectancy differentials and to inform evidence-based policy interventions.

Does it add up? Educational achievement mediates child maltreatment subtypes to allostatic load

BACKGROUND

Childhood maltreatment (CM) has been linked to higher levels of allostatic load (AL) and educational achievement is a possible pathway and may differ across gender. It is also critical to determine if CM severity or specific subtypes of CM are more or less influential.

OBJECTIVE

This study examined educational achievement as a mediator linking cumulative and individual types of CM to AL and examined gender as a moderator.

PARTICIPANTS AND SETTING

Using two waves of data, 897 adults from the study Midlife in the United States were analyzed.

METHODS

Multiple group structural equation models stratified across gender to test were used cumulative maltreatment and maltreatment subtypes to AL and test gender as a moderator.

RESULTS

Overall CM was associated with educational achievement (β = -0.12, p < .01) and AL (β = 0.11, p < .05) and education was inversely associated with AL (β = -0.17, p < .001) in men but not women. The subtypes model revealed that physical abuse predicted lower level of education achievement (β = -0.20, p < .001) and among men. Educational achievement, in turn, was associated with lower levels of AL (β = -0.02, p = .002). Educational achievement was a possible pathway linking physical abuse to AL (β = 0.02, 95 % CI [0.001, 0.040]) among men but was non-significant in women. Gender did not moderate any of the pathways.

CONCLUSIONS

Educational achievement is a potentially modifiable social determinant of health that can be a focus of prevention and intervention efforts among men who were maltreated, particularly for those who experienced physical abuse.

The importance of education for understanding variability of dementia onset in the United States

BACKGROUND

Greater levels of education are associated with lower risk of dementia, but less is known about how education is also associated with the compression of dementia incidence.

OBJECTIVE

We extend the literature on morbidity compression by evaluating whether increased levels of education are associated with greater dementia compression. We evaluate these patterns across race and gender groups.

METHODS

We use the Health and Retirement Study (2000-2016), a nationally representative longitudinal study of older adults in the United States. To evaluate the onset and compression of dementia across education groups, we examine the age-specific distribution of dementia events, identifying the modal age of onset and the standard deviation above the mode (a measure of compression).

RESULTS

While the modal age of onset is around 85 years among adults with a college degree, the modal age for adults with less than a high school education occurs before age 65 - at least a 20-year difference. The standard deviation of dementia onset is about three times greater for adults with less than a high school education compared to adults with a college degree. Patterns were consistent across race and gender groups.

CONCLUSION

This research highlights the variability of dementia experiences in the older population by documenting differences in longevity without dementia and compression of dementia onset among more educated adults and less educated adults.

CONTRIBUTION

We incorporate conceptual insights from the life span variability and compression literature to better understand education-dementia disparities in both the postponement and uncertainty of dementia onset in the US population.

Trends in social inequality in mortality in Denmark 1995-2019: the contribution of smoking- and alcohol-related deaths

BACKGROUND

During the past decades, social inequality in mortality has increased in several countries, including Denmark. Modifiable risk factors, such as smoking and harmful alcohol consumption, have been suggested to moderate the association between socioeconomic position and health-related outcomes. The present study aims to investigate the contribution of smoking- and alcohol-related deaths to the trends in educational inequality in mortality in Denmark 1995-2019 among individuals aged 30-74 years.

METHODS

Nationwide data on mortality and highest attained educational level divided into quartiles were derived from administrative registers. Alcohol-related mortality was directly estimated using information on alcohol-related deaths from death certificates. Smoking-related mortality was indirectly estimated using the Peto-Lopez method. The contribution of smoking- and alcohol-related deaths to the social inequality gap in mortality 1995-2019 was calculated.

RESULTS

Alongside a decrease in all-cause mortality in Denmark 1995-2019, absolute differences in the mortality rate (per 100 000 person-year) between the lowest and the highest educational quartile increased from 494 to 607 among men and from 268 to 376 among women. Among both men and women, smoking- and alcohol-related deaths explained around 60% of the social inequality in mortality and around 50% of the increase in mortality inequality.

CONCLUSION

Smoking and harmful alcohol consumption continue to be important risk factors and causes of social inequality in mortality, with around half of the increase in Denmark 1995-2019 being attributable to smoking- and alcohol-related deaths. Future healthcare planning and policy development should aim at reducing social inequality in modifiable health risk behaviours and their negative consequences.

Race, gender, and cohort differences in the educational experiences of Black and White Americans

Federal legislation and judicial intervention led to significant transformation in the U.S. education system during the early to mid-20th century. These changes may differentiate older adults in their experiences of aging, particularly at the intersection of race, gender, and cohort, but are not well documented among current cohorts of older adults. Our study addresses this gap by providing rich, descriptive information on the educational experiences of U.S. adults who attended primary or secondary school between 1915 and 1977. We used data from the Health and Retirement Study (HRS), a nationally representative, prospective study of U.S. adults over age 50 years. The HRS collected information on respondents' schooling history and experiences through a Life History Mail Survey (LHMS). We restricted our sample to age-eligible HRS-LHMS respondents who self-identified as non-Hispanic White or non-Hispanic Black and completed at least 75% of their primary or secondary schooling in the U.S. (n=10,632). Educational experiences, defined as pre-k to post-secondary education, varied across cohort, regardless of race or gender. Greater course offerings, improvements in learning support, and increasing exposure to integrated schools occurred across successive cohorts. We found the highest rates of enrollment in college preparatory curriculum and foreign-language courses as well as diagnosed learning differences in cohorts born after 1948. Among White adults, many of the gender differences in educational experiences documented in the oldest cohort were still found among the most recent cohort. Few gender differences, however, were found for Black adults regardless of cohort. Conversely, most race inequities in educational experiences persisted. Such inequities may be an important source of continued differences in experiences of aging observed across demographic groups.

[Association between schooling and mortality rate from dengue in Brazil]

Dengue may be associated with individual level variables, such as schooling, increasing the risk of illness. The objective of this study is to analyze the disparities in dengue mortality among the least and the most educated in Brazil, from 2010 to 2018. This is a retrospective ecological study of the differences in the mortality rate due to dengue between the less and the more educated people in Brazil, according to the mortality rates due to general dengue, by age, sex, and Federative Unit (UF). A bootstrap and multiple imputation procedure for the variable schooling was implemented to consider the multilevel structure of the data from each UF over the years. For each aggregate bank generated, a multilevel Poisson model was adjusted. The improvement in the education level of the Brazilian population did not reflect on the decrease in mortality from dengue. There was an increase in the mortality rate from dengue in Brazil and an increase in the difference in mortality rates between less and more educated. Regardless of the imputation process, the results showed higher mortality rates from dengue among the less educated. Low schooling affected younger people more pronouncedly.

Educational disparities in disability-free life expectancy across Europe: A focus on the East-West gaps from a gender perspective

Education plays a crucial role in shaping the health outcomes of adults. This study examines the relationship between educational attainment and health across Europe. Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we estimate educational inequalities in disability-free life expectancy (DFLE) by gender in seven Western European (2004-2019) and three Central and Eastern European (CEE) (2010-2019) countries. We exploit a novel approach that combines the Sullivan method and multivariate life tables to calculate DFLE using SHARE data. We find that educational differences in DFLE favoring the better-educated exist in both CEE and Western European countries, but also that the differences across countries are more pronounced among the low-educated. While the absolute gaps in DFLE between low- and high-educated individuals in CEE and Western European countries are similar, the educational disparities in DFLE impose a more significant burden on the CEE populations due to their overall lower life expectancy. Educational inequalities are larger among women than among men in CEE countries, while the results for Western European countries are mixed. Our findings further highlight the important role of the institutional context in mitigating or exacerbating educational inequalities in health.

Educational Disparities in Hypertension Prevalence and Blood Pressure Percentiles in the Health and Retirement Study

OBJECTIVES

Hypertension and uncontrolled high blood pressure (BP) are more prevalent among less-educated older adults than those with more schooling. However, these dichotomous indicators may fail to fully characterize educational disparities in BP, a continuous measure that predicts morbidity and mortality across much of its range. This study therefore focuses on the distribution of BP, assessing educational disparities across BP percentiles in addition to disparities in hypertension and uncontrolled BP.

METHODS

Data are from the 2014-2016 Health and Retirement Study, a nationally representative survey of older U.S. adults (n = 14,498, ages 51-89). To examine associations between education, hypertension, and uncontrolled BP, I estimate linear probability models. To assess relationships between education and BP, I fit linear and unconditional quantile regression models.

RESULTS

Less-educated older adults are not only more likely to have hypertension and uncontrolled BP than those with more schooling, they also have higher systolic BP across nearly the entire BP distribution. Educational disparities in systolic BP increase in magnitude across BP percentiles and are largest at the highest levels of BP. This pattern is observed for those with and without diagnosed hypertension, is robust to early-life confounders, and is only partially explained by socioeconomic and health-related circumstances in adulthood.

DISCUSSION

Among older U.S. adults, the distribution of BP is compressed at lower, healthier levels for those with more education, and skewed toward the highest, most harmful levels among those with less education. Educational inequities in hypertension awareness and treatment efficacy may underlie these patterns. Implications for fundamental cause theory are discussed.

Dynamic Changes in the Association Between Education and Health in the United States

Policy Points We reviewed some of the recent advances in education and health, arguing that attention to social contextual factors and the dynamics of social and institutional change provide critical insights into the ways in which the association is embedded in institutional contexts. Based on our findings, we believe incorporating this perspective is fundamentally important to ameliorate current negative trends and inequality in Americans' health and longevity.

A distributional approach to measuring lifespan stratification

The study of the mortality differences between groups has traditionally focused on metrics that describe average levels of mortality, for example life expectancy and standardized mortality rates. Additional insights can be gained by using statistical distance metrics to examine differences in lifespan distributions between groups. Here, we use a distance metric, the non-overlap index, to capture the sociological concept of stratification, which emphasizes the emergence of unique, hierarchically layered social strata. We show an application using Finnish registration data that cover the entire population over the period from 1996 to 2017. The results indicate that lifespan stratification and life-expectancy differences between income groups both increased substantially from 1996 to 2008; subsequently, life-expectancy differences declined, whereas stratification stagnated for men and increased for women. We conclude that the non-overlap index uncovers a unique domain of inequalities in mortality and helps to capture important between-group differences that conventional approaches miss.

State-Level Trends in Lifespan Variability in the United States, 1960-2019: A Research Note

State-level disparities in life expectancy are wide, persistent, and potentially growing in the United States. However, the extent to which differences in lifespan variability by state have changed over time is unclear. This research note describes trends in lifespan variability for the United States overall and by state from 1960 to 2019 using period life table data from the United States Mortality Database. Lifespan disparity at birth (e0†) decreased over time in the United States overall from 14.0 years in 1960-1964 to 12.2 in 2015-2019. Lifespan variability decreased in all states, but states differed in the level and pace with which these changes occurred. Southern states and the District of Columbia exhibited consistently higher (i.e., less equitable) levels of lifespan variability than the nation overall. Conversely, lifespan variability was lower among several states in the Northeast (e.g., Connecticut and Massachusetts), Upper Midwest (e.g., Iowa, Minnesota, and Wisconsin), and West (e.g., California, Oregon, Utah, and Washington). We observe a particularly worrisome trend of increasing lifespan variability for the United States overall and for most states from 2010-2014 to 2015-2019. Monitoring state-level trends in lifespan variability has the potential to inform policies designed to ameliorate population health disparities.

Cause-of-Death Diversity From a Multiple-Cause Perspective in the United States

Cause-of-death diversity captures the variability of deaths across causes and is an important marker of heterogeneity in a population's health. We contribute to the debate of cause-of-death diversity dynamics by following a novel multiple causes of death (MCOD) approach and applying it to the U.S. context between 2003 and 2018 and across education groups. Results show that cause-of-death diversity increased over this period, especially up to 2012. These trends were mainly driven by increases in the groups aged 65 years or more. The inclusion of MCOD resulted in higher increases in cause-of-death diversity over time compared with merely using underlying causes of death, except for the 85 or more age group, where no difference was observed for males and a reverted gradient was observed for females. Results by educational attainment reveal lower diversity among the highest educated groups and widening differences across groups from around 2012 onward. The clear educational gradient observed at ages 30-64 diminished at older ages. The observed increases in cause-of-death diversity should be monitored to better understand mortality dynamics in aging populations. Our new MCOD diversity measures suggest that traditional approaches relying on single causes of death might be underestimating cause-of-death diversity dynamics, particularly for males.

Spatial analysis of cardiovascular mortality and associated factors around the world

BACKGROUND

Cardiovascular disease (CVD) is one of the most serious health issues and the leading cause of death worldwide in both developed and developing countries. The risk factors for CVD include demographic, socioeconomic, behavioral, environmental, and physiological factors. However, the spatial distribution of these risk factors, as well as CVD mortality, are not uniformly distributed across countries. Therefore, the goal of this study is to compare and evaluate some models commonly used in mortality and health studies to investigate whether the CVD mortality rates in the adult population (over 30 years of age) of a country are associated with the characteristics of surrounding countries from 2013 to 2017.

METHODS

We present the spatial distribution of the age-standardized crude mortality rate from cardiovascular disease, as well as conduct an exploratory data analysis (EDA) to obtain a basic understanding of the behavior of the variables of interest. Then, we apply the ordinary least squares (OLS) to the country level dataset. As OLS does not take into account the spatial dependence of the data, we apply two spatial modelling techniques, that is, spatial lag and spatial error models.

RESULTS

Our empirical findings show that the relationship between CVD and income, as well as other socioeconomic variables, are important. In addition, we highlight the importance of understanding how changes in individual behavior across different countries might affect future trends in CVD mortality, especially related to smoking and dietary behaviors.

CONCLUSIONS

We argue that this study provides useful clues for policymakers establishing effective public health planning and measures for the prevention of deaths from cardiovascular disease. The reduction of CVD mortality can positively impact GDP growth because increasing life expectancy enables people to contribute to the economy of the country and its regions for longer.

Life Course Socioeconomic Status and Healthy Longevity in China

In 2020, China's population aged 60 or older exceeded 264 million, representing 25% of the global population in that age-group. Older adults in China experienced periods of dramatic political and social unrest in early life, as well as economic transformations leading to drastic improvements in living standards during adulthood and older age. However, the implications of life course socioeconomic status (SES) trajectories for healthy longevity in later life have not been systematically studied in China. We utilize data from the China Health and Retirement Longitudinal Study (CHARLS) to comprehensively investigate how early-life conditions and adult SES combine to influence healthy longevity in later life. We find that both childhood and adulthood SES are associated with late-life health. The largest disparities in life expectancy (LE) and disability-free LE are found between those with persistently low SES throughout life and those with consistently high SES. At age 45, the gap in total LE between the most advantaged and least advantaged groups is six years for men and five years for women. Despite China's major policy changes prioritizing equity in income and health care in recent decades, our findings suggest that dramatic health inequalities among older adults remain. Our findings extend the literature on the effect of socioeconomic patterns across the life course on gradients in later-life health and highlight continuing disparities in healthy longevity among older adults in China.

Why we should monitor disparities in old-age mortality with the modal age at death

Indicators based a fixed “old” age threshold have been widely used for assessing socioeconomic disparities in mortality at older ages. Interpretation of long-term trends and determinants of these indicators is challenging because mortality above a fixed age that in the past would have reflected old age deaths is today mixing premature and old-age mortality. We propose the modal (i.e., most frequent) age at death, M, an indicator increasingly recognized in aging research, but which has been infrequently used for monitoring mortality disparities at older ages. We use mortality and population exposure data by occupational class over the 1971-2017 period from Finnish register data. The modal age and life expectancy indicators are estimated from mortality rates smoothed with penalized B-splines. Over the 1971-2017 period, occupational class disparities in life expectancy at 65 and 75 widened while disparities in M remained relatively stable. The proportion of the group surviving to the modal age was constant across time and occupational class. In contrast, the proportion surviving to age 65 and 75 has roughly doubled since 1971 and showed strong occupational class differences. Increasing socioeconomic disparities in mortality based on fixed old age thresholds may be a feature of changing selection dynamics in a context of overall declining mortality. Unlike life expectancy at a selected fixed old age, M compares individuals with similar survival chances over time and across occupational classes. This property makes trends and differentials in M easier to interpret in countries where old-age survival has improved significantly.

From convergence to divergence: Lifespan variation in US states, 1959-2017

BACKGROUND

Large disparities in life expectancy exist across US states and the gaps have been widening in recent decades. Less is known about the lifespan variability - a measure that can provide important insights into mortality inequalities both between and within states.

METHOD

Using yearly lifetables from the United States Mortality Database, we explore geographic and temporal patterns in lifespan variation (unconditional and conditional on survival to age 10, 35 and 65) across US states between 1959 and 2017. We also examine the contribution of state differences in life expectancy to overall lifespan variation using standard decomposition techniques.

RESULTS

Despite overall convergence in lifespan variation across states over the last six decades, in more recent years there has been notable divergence. Gender-specific analyses show that lifespan variation was generally greater among males than among females; but this pattern reverses for mortality past age 65. Much of the state disparities in lifespan variation, unconditional and conditional on survival to age 10 and 35, were due to mortality differences under the age 65. Decomposition analysis shows that while within-state variability remains the primary driver of overall lifespan variation, the contribution of cross-state differences in life expectancy is growing.

CONCLUSIONS

Variation in longevity is greater within US States than between them, yet cross-states disparities in mortality are increasing. This likely reflects the long-term consequences of rising social, economic, and political stratification for health inequalities both within and across states.

Health Power Resources Theory: A Relational Approach to the Study of Health Inequalities

Link and Phelan's pioneering 1995 theory of fundamental causes urged health scholars to consider the macro-level contexts that "put people at risk of risks." Allied research on the political economy of health has since aptly demonstrated how institutions contextualize risk factors for health. Yet scant research has fully capitalized on either fundamental cause or political economy of health's allusion to power relations as a determinant of persistent inequalities in population health. I address this oversight by advancing a theory of health power resources that contends that power relations distribute and translate the meaning (i.e., necessity, value, and utility) of socioeconomic and health-relevant resources. This occurs through stratification, commodification, discrimination, and devitalization. Resurrecting historical sociological emphases on power relations provides an avenue through which scholars can more fully understand the patterning of population health and better connect the sociology of health and illness to the central tenets of the discipline.

Examining Ethnic Variation in Life Expectancy Among Asians in the United States, 2012-2016

As the fastest growing racial group in the United States, understanding the health patterns of Asians is important to addressing health gaps in American society. Most studies have not considered the unique experiences of the ethnic groups contained in the Asian racial group, implying that Asians have a shared story. However, we should expect differences between the ethnic groups given the differences in their timing and place of migration, socioeconomic status, and racialized experiences in the United States. We estimate the life expectancy of the six largest Asian ethnic groups-Chinese, Asian Indians, Filipinos, Vietnamese, Koreans, and Japanese-analyzing data from the Multiple Cause of Death File (2012-2016) and the American Community Survey (2012-2016) in the United States at the national and regional levels. Nationally, Chinese had the highest life expectancy (males e0 = 86.8; females e0 = 91.3), followed by Asian Indians, Koreans, Japanese, Filipinos, and Vietnamese, generally reflecting the pattern expected given their educational attainment, our primary indicator of socioeconomic status. We also found regional differences in life expectancy, where life expectancy for Asians in the West was significantly lower than all other regions. These findings suggest the presence of underlying selection effects associated with settlement patterns among new and traditional destinations. Our results underline the necessity of studying the experiences of the different Asian ethnic groups in the United States, permitting a better assessment of the varying health needs within this diverse racial group.

Increasing Education-Based Disparities in Healthy Life Expectancy Among U.S. Non-Hispanic Whites, 2000-2010

OBJECTIVES

To examine changes in Healthy Life Expectancy (HLE) against the backdrop of rising mortality among less-educated white Americans during the first decade of the twenty-first century.

METHODS

This study documented changes in HLE by education among U.S. non-Hispanic whites, using data from the U.S. Multiple Cause of Death public-use files, the Integrated Public Use Microdata Sample (IPUMS) of the 2000 Census and the 2010 American Community Survey, and the Health and Retirement Study (HRS). Changes in HLE were decomposed into contributions from: (i) change in age-specific mortality rates; and (ii) change in disability prevalence, measured via Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL).

RESULTS

Between 2000 and 2010, HLE significantly decreased for white men and women with less than 12 years of schooling. In contrast, HLE increased among college-educated white men and women. Declines or stagnation in HLE among less-educated whites reflected increases in disability prevalence over the study period, whereas improvements among the college educated reflected decreases in both age-specific mortality rates and disability prevalence at older ages.

DISCUSSION

Differences in HLE between education groups increased among non-Hispanic whites from 2000 to 2010. In fact, education-based differences in HLE were larger than differences in total life expectancy. Thus, the lives of less-educated whites were not only shorter, on average, compared with their college-educated counterparts, but they were also more burdened with disability.

Racial/Ethnic and Educational Disparities in the Impact of Diabetes on Population Health among the US-Born Population

OBJECTIVES

This study examines total life expectancies (TLE) for both healthy and diabetic US-born populations and two measures capturing quality of life: 1) the proportion of remaining life to be spent without either other chronic conditions or ADL disabilities (ADLs), and 2) the proportion of remaining life to be spent with ADLs for US-born diabetic populations by race/ethnicity and educational attainment.

METHODS

Using the 1998-2014 waves of the Health and Retirement Study (n=16,983), we apply a Bayesian multistate life table method to calculate these quantities from the constructed life tables.

RESULTS

TLE at age 50 is shorter for diabetic individuals than healthy individuals, for non-Hispanic Blacks than members of other racial/ethnic groups, and for less-educated individuals. Gaps in TLE at age 50 between healthy and diabetic populations range from 6.3 to 8.8 years across sex-race combinations, and 5.6 to 9.2 years across sex-education combinations. Among the diabetic population, those with at least a college degree on average have a higher proportion of remaining life to be spent without either other chronic conditions or ADLs. Hispanics and those without a college degree have a particularly high proportion of remaining life to be spent with ADLs. Although diabetic women on average live longer than men, their quality of life tends to be lower.

DISCUSSION

The impact of diabetes on population health varies across racial/ethnic and educational groups. The findings support targeted interventions for vulnerable groups, such as people of color, women, and less-educated individuals.

Social Inequality and the Future of U.S. Life Expectancy

Despite decades of progress, the future of life expectancy in the United States is uncertain due to widening socioeconomic disparities in mortality, continued disparities in mortality across racial/ethnic groups, and an increase in extrinsic causes of death. These trends prompt us to scrutinize life expectancy in a high-income but enormously unequal society like the United States, where social factors determine who is most able to maximize their biological lifespan. After reviewing evidence for biodemographic perspectives on life expectancy, the uneven diffusion of health-enhancing innovations throughout the population, and the changing nature of threats to population health, we argue that sociology is optimally positioned to lead discourse on the future of life expectancy. Given recent trends, sociologists should emphasize the importance of the social determinants of life expectancy, redirecting research focus away from extending extreme longevity and towards research on social inequality with the goal of improving population health for all.

Do the Benefits of Educational Attainment for Late-life Cognition Differ by Racial/Ethnic Group?: Evidence for Heterogenous Treatment Effects in the Kaiser Healthy Aging and Diverse Life Experience (KHANDLE) Study

INTRODUCTION

Educational attainment is associated with late-life cognitive performance and dementia; few studies have examined diverse racial/ethnic groups to assess whether the association differs by race/ethnicity.

METHODS

We investigated whether the association between educational attainment and cognition differed between White, Black, Asian, and Latino participants in the Kaiser Healthy Aging and Diverse Life Experiences study (n=1348). Covariate-adjusted multivariable linear regression models examined domains of verbal episodic memory, semantic memory, and executive functioning.

RESULTS

We observed significant effect heterogeneity by race/ethnicity only for verbal episodic memory (P=0.0198), for which any schooling between high school and college was beneficial for White, Asian, and Black participants, but not Latino participants. We found no evidence of heterogeneity for semantic memory or executive function.

DISCUSSION

With the exception of Latino performance on verbal episodic memory, more education consistently predicted better cognitive scores to a similar extent across racial/ethnic groups, despite likely heterogenous educational and social experiences.

Chronic respiratory disease mortality and its associated factors in selected Asian countries: evidence from panel error correction model

Background

Chronic Respiratory Diseases (CRDs) in Asian countries are a growing concern in terms of morbidity and mortality. However, a systematic understanding of the increasing age-adjusted mortality rate of chronic respiratory disease (CRD) and its associated factors is not readily available for many Asian countries. We aimed to determine country-level factors affecting CRD mortality using a panel error correction model.

Methods

Based on data from the Global Burden of Disease Study 2017, we estimated the trends and distribution of CRD mortality for selected Asian countries from 2010 to 2017. Furthermore, we evaluated the relationship between CRD mortality and Gross Domestic Product (GDP) per capita, average years of schooling, urbanization, and pollutant emission (PM2.5 concentration) using a fixed-effect model. We corrected the estimates for heteroscedasticity and autocorrelation through Prais-Winsten adjustment along with robust standard error.

Results

Between 2010 and 2017, approximately 21.4 million people died from chronic respiratory diseases in the countries studied. Age-standardized crude mortality rate from CRDs in the period had minimum and maximum values of 8.19 (Singapore in 2016) and 155.42 (North Korea in 2010) per 100,000 population, respectively. The coefficients corrected for autocorrelation and heteroskedasticity based on the final model of our study (Prais-Winsten), showed that all explanatory variables were statistically significant (p < 0.001). The model shows that the 1% increase in GDP per capita results in a 20% increase (0.203) in the CRD mortality rate and that a higher concentration of air pollution is also positively associated with the CRD deaths (0.00869). However, an extra year of schooling reduces the mortality rate by 4.79% (− 0.0479). Further, rate of urbanization is negatively associated with the CRD death rate (− 0.0252).

Conclusions

Our results indicate that both socioeconomic and environmental factors impact CRD mortality rates. Mortality due to CRD increases with rising GDP per capita and decreases with the percentage of the total population residing in urban areas. Further, mortality increases with greater exposure to PM2.5. Also, higher years of schooling mitigate rising CRD mortality rates, showing that education can act as a safety net against CRD mortality. These results are an outcome of sequential adjustments in the final model specification to correct for heteroscedasticity and autocorrelation.

Insight into stagnating adult life expectancy: Analyzing cause of death patterns across socioeconomic groups

This study analyzes the complexity of female longevity improvements. As socioeconomic status is found to influence health and mortality, we partition all individuals, at each age in every year, into five socioeconomic groups based on an affluence measure that combine an individual's income and wealth. We identify the particular socioeconomic groups that have been driving the standstill for Danish females at older ages. Within each socioeconomic group, we further analyze the cause of death patterns. The decline in life expectancy for Danish females is present for four out of five subgroups, however, with particular large decreases for the low-middle and middle-affluence groups. Cancers, smoking-related lung and bronchus causes, and other diseases particularly contribute to the stagnation. For four of the five socioeconomic groups only small cardiovascular improvement are experienced during the period of stagnating life expectancy compared to an equally long and subsequent period.

Modal lifespan and disparity at older ages by leading causes of death: a Canada-U.S. comparison

The U.S. elderly experience shorter lifespans and greater variability in age at death than their Canadian peers. In order to gain insight on the underlying factors responsible for the Canada-U.S. old-age mortality disparities, we propose a cause-of-death analysis. Accordingly, the objective of this paper is to compare levels and trends in cause-specific modal age at death (M) and standard deviation above the mode (SD(M +)) between Canada and the U.S. since the 1970s. We focus on six broad leading causes of death, namely cerebrovascular diseases, heart diseases, and four types of cancers. Country-specific M and SD(M +) estimates for each leading cause of death are calculated from P-spline smooth age-at-death distributions obtained from detailed population and cause-specific mortality data. Our results reveal similar levels and trends in M and SD(M +) for most causes in the two countries, except for breast cancer (females) and lung cancer (males), where differences are the most noticeable. In both of these instances, modal lifespans are shorter in the U.S. than in Canada and U.S. old-age mortality inequalities are greater. These differences are explained in part by the higher stratification along socioeconomic lines in the U.S. than in Canada regarding the adoption of health risk behaviours and access to medical services.

Explaining the Education-Health Gradient in Preventing STIs in Andean Peru: Cognitive Executive Functioning, Awareness and Health Knowledge

CONTEXT

Little is known about the pathways mediating the relationship between education and health. It is widely assumed that formal schooling leads to awareness of health risks (e.g., STIs) and, in turn, to adoption of preventive behavior (e.g., condom use); however, evidence supporting this mechanism has been limited.

METHODS

Survey data were collected in 2010 from a sample of 247 adults aged 30-62 living in an isolated Andean district of Peru; these individuals had widely varying exposure to schooling, and their community had recently experienced elevated risks of STIs. Structural equation modeling was used to estimate the degree to which schooling is associated with cognitive resources, STI awareness and sexual health knowledge, and how these jointly are associated with ever-use of condoms.

RESULTS

Thirty-two percent of respondents reported ever-use of condoms. One additional year of schooling was associated with a 2.7-percentage-point increase in the probability of condom use, after adjustment for covariates. The pathway between education and condom use was mediated by cognitive executive functioning (CEF) skills (0.26 standard deviations), STI awareness (0.09) and sexual health knowledge (0.10); CEF skills were associated with condom use both directly and indirectly, through STI awareness and sexual health knowledge, and accounted for two-thirds of the education-condom use gradient.

CONCLUSIONS

The relationship between education and STI prevention may be more complex than is often assumed and is mediated by CEF skills, STI awareness and sexual health knowledge. Studies should examine whether STI prevention interventions are more effective if they enhance cognitive skills used to translate information into protective behaviors.

Is Conscientiousness Always Associated With Better Health? A U.S.-Japan Cross-Cultural Examination of Biological Health Risk

In Western societies, conscientiousness is associated with better health. Here, we tested whether this pattern would extend to East Asian, collectivistic societies. In these societies, social obligation motivated by conscientiousness could be excessive and thus health-impairing. We tested this prediction using cross-cultural surveys of Americans (N = 1,054) and Japanese (N = 382). Biomarkers of inflammation (interleukin-6 and C-reactive protein) and cardiovascular malfunction (systolic blood pressure and total-to-HDL cholesterol ratio) were adopted to define biological health risk (BHR). Among Americans, conscientiousness was associated with lower BHR. Moreover, this relationship was mediated by healthy lifestyle. In contrast, among Japanese, the relationship between conscientiousness and BHR was not significant. Further analysis revealed, however, that conscientiousness was associated with a greater commitment to social obligation, which in turn predicted higher BHR. These findings suggest that conscientiousness may or may not be salubrious, depending on health implications of normatively sanctioned behaviors in varying cultures.

Prostate Cancer Screening in Middle-Aged and Older American Men: Combined Effects of Ethnicity and Years of Schooling

BACKGROUND

Prostate cancer screening is more commonly utilized by highly educated people. As shown by marginalization-related diminished returns (MDRs), the effects of socioeconomic status (SES) such as education on the health outcomes are considerably smaller for ethnic minorities than for Whites. The role of MDRs as a source of ethnic health disparities is, however, still unknown.

OBJECTIVES

The current study had two aims: first, to explore the association between years of schooling and having taken a prostate-specific antigen (PSA) test among men in the US, and second, to explore ethnic differences in this association.

METHODS

This study was a secondary analysis of data from the National Health Interview Survey (NHIS-2015). The data of 5,053 men aged 55 years or older who were either Latino, non-Latino, African-American, or White were analyzed. Years of schooling was the independent variable. The dependent variable was taking a PSA test sometime during one's lifetime. Age, region, and employment were the control variables. Ethnicity was the focal moderating variable. Binary logistic regression was used for data analysis.

RESULTS

A higher number of years of schooling was associated with higher odds of having taken a PSA test, net of all confounders. Ethnicity showed a significant statistical interaction with years of schooling on having taken a PSA test. This interaction was suggestive of a smaller slope for Latino men than non-Latino men. White and African American men did not show differential effects of years of schooling on having taken a PSA test.

CONCLUSION

Similar to the MDRs patterns in other domains, non-Latino White men show more health gain from their years of schooling than Latino men. Highly educated Latino men still need programs to encourage their use of prostate cancer screening.

Combined Effects of Race and Educational Attainment on Physician Visits Over 24 Years in a National Sample of Middle-Aged and Older Americans

Background

The literature on Minorities' Diminished Returns (MDRs) have shown worse than expected health of the members of racial and ethnic minority groups particularly Blacks. Theoretically, this effect can be in part due to weaker effects of educational attainment on preventive care and disease management in highly educated racial and ethnic minorities.

Objectives

The current study explored the racial and ethnic differences in the effect of baseline educational attainment on % adherance to the routine physician visits among middle-aged and older adults in the US.

Methods

This is a prospective study with 24 years of follow up. The Health and Retirement Study (HRS: 1992-2016) included 10 880 middle-aged and older adults who were Hispanic, non-Hispanic, Black or White. The independent variable was educational attainment. The dependent variable was adherance to the routine physician visits (%). Age, gender, marital status, income, health behaviors (smoking and drinking) and health (depression, self-rated health, and chronic diseases) were the covariates. Race and ethnicity were the focal moderators. Linear regression was used for data analysis.

Results

Overall, higher educational attainment was associated with higher % of adherance to the routine physician visits over the course of follow-up, net of all confounders. Race showed a significant statistical interaction with educational attainment suggesting of a smaller effect of high education attainment on % adherance to the routine physician visits for Black than White middle-aged and older adults. A similar interaction could not be found for the comparison of Hispanic and non-Hispanic middle-aged and older adults.

Conclusion

Educational attainment is associated with a larger increase in preventive and disease management doctor visits for White than Black middle-aged and older adults. This is a missed opportunity to improve the health of highly educated middle-aged and older adults. It is not race/ethnicity or class that shapes health behaviors but race/ethnicity and class that shape people's pro-health behaviors. At least some of the racial health disparities is not due to low SES but diminished returns of SES.

Educational Attainment Better Increases the Chance of Breast Physical Exam for Non-Hispanic Than Hispanic American Women: National Health Interview Survey

Background

The Minorities' Diminished Returns (MDRs) theory suggests that the health effect of educational attainment is considerably smaller for members of racial and ethnic minority groups than for Whites.

Objective

The current study explored the racial and ethnic differences in the association between educational attainment and breast physical exam (BPE) among women in the U.S.

Methods

The National Health Interview Survey (NHIS 2015) included 12 510 women who were Hispanic or non-Hispanic Black or White people. The independent variable was the level of educational attainment. The dependent variable was lifetime BPE. Age, region, marital status, and employment were the covariates. Race and ethnicity were the focal moderators. Logistic regressions were used for data analysis.

Results

Overall, higher educational attainment was associated with higher odds of BPE, net of all confounders (odds ratio [OR] = 1.11, 95% CI = 1.09-1.13). Ethnicity showed a significant statistical interaction with educational attainment on BPE (OR = 0.96, 95% CI = 0.93-1.00), which was suggestive of a smaller effect of high education attainment on BPE for Hispanic than non-Hispanic women. The same interaction could not be found for the comparison of White and Black women (OR = 0.98, 95% CI =0.94-1.02).

Conclusion

In line with other domains, non-Hispanic White women show a larger amount of health gain from their educational attainment than Hispanic women. It is not ethnicity or class but ethnicity and class that shapes how people engage in pro-health behaviors. This result may help hospitals and healthcare systems to better reduce health disparities in their target populations.

Higher Educational Attainment is Associated with Lower Risk of a Future Suicide Attempt Among Non-Hispanic Whites but not Non-Hispanic Blacks

PURPOSE

In a sample of patients presenting to the emergency department (ED), the current study was conducted with two aims: (1) to investigate the protective effects of educational attainment (i.e., completing college) on subsequent risk of suicide attempt/death among patients presenting to the ED and (2) to compare this effect between non-Hispanic Black and non-Hispanic White ED patients.

METHODS

The current study analyzed data from the Emergency Department Safety Assessment and Follow-Up Evaluation (ED-SAFE) study, a quasi-experimental, eight-center study of universal suicide screening and follow-up of ED patients presenting for suicidal ideation and behavior. Our sample included 937 non-Hispanic White and 211 non-Hispanic Blacks. The dependent variable was suicide attempt/death during the 52-week follow-up. The independent variable was completing college. Age, gender, lesbian/gay/bisexual status, psychiatric history, and previous suicide attempts at baseline were covariates. Race/ethnicity was the focal effect modifier. Logistic regression models were used to test the protective effects of educational attainment on suicide risk in the overall sample and by race/ethnicity.

RESULTS

In the overall sample, educational attainment was not associated with suicide risk over the follow-up period. A significant interaction was found between race/ethnicity and educational attainment on suicide risk, suggesting a larger protective effect for non-Hispanic Whites compared with non-Hispanic Blacks. In race/ethnicity-specific models, completing college was associated with decreased future suicide risk for non-Hispanic Whites but not Blacks.

CONCLUSIONS

Consistent with the Minorities' Diminished Return theory, educational attainment better protected non-Hispanic White than non-Hispanic Blacks against future suicide attempt/death. While Whites who have not completed college may be at an increased risk of suicide, risk of suicide seems to be independent of educational attainment for non-Hispanic Blacks.

Public Health and School Health Education: Aligning Forces for Change

The interdependent relationship between health and education has long been documented by leading health and education scholars. Children who are not physically, mentally, socially, or emotionally healthy will not be ready to learn and thus hampered to achieve their full potential as productive members of society. Despite this evidence, the United States has yet to bridge the divide between the health and education systems. This perspective introduces three manuscripts in this Special School Health Education Collection on the future of school health education in the United States, and provides a context for the challenges and recommendations each article outlines to improve the quantity and quality of school health education for preK-12 youth. Although some of the challenges and recommendations are not novel, what is exciting is the opportunity to move the agenda forward given the Whole School, Whole Community, Whole Child model and the Every Student Succeeds Act of 2015. Aligning the forces of public health and school health educators is essential to make school health education a societal imperative.

Longevity and Lifespan Variation by Educational Attainment in Spain: 1960-2015

For a long time, studies of socioeconomic gradients in health have limited their attention to between-group comparisons. Yet, ignoring the differences that might exist within groups and focusing on group-specific life expectancy levels and trends alone, one might arrive at overly simplistic conclusions. Using data from the Spanish Encuesta Sociodemográfica and recently released mortality files by the Spanish Statistical Office (INE), this is the first study to simultaneously document (1) the gradient in life expectancy by educational attainment groups, and (2) the inequality in age-at-death distributions within and across those groups for the period between 1960 and 2015 in Spain. Our findings suggest that life expectancy has been increasing for all education groups but particularly among the highly educated. We observe diverging trends in life expectancy, with the differences between the low- and highly educated becoming increasingly large, particularly among men. Concomitantly with increasing disparities across groups, length-of-life inequality has decreased for the population as a whole and for most education groups, and the contribution of the between-group component of inequality to overall inequality has been extremely small. Even if between-group inequality has increased over time, its contribution has been too small to have sizable effects on overall inequality. In addition, our results suggest that education expansion and declining within-group variability might have been the main drivers of overall lifespan inequality reductions. Nevertheless, the diverging trends in longevity and lifespan inequality across education groups represent an important phenomenon whose underlying causes and potential implications should be investigated in detail.

Urban-rural differentials in age-related biological risk among middle-aged and older Chinese

OBJECTIVES

To assess urban-rural differentials in age-related biological risk among middle-aged and older Chinese and links to individual and community characteristics.

METHODS

Data come from the national baseline survey of the China Health and Retirement Longitudinal Study. Biological risk is assessed using a set of measured biomarkers that reflect cardiovascular, metabolic, and inflammatory processes.

RESULTS

Urban residents who are officially registered in urban areas have greater biological risk than rural residents. Having junior school or higher education provides an independent and persistent protective effect against biological risk and eliminates the effect of community-level measures. The reduced physical activity of urban dwellers with urban origins explains a substantial part of the difference in risk.

CONCLUSIONS

Urban dwellers with urban household registration have elevated risk compared with their rural peers, indicating that lifetime exposure to urban areas is an important risk factor for increased biological risk in China. The urban-rural differential in risk is accounted for by adjusting for health behaviors, particularly physical activity. The reduced physical activity among urban dwellers with urban household registration appears to be highly related to their elevated risk. No significant associations between community-level characteristics and biological risk are found beyond individual characteristics.

The increasing lifespan variation gradient by area-level deprivation: A decomposition analysis of Scotland 1981-2011

Life expectancy inequalities are an established indicator of health inequalities. More recent attention has been given to lifespan variation, which measures the amount of heterogeneity in age at death across all individuals in a population. International studies have documented diverging socioeconomic trends in lifespan variation using individual level measures of income, education and occupation. Despite using different socioeconomic indicators and different indices of lifespan variation, studies reached the same conclusion: the most deprived experience the lowest life expectancy and highest lifespan variation, a double burden of mortality inequality. A finding of even greater concern is that relative differences in lifespan variation between socioeconomic group were growing at a faster rate than life expectancy differences. The magnitude of lifespan variation inequalities by area-level deprivation has received limited attention. Area-level measures of deprivation are actively used by governments for allocating resources to tackle health inequalities. Establishing if the same lifespan variation inequalities emerge for area-level deprivation will help to better inform governments about which dimension of mortality inequality should be targeted. We measure lifespan variation trends (1981-2011) stratified by an area-level measure of socioeconomic deprivation that is applicable to the entire population of Scotland, the country with the highest level of variation and one of the longest, sustained stagnating trends in Western Europe. We measure the gradient in variation using the slope and relative indices of inequality. The deprivation, age and cause specific components driving the increasing gradient are identified by decomposing the change in the slope index between 1981 and 2011. Our results support the finding that the most advantaged are dying within an ever narrower age range while the most deprived are facing greater and increasing uncertainty. The least deprived group show an increasing advantage, over the national average, in terms of deaths from circulatory disease and external causes.

Educational Disparities in Adult Mortality Across U.S. States: How Do They Differ, and Have They Changed Since the Mid-1980s?

Adult mortality varies greatly by educational attainment. Explanations have focused on actions and choices made by individuals, neglecting contextual factors such as economic and policy environments. This study takes an important step toward explaining educational disparities in U.S. adult mortality and their growth since the mid-1980s by examining them across U.S. states. We analyzed data on adults aged 45-89 in the 1985-2011 National Health Interview Survey Linked Mortality File (721,448 adults; 225,592 deaths). We compared educational disparities in mortality in the early twenty-first century (1999-2011) with those of the late twentieth century (1985-1998) for 36 large-sample states, accounting for demographic covariates and birth state. We found that disparities vary considerably by state: in the early twenty-first century, the greater risk of death associated with lacking a high school credential, compared with having completed at least one year of college, ranged from 40 % in Arizona to 104 % in Maryland. The size of the disparities varies across states primarily because mortality associated with low education varies. Between the two periods, higher-educated adult mortality declined to similar levels across most states, but lower-educated adult mortality decreased, increased, or changed little, depending on the state. Consequently, educational disparities in mortality grew over time in many, but not all, states, with growth most common in the South and Midwest. The findings provide new insights into the troubling trends and disparities in U.S. adult mortality.

Are China's oldest-old living longer with less disability? A longitudinal modeling analysis of birth cohorts born 10 years apart

BACKGROUND

China has transitioned from being one of the fastest-growing populations to among the most rapidly aging countries worldwide. In particular, the population of oldest-old individuals, those aged 80+, is projected to quadruple by 2050. The oldest-old represent a uniquely important group-they have high demand for personal assistance and the highest healthcare costs of any age group. Understanding trends in disability and longevity among the oldest-old-that is, whether successive generations are living longer and with less disability-is of great importance for policy and planning purposes.

METHODS

We utilized data from successive birth cohorts (n = 20,520) of the Chinese oldest-old born 10 years apart (the earlier cohort was interviewed in 1998 and the later cohort in 2008). Disability was defined as needing personal assistance in performing one or more of five essential activities (bathing, transferring, dressing, eating, and toileting) or being incontinent. Participants were followed for age-specific disability transitions and mortality (in 2000 and 2002 for the earlier cohort and 2011 and 2014 for the later cohort), which were then used to generate microsimulation-based multistate life tables to estimate partial life expectancy (LE) and disability-free LE (DFLE), stratified by sex and age groups (octogenarians, nonagenarians, and centenarians). We additionally explored sociodemographic heterogeneity in LE and DFLE by urban/rural residence and educational attainment.

RESULTS

More recently born Chinese octogenarians (born 1919-1928) had a longer partial LE between ages 80 and 89 than octogenarians born 1909-1918, and octogenarian women experienced an increase in partial DFLE of 0.32 years (P = 0.004) across the two birth cohorts. Although no increases in partial LE were observed among nonagenarians or centenarians, partial DFLE increased across birth cohorts, with a gain of 0.41 years (P < 0.001) among nonagenarians and 0.07 years (P = 0.050) among centenarians. Subgroup analyses revealed that gains in partial LE and DFLE primarily occurred among the urban resident population.

CONCLUSIONS

Successive generations of China's oldest-old are living with less disability as a whole, and LE is expanding among octogenarians. However, we found a widening urban-rural disparity in longevity and disability, highlighting the need to improve policies to alleviate health inequality throughout the population.

Parental Educational Attainment and Academic Performance of American College Students; Blacks' Diminished Returns

BACKGROUND

As suggested by the Minorities' Diminished Returns (MDR) theory, socioeconomic status (SES) systemically results in smaller outcomes for non-Whites compared to Whites. We still know very little about diminished trans-generational returns of SES resources such as parental educational attainment (PEA).

PURPOSE

This cross-sectional study explored racial variation in the effect of PEA on the college students' grade point average (GPA) in the US.

METHODS

The Healthy Mind Study (HMS, 2016-2017) is a national telephone of college students in the US. The total sample was 18,072 domestic undergraduate college students who were either non-Hispanic Whites (n = 16,718; %92.50) or non-Hispanic Blacks (n = 1,354; %7.50). The independent variable was PEA. The main outcome was GPA measured using self-reported data. Age, gender, sexual orientation, transgender status, and financial difficulty were covariates. Race/ethnicity was the effect modifier. Linear regression models were used to analyze the data.

RESULTS

Overall, higher PEA was associated with a higher GPA, independent of all possible confounders. Race/ethnicity, however, showed a significant interaction with PEA on students' GPA, indicating a smaller positive effect of PEA on non-Hispanic Blacks compared to non-Hispanic Whites college students' GPA. Race/ethnicity stratified models also showed a larger effect for White than Black students.

CONCLUSIONS

The boosting effect of PEA in GPA is smaller for Black compared to White college students. US should systematically reduce extra costs of upward social mobility for racial and ethnic minority families.

Subjective financial status and suicidal ideation among American college students: Racial differences

PURPOSE

The current study aimed to compare American Black and White college students for the protective effect of subjective socioeconomic status (SES) on suicidal ideation.

METHODS

This study used data from the Healthy Mind Study (HMS 2015-2017). This study included 2,983 undergraduate college students who were at least 18 years of old. These participants were either White (n=2,704) or Black (n=279). The dependent variable was suicidal ideation. The independent variable was subjective SES. Age, gender, transition status, first generation status, and social isolation were covariates. Race/ethnicity was the moderator. Logistic regressions were applied to test the effect of subjective SES on suicidal ideation in the overall sample and by race/ ethnicity.

RESULTS

In the overall sample, high subjective SES was associated with less suicidal ideation in the pooled sample of college students. A significant interaction was found between race and subjective SES on suicide risk, suggesting a larger protective effect of high subjective SES for Whites than Blacks. In race-stratified models, high subjective SES was associated with less suicidal ideation for White college students but not for Black college students.

CONCLUSIONS

Consistent with the Minorities' Diminished Returns theory and in line with previous research that has documented worse mental health of high SES Blacks particularly Black men, this study showed that high SES protects White college students but not Black college students against suicidal ideation. While Whites with low SES are protected against risk of suicide, risk of suicidal ideation seems to be constant regardless of SES among Black college students.

Exceptional Human Longevity

Exceptional longevity represents an extreme phenotype. Current centenarians are survivors of a cohort who display delayed onset of age-related diseases and/or resistance to otherwise lethal illnesses occurring earlier in life. Characteristics of aging are heterogeneous, even among long-lived individuals. Associations between specific clinical or genetic biomarkers exist, but there is unlikely to be a single biomarker predictive of long life. Careful observations in the oldest old offer some empirical strategies that favor increased health span and life span, with implications for compression of disability, identification and implementation of lifestyle behaviors that promote independence, identification and measurement of more reliable markers associated with longevity, better guidance for appropriate health screenings, and promotion of anticipatory health discussions in the setting of more accurate prognostication. Comprehensive PubMed literature searches were performed, with an unbiased focus on mechanisms of longevity. Overall, the aggregate literature supports that the basis for exceptional longevity is multifactorial and involves disparate combinations of genes, environment, resiliency, and chance, all of which are influenced by culture and geography.

Educational differences in the compression of disability incidence in the United States

Objective

To examine educational differences in the compression of disability incidence in the United States.

Method

We use the Health and Retirement Study and techniques of microsimulation and bootstrap to estimate the distribution of mortality and disability incidence for major education groups.

Results

Higher education is associated with a right shift in the age distributions of both mortality and disability incidence, and more compressed distributions above the modal ages (p<0.05). Our study also points to gender differences in the association between education and compression of mortality and disability incidence (p<0.05).

Discussion

To our knowledge, no prior studies have examined educational difference in compression of disability incidence and conducted formal tests for statistical significance. Educational differences in life span variation in mortality correspond closely with life span variation in disability incidence. One long-range implication of this work is growing inequality in life-span variation in disability incidence given trends in educational differences in life-span variation in mortality.

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Educational differences: Higher education is associated with a right shift in the age distributions of both mortality and disability incidence, and more compressed distributions above the modal ages. In other words, education is significantly associated with mortality compression and compression of disability incidence.

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Gender differences: The distributions of ages of deaths and disability incidence are more compressed among women than men in the same education group. That is to say, there are significant gender differences in the association between education and compression of mortality and disability incidence.

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First study: To our knowledge, no prior studies have examined educational difference in compression of disability incidence and conducted formal tests for statistical significance.

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Future trends: Educational differences in life span variation in mortality correspond closely with life span variation in disability incidence. One long-range implication of this work is growing inequality in life-span variation in disability incidence given trends in educational differences in life-span variation in mortality.

Comparability of Mortality Estimates from Social Surveys and Vital Statistics Data in the United States

Social surveys prospectively linked with death records provide invaluable opportunities for the study of the relationship between social and economic circumstances and mortality. Although survey-linked mortality files play a prominent role in U.S. health disparities research, it is unclear how well mortality estimates from these datasets align with one another and whether they are comparable with U.S. vital statistics data. We conduct the first study that systematically compares mortality estimates from several widely-used survey-linked mortality files and U.S. vital statistics data. Our results show that mortality rates and life expectancies from the National Health Interview Survey Linked Mortality Files, Health and Retirement Study, Americans' Changing Lives study, and U.S. vital statistics data are similar. Mortality rates are slightly lower and life expectancies are slightly higher in these linked datasets relative to vital statistics data. Compared with vital statistics and other survey-linked datasets, General Social Survey-National Death Index life expectancy estimates are much lower at younger adult ages and much higher at older adult ages. Cox proportional hazard models regressing all-cause mortality risk on age, gender, race, educational attainment, and marital status conceal the issues with the General Social Survey-National Death Index that are observed in our comparison of absolute measures of mortality risk. We provide recommendations for researchers who use survey-linked mortality files.

Health Literacy and Mortality in Patients With Heart Failure: A Systematic Review and Meta-Analysis

Heart failure (HF) remains the most common diagnosis of hospital admission among U.S. adults. Although diagnosis and treatment have improved, mortality rates have not changed, and mortality risk remains high after hospitalization. The current researchers examined how limited health literacy is associated with mortality risk in adults with recent hospitalization due to decompensated HF. Researchers conducted a systematic literature search, selecting three cohort and three intervention studies. The fixed-effect model was used. From the three cohort studies, 2,858 study participants were analyzed. Among participants, limited health literacy was associated with higher all-cause mortality (pooled odds ratio = 2.95; 95% confidence interval [2.34, 3.72]; p < 0.01; I² = 47.38%). However, none of the intervention studies showed an association between limited health literacy and cardiac (or all-cause) mortality. Future research should focus on the efficiency and safety of telehealth-based medicine in patients with HF, particularly those with limited health literacy. [Res Gerontol Nurs. 2019; 12(2):91-108.].

Deaths of Despair in Florida: Assessing the Role of Social Determinants of Health

Deaths of despair (DOD) is a new term appearing in public health literature to describe deaths attributable to suicide, liver disease, and drug overdose. In Florida, suicide and liver disease are the 8th and 10th leading causes of death, respectively. Additional mortality data show that the rate of drug overdose deaths in Florida is 12.5% higher than the suicide death rate. Some have hypothesized that economic social determinants of health (SDH) may be responsible for the recent increase in DOD. The current study, using secondary data, sought to identify what county-level SDH were significantly associated with county-level DOD. Using backward regression methodology, the results of the analysis indicate that 44% of the variance in county-level DOD is significantly associated with six county-level SDH: (a) Recent Medical Checkup, (b) Income, (c) Education Level, (d) Age, (e) Mental Health Professionals, and (f) the Income × Age interaction term. Higher than average income, age, and mental health professionals in a Florida county was associated with significantly higher rates of DOD. Higher than average levels of education and recent checkups in a Florida county were associated with a significant decrease in DOD. Possible explanations and implications are discussed.

Osteoporosis and osteopenia in the distal forearm predict all-cause mortality independent of grip strength: 22-year follow-up in the population-based Tromsø Study

Low bone mineral density (BMD) gives an increased risk of fractures, which can lead to premature death. Can BMD of the wrist predict mortality? BMD consistent with osteopenia and osteoporosis gave a significantly increased risk of death for both men and women in a general population in Tromsø, Norway.

INTRODUCTION

To investigate if bone mineral density (BMD) levels of the distal forearm, consistent with osteopenia and osteoporosis, can predict mortality and if grip strength is an effect modifier.

METHODS

The study population constituted 6565 participants aged 50-79 years at baseline in the Tromsø Study wave 4 conducted in 1994-1995. Forearm BMD measured by SXA was categorized as "normal," "osteopenia," or "osteoporosis" following WHO's definition. Cox regression with all-cause mortality as the outcome over 22 years of follow-up was performed for men and women separately, adjusting for health-related factors, as well as BMD by grip strength interaction. A secondary analysis with a 15-year follow-up also adjusted for hip fractures and osteoporotic fractures.

RESULTS

During follow-up, 3176 of participants died (47%). Those categorized as osteoporotic had higher mortality hazard ratio (HR) compared to those with normal BMD; men HR = 1.37 (95% confidence interval (CI) 1.19, 1.58) and women HR = 1.32 (1.14, 1.53) were adjusted for age, body mass index, physical activity, smoking habits, education, health status, chronic diseases, and grip strength. Corresponding HRs for osteopenia were men HR = 1.13 (1.00, 1.27) and women HR = 1.17 (1.01, 1.35). Further adjustments for fractures did only marginally attenuate the results, and HRs were still significant. There was no grip strength by BMD interaction.

CONCLUSION

Men and women with low distal forearm BMD values, consistent with osteoporosis or osteopenia, had an increased mortality compared to normal BMD participants. High grip strength did not modify this association, and the association remained after adjustment for a range of health-related factors.