Air quality and life expectancy in the United States: An analysis of the moderating effect of income inequality

Examining the dynamics between economic development, tourism, renewable energy and life expectancy in the Nordic economies

As the world struggles with pressing issues like climate change and sustainable development, affecting health outcomes and environmental quality, the Nordic regionsare at the forefront of major global challenges. This paper investigates the role of human capital, renewable energy use, tourism, natural resources, and economic growth in shaping life in the Nordic region i.e., Denmark, Norway, Sweden, Finland, and Iceland).Utilizing panel data spanning from 1990 to 2020, the Driscoll and Kraay standard error (DSK) technique is employed to analyze this intricate interplay. The study reveals that in the Nordic context, sustainable economic growth, bolstered by investments in human capital and the widespread acceptance of renewable energy sources, has been positively associated with increased life expectancies. Furthermore, prudent management of natural resources has helped mitigate adverse health effects related to depletion, maintaining environmental and public health standards. The thriving tourism industry has also been shown to influence lifespan in this region positively. On the contrary, the empirical finding contended that an adverse correlation exists between carbon emissions and LEX. This research underscores the importance of a comprehensive and balanced approach that considers economic development, sustainable development, and public health in pursuing longer and healthier lives, providing valuable insights for policymakers and regions seeking to replicate these positive outcomes.The findings of this study are both conceptually reliable and empirically robust, providing important insights for the formulation of environmental and health policy.

Income Inequality, Economic Complexity, and Renewable Energy Impacts in Controlling Consumption-Based Carbon Emissions

Although many studies have been conducted on the role of renewable energy in the environment, literature has ignored the potential role of socioeconomic indicators in renewable energy and pollution nexus. Also, critical questions arose with the critical factors, such as income inequality and economic complexity, have not been answered properly. This study explores the nexus between income inequality, economic complexity, renewable energy consumption, GDP per capita, and pollution and thus aims to reach efficient policy strategies by revealing empirical evidence. The study follows an environmental impact model structure and conducts the panel-corrected standard errors and fixed effect regression. BRICS countries (Brazil, Russia, India, China, and South Africa) are selected to conduct our research. Annual data covering the period 1990-2017 for the sample countries are employed. Consumption-based carbon dioxide emissions as an indicator of environmental pollution are used since income inequality makes more sense in terms of the consumption side of an economy and is more related to consumers rather than the production sector. The obtained results reveal that income inequality has a positive and significant impact on consumption-based carbon dioxide emissions. However, GDP per capita, renewable energy, and economic complexity reduce pollution. It is also observed that the interaction term of inequality and renewable energy decreases emissions. Findings confirm that socioeconomic indicators, such as economic complexity and income inequality with the interaction of renewable energy, are crucial factors in reducing emissions and designing a greener future.

Just Transition on air quality governance: a case study of heavy-duty diesel truck protests in Taiwan

Just Transitions are gaining attention in environmental research, and most studies have focused on climate change; however, the insights from this work may be usefully applied to the rarely discussed area in just transition studies. This article uses traditional dimensions of environmental and social justice, such as distributive, procedural, recognition, and restorative justice, to understand why heavy-duty diesel truck drivers fought back against stricter air pollution regulations while demanding destigmatization. The protest resulted in policy failure, and Taiwan's transition to cleaner, newer diesel trucks were halted. This study finds that the key social contextual factor in Taiwan's transportation industry was the labor relations of license-leasing. The drivers' protest began with a lack of procedural justice, and communication occurred only after the law was passed. There was insufficient regard for procedural justice, and although the drivers were concerned, the new rule would significantly impact their right to work and life. Furthermore, the drivers felt disrespected and even carried the stigma of creating environmental pollution. The article assumes that the results should be different if the governance mechanism can handle the key factor in a social context and make appropriate arrangements for the four dimensions of Just Transition. This argument may be relevant for other countries looking to transition from older diesel vehicles to cleaner vehicles through Just Transition.

Income Inequality and Population Health: Examining the Role of Social Policy

Studies of the relationship between income inequality and life expectancy often speculate about the role of policy, but direct empirical research is limited. Drawing on the neo-materialist perspective, we examine whether the longitudinal association between income inequality and life expectancy is mediated and moderated by policy liberalism in U.S. states (2000-2014). More liberal policy contexts are characterized by greater efforts to regulate the economy, redistribute income, and protect vulnerable groups and lesser efforts to penalize deviant social behavior. We find that state-level income inequality is inversely associated with policy liberalism and life expectancy. The association between income inequality and life expectancy was not mediated by policy liberalism but was moderated by it. The association is attenuated in states with more liberal policy contexts, supporting the neo-materialist perspective. This finding illustrates how states like New York and California (with liberal policy contexts) can exhibit high income inequality and high life expectancy.

Air pollution, governance quality, and health outcomes: evidence from developing countries

While studies have demonstrated that air pollution can be catastrophic to the population's health, few empirical studies are found in the economic literature because a considerable proportion of the evidence comes from epidemiological studies. Because of the crucial role of governance in the health community, good governance has been a contentious issue in public sector management in recent years. Therefore, the aim of this study is to examine the effects of air pollution and the role of governance on health outcomes. This study employed the generalized method of moment (GMM) estimation techniques to analyse panel data for 72 developing countries from 2010 to 2017. The empirical results confirm that higher PM_2.5 and CO₂ levels have a detrimental influence on life expectancy and healthy life expectancy, whereas the role of governance has a positive impact on life expectancy and healthy life expectancy. Furthermore, the findings show governance quality plays a role in moderating the negative effect of PM_2.5 on health outcomes. The ongoing rise in air pollution has had a significant impact on the health of developing countries. It appears that governance quality has improved health outcomes. The findings have important policy implications, such that strengthening governance can reduce air pollution emissions in developing countries. However, to reduce the health effects of air pollution, developing countries must implement effective environmental development policies and track the implementation and enforcement of such policies.

Environmental factors and its influence on human health in BRICS: implications for human development

BRICS economies are facing severe environmental issues that exert a detrimental impact on human health. The analysis intends to examine the impact of CO₂ emissions, environmental policy stringency, and environmental innovations on health outcomes for the BRICS economies. The long-run results of the ARDL-PMG infer that CO₂ has a significant negative in the life expectancy model while it has a significant positive in the death rate model. These findings imply that the rise in CO₂ emissions reduces life expectancy and increases the death rate in BRICS economies. On the other side, the estimates of environmental innovation and environmental policy stringency are positively significant in the life expectancy model; however, in the death rate model, the estimate of environmental innovation is insignificant, and environmental policy stringency is negatively significant in the death rate model. In a nutshell, the findings imply that CO₂ emissions exacerbate health problems, environmental innovations, and environmental policy stringency, improving the health status of the people. Our findings suggest that the BRICS economies should revisit their environmental policies for the betterment of human health.

Air Pollution and Migration Decision of Migrants in Low-Carbon Society

The influence of environmental quality on the quality of urban life and on migration decisions is an important research issue in urban economics and environmental economics. Using the 2012-2014 China Labor Dynamics Survey data (CLDS), this paper uses a conditional logit model (CLM) and Instrumental Variable (IV) estimation to examine the impact of air pollution on the migrant migration decision. We find that air pollution significantly negatively impacts the migration decisions of migrants. Specifically, if the PM2.5 level of a city increases by 10 μg/m³, the probability of migrants flowing into the city will be significantly reduced by 21.2%. It shows that migrants choose to flow into cities with better spatial quality to reduce the risk of exposure to air pollution. After controlling for the characteristics of the outflow and the reasons for the flow, the impact of air pollution on migrants' migration decisions remains robust. Heterogeneity analysis shows that middle-aged, male, married, and highly educated migrants are more sensitive to air pollution. This paper enriches the research on air pollution and labor mobility at the micro level and provides empirical evidence for policymaking related to environmental governance and labor mobility in a low-carbon society.

Beyond COP26: can income level moderate fossil fuels, carbon emissions, and human capital for healthy life expectancy in Africa?

The growing concerns on the need to moderate the unceasing surge in global greenhouse gas (GHG) emissions believed to be detrimental to the environment and wellbeing of the human race have generated concerted efforts from governments and policymakers worldwide. Among many other factors, fossil fuels which remain the most consumed energy resource have been identified as the primary culprit to demeaning life expectancy. To this end, this study probes how income mediates between fossil fuels and carbon emissions to promote life expectancy in selected oil-abundant African economies from 1980 to 2019. The roles of human capital through investment in education are considered in the current inquiry. The empirical evidence is anchored on second-generation tests comprising cross-sectional dependence, slope homogeneity, and Westerlund cointegration tests. The empirical model is estimated based on advanced panel techniques comprising cross-sectional dependence autoregressive distributed lag model, common correlated effects mean group, augmented mean group, and quantile regression. Findings from the study reveal that fossil fuels and carbon emissions reduce life expectancy. Besides, income level promotes healthy life expectancy while equally subduing the negative impacts of fossil fuels on it. Additionally, the life-improving roles of human capital are empirically confirmed. Based on the findings, withdrawing the subsidies on fossil fuels and making aggregate income inclusive are among the key policies formulated.

Air Pollution, Health Shocks and Labor Mobility

The health shocks caused by air pollution seriously interfere with people’s economic life. Based on the air pollution index and health shock index calculated by the principal component entropy weight method, this article analyzes the impact of air pollution on labor mobility, and adopts the mediation effect model to test the mediation effect of health shocks, using the threshold model to analyze the time and the health shocks threshold effect of air pollution on labor mobility. Its conclusions are as follows: (1) Air pollution has a negative impact on the net inflow of labor mobility, and the net inflow of labor mobility decreases between 24.9% and 44.7% on average for each unit increase in the health shocks of air pollution. (2) The impact of air pollution on labor mobility is all caused by health shocks; the health shocks are also an important factor influencing the decrease in the labor mobility supply across provinces, and the different health levels of the migrating individuals due to air pollution. (3) The health shocks of air pollution have a single-time threshold effect on labor mobility, and the health shocks of air pollution in China have intensified after 2010, confirming that China’s Lewis turning point was 2010. (4) The attraction effect of stable and higher regional real income will partially offset the repulsion effect of health shocks of air pollution on labor mobility, when the health-shocks index of air pollution exceeds the threshold value of 1.9873. Finally, the policy implications of the health shocks of air pollution on labor mobility are also formulated.

Air pollution and life expectancy in Europe: Does investment in renewable energy matter?

This study examines the relationship between health and air pollution using a novel approach that allows differentiation between potential and observed health. It also permits an analysis of those factors that may contribute towards reducing any differences between the latter concepts. To this end, a panel data from 29 European countries for the periods 2005 and 2018 is used. Results indicate that the main pollutants affecting European countries, namely NOx, PM10 and PM2.5 have a negative impact on life expectancy at birth, while investment in renewable energies has a positive effect. Several conclusions can be drawn from these results. Firstly, if the aim is to minimize the detrimental effects of the global production of goods and services on air quality, a greater investment in renewable energies as compared to other more polluting ones, is called for. In turn, this would contribute to an improvement in the general health of citizens and the planet thereby increasing overall potential life expectancy. Secondly, NOx gases seem to be the ones that most affect the population's mean potential life expectancy. Results indicate that with regard to particulate matters, those with a diameter of less than 2.5 μm, are the ones that have the greatest impact on the health of European citizens, more so than larger particles (with a diameter between 10 and 2.5 μm).

Impact of Income Inequality on Urban Air Quality: A Game Theoretical and Empirical Study in China

Income inequality and environmental pollution are of great concern in China. It is important to better understand whether the narrowing of income inequality and environmental improvement contradict each other. The study aims to investigate the linkage between income inequality and environmental pollution. To illustrate the interplay between different income groups on environmental issues, we apply a mixed-strategy game. Based on the game-theoretic analytical result, the probability of residents supporting clean energy and environmental protection decreases as income inequality widens and increases as inequality narrows. This empirical study is based on the proportion of coal consumption and urban air pollution data from 113 key environmental protection cities and regions in China. The air quality data are from the National Environmental Air Quality Monitoring Network published in the China Statistical Yearbook from 2014–2018. Convincing results show that regions with higher income inequality suffer severe smog and related pollution and that economies with narrow income disparity experience significant improvements in smog and pollution control, with the expansion of the proportion of clean energy use. The results also provide no evidence of the impact of per capita income on pollution. We studied the relationship between individuals of different wealth levels within an economy, within a repeated-game setting. The finding suggests that the distribution of growth impacts pollution. Imposing higher taxes on air polluters while transferring the revenue to the lower-income group is suggested.

Acute effects of ambient air pollution on clinic visits of college students for upper respiratory tract infection in Wuhan, China

Ambient air pollutants have been linked to adverse health outcomes, but evidence is still relatively rare in college students. Upper respiratory tract infection (URTI) is a common disease of respiratory system among college students. In this study, we assess the acute effect of air pollution on clinic visits of college students for URTI in Wuhan, China. Data on clinic visits due to URTI were collected from Wuhan University Hospital, meteorological factors (including daily temperature and relative humidity) provided by Wuhan Meteorological Bureau, and air pollutants by Wuhan Environmental Protection Bureau. In the present study, generalized additive model with a quasi-Poisson distribution link function was used to examine the association between ambient air pollutants (fine particulate matter (PM2.5), particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3)) and the daily number of clinic visits of college students for URTI at Wuhan University Hospital in Wuhan, China. In the meantime, the model was adjusted for the confounding effects of long-term trends, seasonality, day of the week, public holidays, vacation, and meteorological factors. The best degrees of free in model were selected based on AIC (Akaike Information Criteria). The effect modification by gender was also examined. A total of 44,499 cases with principal diagnosis of URTI were included from January 1, 2016, to December 31, 2018. In single-pollutant models, the largest increment of URTI visits were found at lag 0 day in single-day lags, and the effect values in cumulative lags were greater than those in single-day lags. PM2.5 (0.74% (95%CI: 0.05, 1.44)) at lag 0 day, PM10 (0.61% (95%CI: 0.12, 1.11)) and O3 (1.01% (95%CI: 0.24, 1.79)) at lag 0-1 days, and SO2 (9.18% (95%CI: 3.27, 15.42)) and NO2 (3.40% (95% CI:1.64, 5.19)) at lag 0-3 days were observed to be strongly and significantly associated with clinic visits for URTI. PM10 and NO2 were almost still significantly associated with URTI after controlling for the other pollutants in our two-pollutant models, where the effect value of SO2 after inclusion of O3 appeared to be the largest and the effects of NO2 were also obvious compared with the other pollutants. Subgroups analysis demonstrated that males were more vulnerable to PM10 and O3, while females seemed more vulnerable to exposure to SO2 and NO2. This study implied that short-term exposure to ambient air pollution was associated with increased risk of URTI among college students at Wuhan University Hospital in Wuhan, China. And gaseous pollutants had more negative health impact than solid pollutants. SO2 and NO2 were the major air pollutants affecting the daily number of clinic visits on URTI, to which females seemed more vulnerable than males.

Confounding by Socioeconomic Status in Epidemiological Studies of Air Pollution and Health: Challenges and Opportunities

BACKGROUND

Despite a vast air pollution epidemiology literature to date and the recognition that lower-socioeconomic status (SES) populations are often disproportionately exposed to pollution, there is little research identifying optimal means of adjusting for confounding by SES in air pollution epidemiology, nor is there a strong understanding of biases that may result from improper adjustment.

OBJECTIVE

We aim to provide a conceptualization of SES and a review of approaches to its measurement in the U.S. context and discuss pathways by which SES may influence health and confound effects of air pollution. We explore bias related to measurement and operationalization and identify statistical approaches to reduce bias and confounding.

DISCUSSION

Drawing on the social epidemiology, health geography, and economic literatures, we describe how SES, a multifaceted construct operating through myriad pathways, may be conceptualized and operationalized in air pollution epidemiology studies. SES varies across individuals within the contexts of place, time, and culture. Although no single variable or index can fully capture SES, many studies rely on only a single measure. We recommend examining multiple facets of SES appropriate to the study design. Furthermore, investigators should carefully consider the multiple mechanisms by which SES might be operating to identify those SES indicators that may be most appropriate for a given context or study design and assess the impact of improper adjustment on air pollution effect estimates. Last, exploring model contraction and expansion methods may enrich adjustment, whereas statistical approaches, such as quantitative bias analysis, may be used to evaluate residual confounding. https://doi.org/10.1289/EHP7980.

Adopting a "Compound" Exposome Approach in Environmental Aging Biomarker Research: A Call to Action for Advancing Racial Health Equity

BACKGROUND

In June 2020, the National Academies of Sciences, Engineering, and Medicine hosted a virtual workshop focused on integrating the science of aging and environmental health research. The concurrent COVID-19 pandemic and national attention on racism exposed shortcomings in the environmental research field's conceptualization and methodological use of race, which have subsequently hindered the ability of research to address racial health disparities. By the workshop's conclusion, the authors deduced that the utility of environmental aging biomarkers-aging biomarkers shown to be specifically influenced by environmental exposures-would be greatly diminished if these biomarkers are developed absent of considerations of broader societal factors-like structural racism-that impinge on racial health equity.

OBJECTIVES

The authors reached a post-workshop consensus recommendation: To advance racial health equity, a "compound" exposome approach should be widely adopted in environmental aging biomarker research. We present this recommendation here.

DISCUSSION

The authors believe that without explicit considerations of racial health equity, people in most need of the benefits afforded by a better understanding of the relationships between exposures and aging will be the least likely to receive them because biomarkers may not encompass cumulative impacts from their unique social and environmental stressors. Employing an exposome approach that allows for more comprehensive exposure-disease pathway characterization across broad domains, including the social exposome and neighborhood factors, is the first step. Exposome-centered study designs must then be supported with efforts aimed at increasing the recruitment and retention of racially diverse study populations and researchers and further "compounded" with strategies directed at improving the use and interpretation of race throughout the publication and dissemination process. This compound exposome approach maximizes the ability of our science to identify environmental aging biomarkers that explicate racial disparities in health and best positions the environmental research community to contribute to the elimination of racial health disparities. https://doi.org/10.1289/EHP8392.

Chronic exposure to PM2.5 aggravates SLE manifestations in lupus-prone mice

Background

Air pollution causes negative impacts on health. Systemic lupus erythematosus (SLE) is an autoimmune disease with diverse clinical manifestations and multifactorial etiology. Recent studies suggest that air pollution can trigger SLE and induce disease activity. However, this association has not been deeply investigated. Thus, the aim of this study was to evaluate whether exposure to fine particulate matter (PM2.5) exacerbates SLE manifestations, focusing on renal complications, in a lupus-prone animal model. Female NZBWF1 mice were exposed daily to 600 μg/m³ of inhaled concentrated ambient particles (CAP) or filtered air (FA). Survival rate, body weight, weight of organs (kidney, spleen, thymus, liver and heart), blood cell count, proteinuria, kidney stereology, renal histopathology, gene expression and oxidative stress were analyzed.

Results

Female NZBW mice exposed to CAP showed decreased survival, increased circulating neutrophils, early onset of proteinuria and increased kidney weight with renal cortex enlargement when compared to NZBW mice exposed to FA.

Conclusions

This work shows that air pollution aggravates some SLE manifestations in lupus-prone mice. These results reinforce the need of reducing air pollutant levels in order to promote a better quality of life for individuals diagnosed with SLE.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12989-021-00407-0.

Trends of biomarkers of cardiovascular disease in the United States by income: Disparities between the richest 20% and the poorest 80%,1999-2018

INTRODUCTION

Income inequality between the richest 20% and the poorest 80% in the United States has been increasing over the past two decades. Emerging evidence indicates widening disparities between the two groups in cardiovascular disease prevalence as well. However, the mechanisms behind this trend remains unclear. This analysis examines whether a similar trend exists in the levels of biomarkers and risk factors of cardiovascular disease in the United States.

METHODS

We conducted a serial cross-sectional analysis of a nationally representative data from the National Health and Nutrition Examination Survey (NHANES) for participants age 20 or older between 1999 and 2018. We calculated trends in age-standardized means of body mass index (BMI), systolic blood pressure (SBP), and high-density lipoproteins (HDL) and the trend in prevalence of obesity, high SBP, and low HDL by income group.

RESULTS

This analysis included 49,764 participants. Age-standardized mean BMI increased every two years by an average of 0.15 kg/m 2 among the richest 20% and by an average of 0.21 kg/m 2 among the poorest 80%. Age-standardized mean SBP decreased every two years by an average of 0.13 mm Hg among the richest 20% and by an average of 0.10 mm Hg among the poorest 80%. Age-standardized mean HDL increased every two years by an average of 0.39 mg/dL among the richest 20% and by an average of 0.19 mg/dL among the poorest 80%. When adjusted for demographic factors and time, the richest 20% had lower mean BMI (OR = -0.67, 95% CI: -0.89, - 0.44), lower mean SBP (OR = -0.72, 95% CI: -1.24, -0.20), and higher mean HDL (OR = 3.04, 95% CI: 2.46, 3.62) compared to the poorest 80.

CONCLUSION

There are increasing disparities in cardiovascular disease biomarkers by income in the US. Between 1999 and 2018, improvement in biomarkers overwhelmingly occurred among the richest 20.

A Systematic Review of Sociodemographic, Macroeconomic, and Health Resources Factors on Life Expectancy

This review was aimed at systematically synthesizing and appraising the existing literature of sociodemographic, macroeconomic, and health resources factors on life expectancy. A systematic literature search of English databases, that is, PubMed/MEDLINE were scrutinized for exploring sociodemographic, macroeconomic, and health resources factors on life expectancy. The literature search was conducted in January 2020, covering a total of 46 articles from 2004 to 2019 met the review criteria, which were fully discussed subsequently. Among sociodemographic factors, infant mortality rate, literacy rate, education level, socioeconomic status, population growth, and gender inequality have a significant impact on life expectancy. Gross domestic product, Gini, income level, unemployment rate, and inflation rate are the main macroeconomic factors that significantly correlated with life expectancy. Among various health care resources, health care facilities, the number of the health care profession, public health expenditure, death rates, smoking rate, pollution, and vaccinations had a significant correlation with life expectancy. The systematic review showed general conformity of different studies, with a significant association between life expectancy and factors comprising several sociodemographic, macroeconomic, and various health care variables. This review found that only one study examined factors affecting life expectancy in Arabic countries. More studies on this region to fill this research gap were highly recommended.

What Is Driving the Drug Overdose Epidemic in the United States?

The demand-side perspective argues that the drug overdose epidemic is a consequence of changes in the economy that leave behind working-class people who lack a college education. In contrast, the supply-side perspective maintains that the epidemic is primarily due to changes in the licit and illicit drug environment, whereas a third, distinct perspective argues that income inequality is likely a key driver of the epidemic. To evaluate these competing perspectives, we use a two-level random intercept model and U.S. state-level data from 2006 to 2017. Contrary to the demand-side approach, we find that educational attainment is not associated with drug-related mortality. In support of the supply-side approach, we provide evidence indicating that opioid prescription rates are positively associated with drug-related mortality. We also find that income inequality is a key driver of the epidemic, particularly the lack of resources going to the bottom 20% of earners. We conclude by arguing that considerations of income inequality are an important way to link the arguments made by the demand-side and the supply-side perspectives.

Particulate air pollution, birth outcomes, and infant mortality: Evidence from Japan's automobile emission control law of 1992

This study investigates the impacts of the Automobile NO_x Law of 1992 on ambient air pollutants and fetal and infant health outcomes in Japan. Using panel data taken from more than 1500 monitoring stations between 1987 and 1997, we find that NO_x and SO₂ levels reduced by 5% and 11%, respectively in regulated areas following the 1992 regulation. In addition, using a municipal-level panel data set from Japan's Vital Statistics Survey and a difference-in-differences approach, we find that the regulation explains most of the improvements in the fetal death rate after the regulation came into effect. This study provides evidence on the positive impacts of this large-scale automobile regulation policy on fetal health.

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We estimate the effects of Automobile NOx Law on fetal and infant health.

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Monitoring station-level and municipal-level panel datasets are used.

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Regression differences-in-differences models are adopted.

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NOx and SO₂ levels were reduced by 5% and 11% by the regulation.

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The fetal death rate was substantially improved by the regulation.

Caregiving and Place: Combining Geographic Information System (GIS) and Survey Methods to Examine Neighborhood Context and Caregiver Outcomes

Background

Little is known about the impact of neighborhood context on family caregivers, or how environmental factors combine with individual-level caregiver risk factors to affect caregiver outcomes.

Objectives

To combine Geographic Information System (GIS) and survey methods to examine the effects of caregiver residence in disadvantaged/underserved neighborhoods on caregiver outcomes.

Research Design and Methods

Telephone surveys with 758 caregivers from the Pittsburgh Regional Caregiver Survey geocoded for classification into Environmental Justice Areas (EJAs) and Medically Underserved Areas (MUAs). We examine the impact of EJA/MUA caregiver residence on care recipient unmet needs for care, caregiver depression and burden, and positive aspects of caregiving, adjusting for sociodemographics, caregiving context, care recipient disability level, caregiving intensity, and additional risk factors.

Results

There was spatial clustering of caregiver depression and burden outside of the disadvantaged/underserved areas, while positive aspects of caregiving were clustered within EJAs/MUAs. Approximately 36% of caregivers lived in EJAs/MUAs, and they differed, sociodemographically, on caregiver risk factors and caregiver outcomes. Multivariable models showed that caregivers residing in EJAs/MUAs were less likely to be depressed and reported more positive aspects of caregiving after adjusting for known individual-level risk factors. Residence in disadvantaged/underserved areas also modified the effects of several risk factors on caregiver outcomes.

Discussion and Implications

Caregiver outcomes show interesting spatial patterns. Unexpectedly, caregivers living in these potentially challenging environments were less depressed and reported more gains from caregiving after adjusting for known risk factors. Results suggest that socioeconomic disadvantage does not necessarily translate into poor caregiver outcomes. Understanding the mechanism for these effects is important to designing effective caregiver interventions. The paper also demonstrates the value of using GIS methods to study caregiving.

A new approach to study the relative age effect with the use of additive logistic regression models: A case of study of FIFA football tournaments (1908-2012)

The relative age effect plays an important role in the pursuit of excellence, providing advantage to athletes born at the beginning of the year or near the cut-off date. This phenomenon has been observed in areas such as sports, education or business. Traditionally, the chi-square test has been used to analyze whether there are statistically significant differences in the distribution of births in each of the four quarters of the year. However, this approach is limited, focusing only on the analysis of the response variable, without taking into account the effect of a set of predictive variables. In this paper a new approach is proposed to study the relative age effect with the use of a logistic regression additive model. The new method has been evaluated with a sample of 21,639 players involved in football tournaments organized by the Fédération Internationale de Football Association (FIFA) between 1908 and 2012. New conclusions have been established that the relative age effect exists regarding player age and the year of the competition in male FIFA competitions and its effect is dynamic and complex.

Putting 'place' in its place: Comparing place-based factors in interurban analyses of life expectancy in the United States

Extant interurban research in life expectancy greatly suffers from an underestimation of the role of place. Place is often conceptualized as a level of geography; this view ignores categorical differences between types of places. In addition, despite advances in theory and research that support their use, many important place-based factors remain under-utilized as control variables. We use multivariate analyses of life expectancy for the top and bottom quartiles of household income by sex in 148 US counties to compare the strengths of seventeen diverse variables. We find that cities' built, natural, and social environments play strong roles in life expectancy disparity among cities; many place-based variables consistently compare in strength to well-known control variables such as race, education, and behaviors. Furthermore, we find that place impacts men and women differently, even within the same income quartile. Indeed, some factors are associated with higher life expectancy in some demographic groups, and lower life expectancy in others. Researchers can protect against omitted variable bias when investigating public health outcomes by using a wider range of control variables. Researchers should also use better measures of place, and consider selecting specific cases to study.