1
|
Zang E, Tian M. Upward Mobility Context and Health Outcomes and Behaviors during Transition to Adulthood: The Intersectionality of Race and Sex. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465231223944. [PMID: 38279819 DOI: 10.1177/00221465231223944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
This study investigates how upward mobility context affects health during transition to adulthood and its variations by race and sex. Using county-level upward mobility measures and data from the Panel Study of Income Dynamics, we apply propensity score weighting techniques to examine these relationships. Results show that low upward mobility context increases the likelihood of poor self-rated health, obesity, and cigarette use but decreases alcohol consumption probability. Conversely, high upward mobility context raises the likelihood of distress, chronic conditions, and alcohol use but reduces cigarette use likelihood. In low-opportunity settings, Black individuals have lower risks of chronic conditions and cigarette use than White men. In high-opportunity settings, Black women are more likely to experience depression and chronic conditions, and Black men are likelier to smoke than White men. Our findings emphasize the complex link between upward mobility context and health for different racial and sex groups.
Collapse
|
2
|
Weeks WB, Chang JE, Pagán JA, Lumpkin J, Michael D, Salcido S, Kim A, Speyer P, Aerts A, Weinstein JN, Lavista JM. Rural-urban disparities in health outcomes, clinical care, health behaviors, and social determinants of health and an action-oriented, dynamic tool for visualizing them. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002420. [PMID: 37788228 PMCID: PMC10547156 DOI: 10.1371/journal.pgph.0002420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023]
Abstract
While rural-urban disparities in health and health outcomes have been demonstrated, because of their impact on (and intervenability to improve) health and health outcomes, we sought to examine cross-sectional and longitudinal inequities in health, clinical care, health behaviors, and social determinants of health (SDOH) between rural and non-rural counties in the pre-pandemic era (2015 to 2019), and to present a Health Equity Dashboard that can be used by policymakers and researchers to facilitate examining such disparities. Therefore, using data obtained from 2015-2022 County Health Rankings datasets, we used analysis of variance to examine differences in 33 county level attributes between rural and non-rural counties, calculated the change in values for each measure between 2015 and 2019, determined whether rural-urban disparities had widened, and used those data to create a Health Equity Dashboard that displays county-level individual measures or compilations of them. We followed STROBE guidelines in writing the manuscript. We found that rural counties overwhelmingly had worse measures of SDOH at the county level. With few exceptions, the measures we examined were getting worse between 2015 and 2019 in all counties, relatively more so in rural counties, resulting in the widening of rural-urban disparities in these measures. When rural-urban gaps narrowed, it tended to be in measures wherein rural counties were outperforming urban ones in the earlier period. In conclusion, our findings highlight the need for policymakers to prioritize rural settings for interventions designed to improve health outcomes, likely through improving health behaviors, clinical care, social and environmental factors, and physical environment attributes. Visualization tools can help guide policymakers and researchers with grounded information, communicate necessary data to engage relevant stakeholders, and track SDOH changes and health outcomes over time.
Collapse
Affiliation(s)
- William B. Weeks
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| | - Ji E. Chang
- School of Global Public Health, New York University, New York, New York, United States of America
| | - José A. Pagán
- School of Global Public Health, New York University, New York, New York, United States of America
| | - Jeffrey Lumpkin
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| | - Divya Michael
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| | - Santiago Salcido
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| | - Allen Kim
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| | | | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
| | - James N. Weinstein
- Microsoft Research, Microsoft Corporation, Redmond, Washington, United States of America
- The Dartmouth Institute and Tuck School of Business, Dartmouth College, Hanover, New Hampshire, United States of America
- Kellogg School of Business, Northwestern University, Evanston, Illinois, United States of America
| | - Juan M. Lavista
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| |
Collapse
|
3
|
Weeks WB, Chang JE, Pagán JA, Aerts A, Weinstein JN, Ferres JL. An observational, sequential analysis of the relationship between local economic distress and inequities in health outcomes, clinical care, health behaviors, and social determinants of health. Int J Equity Health 2023; 22:181. [PMID: 37670348 PMCID: PMC10478428 DOI: 10.1186/s12939-023-01984-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/10/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Socioeconomic status has long been associated with population health and health outcomes. While ameliorating social determinants of health may improve health, identifying and targeting areas where feasible interventions are most needed would help improve health equity. We sought to identify inequities in health and social determinants of health (SDOH) associated with local economic distress at the county-level. METHODS For 3,131 counties in the 50 US states and Washington, DC (wherein approximately 325,711,203 people lived in 2019), we conducted a retrospective analysis of county-level data collected from County Health Rankings in two periods (centering around 2015 and 2019). We used ANOVA to compare thirty-three measures across five health and SDOH domains (Health Outcomes, Clinical Care, Health Behaviors, Physical Environment, and Social and Economic Factors) that were available in both periods, changes in measures between periods, and ratios of measures for the least to most prosperous counties across county-level prosperity quintiles, based on the Economic Innovation Group's 2015-2019 Distressed Community Index Scores. RESULTS With seven exceptions, in both periods, we found a worsening of values with each progression from more to less prosperous counties, with least prosperous counties having the worst values (ANOVA p < 0.001 for all measures). Between 2015 and 2019, all except six measures progressively worsened when comparing higher to lower prosperity quintiles, and gaps between the least and most prosperous counties generally widened. CONCLUSIONS In the late 2010s, the least prosperous US counties overwhelmingly had worse values in measures of Health Outcomes, Clinical Care, Health Behaviors, the Physical Environment, and Social and Economic Factors than more prosperous counties. Between 2015 and 2019, for most measures, inequities between the least and most prosperous counties widened. Our findings suggest that local economic prosperity may serve as a proxy for health and SDOH status of the community. Policymakers and leaders in public and private sectors might use long-term, targeted economic stimuli in low prosperity counties to generate local, community health benefits for vulnerable populations. Doing so could sustainably improve health; not doing so will continue to generate poor health outcomes and ever-widening economic disparities.
Collapse
Affiliation(s)
| | - Ji E Chang
- NYU School of Global Public Health, New York, NY, USA
| | - José A Pagán
- NYU School of Global Public Health, New York, NY, USA
| | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
| | | | | |
Collapse
|
4
|
Chen H, Duan Q, Zhu H, Wan S, Zhao X, Ye D, Fang X. Short-term association of CO and NO 2 with hospital visits for glomerulonephritis in Hefei, China: a time series study. Front Public Health 2023; 11:1239378. [PMID: 37670834 PMCID: PMC10475946 DOI: 10.3389/fpubh.2023.1239378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/24/2023] [Indexed: 09/07/2023] Open
Abstract
Objective Recent studies suggest air pollution as an underlying factor to kidney disease. However, there is still limited knowledge about the short-term correlation between glomerulonephritis (GN) and air pollution. Thus, we aim to fill this research gap by investigating the short-term correlation between GN clinical visits and air pollution exposure. Methods Between 2015 and 2019, daily GN visit data from two grade A tertiary hospitals in Hefei City were collected, along with corresponding air pollution and meteorological data. A generalized linear model integrated with a distributed lag nonlinear model was employed to analyze the relationship between GN visits and air pollutants. Moreover, we incorporated a dual pollutant model to account for the combined effects of multiple pollutants. Furthermore, subgroup analyses were performed to identify vulnerable populations based on gender, age, and season. Results The association between 23,475 GN visits and air pollutants was assessed, and significant positive associations were found between CO and NO2 exposure and GN visit risk. The single-day lagged effect model for CO showed increased risks for GN visits from lag0 (RR: 1.129, 95% CI: 1.031-1.236) to lag2 (RR: 1.034, 95% CI: 1.011-1.022), with the highest risk at lag0. In contrast, NO2 displayed a more persistent impact (lag1-lag4) on GN visit risk, peaking at lag2 (RR: 1.017, 95% CI: 1.011-1.022). Within the dual-pollutant model, the significance persisted for both CO and NO2 after adjusting for each other. Subgroup analyses showed that the cumulative harm of CO was greater in the cold-season and older adult groups. Meanwhile, the female group was more vulnerable to the harmful effects of cumulative exposure to NO2. Conclusion Our study indicated that CO and NO2 exposure can raise the risk of GN visits, and female and older adult populations exhibited greater susceptibility.
Collapse
Affiliation(s)
- Haifeng Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Qiong Duan
- Department of Health Management Center, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Huahui Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Shuai Wan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Xinyi Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Dongqing Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Xinyu Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| |
Collapse
|
5
|
Poulson MR, Papageorge MV, LaRaja AS, Kenzik KM, Sachs TE. Socioeconomic Mediation of Racial Segregation in Pancreatic Cancer Treatment and Outcome Disparities. Ann Surg 2023; 278:246-252. [PMID: 35837973 DOI: 10.1097/sla.0000000000005543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To understand the mediating effect of socioeconomic factors on the association between residential segregation and racial disparities in pancreatic cancer (PC). BACKGROUND Black patients with PC present at a later stage and have worse mortality than White patients. These disparities have been explained by the level of residential segregation. METHODS Data were obtained from Surveillance, Epidemiology, and End-Results (SEER) and included all Black and White patients who were diagnosed with PC between 2005 and 2015. The primary exposure variable was the Index of Dissimilarity, a validated measure of segregation. County-level socioeconomic variables from the US Census were assessed as mediators. The primary outcomes were advanced stage at diagnosis, surgical resection for localized disease, and overall mortality. Generalized structural equation modeling was used to assess the mediation of each of the socioeconomic variables. RESULTS Black patients in the highest levels of segregation saw a 12% increased risk [relative risk=1.12; 95% confidence interval (CI): 1.08, 1.15] of presenting at an advanced stage, 11% decreased likelihood of undergoing surgery (relative risk=0.89; 95% CI: 0.83, 0.94), and 8% increased hazards of death (hazard ratio=1.08; 95% CI: 1.03, 1.14) compared with White patients in the lowest levels. The Black share of the population, insurance status, and income inequality mediated 58% of the total effect on the advanced stage. Poverty and Black income immobility mediated 51% of the total effect on surgical resection. Poverty and Black income immobility mediated 50% of the total effect on overall survival. CONCLUSIONS These socioeconomic factors serve as intervention points for legislators to address the social determinants inherent to the structural racism that mediate poor outcomes for Black patients.
Collapse
Affiliation(s)
- Michael R Poulson
- Department of Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | | | | | - Kelly M Kenzik
- Department of Surgery, Boston Medical Center, Boston, MA
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Teviah E Sachs
- Department of Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| |
Collapse
|
6
|
ANDERSON NATHANIELW, HALFON NEAL, EISENBERG DANIEL, MARKOWITZ ANNAJ, MOORE KRISTINANDERSON, ZIMMERMAN FREDERICKJ. Mixed Signals in Child and Adolescent Mental Health and Well-Being Indicators in the United States: A Call for Improvements to Population Health Monitoring. Milbank Q 2023; 101:259-286. [PMID: 37052602 PMCID: PMC10262392 DOI: 10.1111/1468-0009.12634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 01/13/2023] [Accepted: 02/02/2023] [Indexed: 04/14/2023] Open
Abstract
Policy Points Social indicators of young peoples' conditions and circumstances, such as high school graduation, food insecurity, and smoking, are improving even as subjective indicators of mental health and well-being have been worsening. This divergence suggests policies targeting the social indicators may not have improved overall mental health and well-being. There are several plausible reasons for this seeming contradiction. Available data suggest the culpability of one or several common exposures poorly captured by existing social indicators. Resolving this disconnect requires significant investments in population-level data systems to support a more holistic, child-centric, and up-to-date understanding of young people's lives.
Collapse
Affiliation(s)
| | - NEAL HALFON
- University of California Los Angeles Jonathan and Karin Fielding School of Public
- University of California Los Angeles David Geffen School of Medicine
- University of California Los Angeles Meyer and Renee Luskin School of Public Affairs
| | - DANIEL EISENBERG
- University of California Los Angeles Jonathan and Karin Fielding School of Public
| | - ANNA J. MARKOWITZ
- University of CaliforniaLos Angeles Graduate School of Education and Information Studies
| | | | - FREDERICK J. ZIMMERMAN
- University of California Los Angeles Jonathan and Karin Fielding School of Public
- University of California Los Angeles Meyer and Renee Luskin School of Public Affairs
| |
Collapse
|
7
|
Azap L, Azap R, Hyer M, Diaz A, Pawlik TM. The association of upward economic mobility with textbook outcomes among patients undergoing general and cardiovascular surgery. Am J Surg 2023; 225:494-498. [PMID: 36323621 DOI: 10.1016/j.amjsurg.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/23/2022] [Accepted: 10/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND While disadvantaged neighborhoods may be associated with worse outcomes and earlier death, the relationship between economic opportunity and surgical outcomes remains unexplored. METHODS Medicare beneficiaries who underwent AAA, CABG, colectomy or cholecystectomy were identified and stratified into quintiles based on upward economic mobility. Risk-adjusted probability of adverse postoperative outcomes were examined relative to economic mobility. RESULTS Among 1,081,745 Medicare beneficiaries (age: 75.5 years, female: 43.0%, White: 91.3%), risk-adjusted 30-day postoperative mortality decreased in a stepwise fashion from 6.0%(5.9-6.1) in the lowest quintile of upward economic mobility to 5.3%(5.2-5.4) in highest upward economic mobility (lowest vs. highest economic mobilityobility OR:1.14 (95%CI:1.11-1.17)). Similar associations were noted for postoperative complications (OR:1.04, 95%CI:1.02-1.06), extended length-of-stay (OR:1.07, 95%CI:1.06-1.09), and 30-day readmission (OR:1.04, 95%CI:1.02-1.05). Black beneficiaries had a higher risk of post-operative mortality across upward economic mobility quintiles except within the highest upward mobility group (referent, White patients, OR:0.93, 95%CI:0.79-1.09, p=0.355). CONCLUSION Economic upward mobility was associated with post-operative outcomes. Race-based differences were mitigated at the highest levels of upward economic mobility, highlighting the importance of socioeconomics as a health equity lever.
Collapse
Affiliation(s)
- Lovette Azap
- Department of Surgery, The Ohio State University, Wexner Medical Center, James Comprehensive Cancer Center, USA
| | - Rosevine Azap
- Department of Surgery, The Ohio State University, Wexner Medical Center, James Comprehensive Cancer Center, USA
| | - Madison Hyer
- Department of Surgery, The Ohio State University, Wexner Medical Center, James Comprehensive Cancer Center, USA
| | - Adrian Diaz
- Department of Surgery, The Ohio State University, Wexner Medical Center, James Comprehensive Cancer Center, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University, Wexner Medical Center, James Comprehensive Cancer Center, USA.
| |
Collapse
|
8
|
Zang E, Sobel ME, Luo L. The mobility effects hypothesis: Methods and applications. SOCIAL SCIENCE RESEARCH 2023; 110:102818. [PMID: 36796994 PMCID: PMC9936082 DOI: 10.1016/j.ssresearch.2022.102818] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 06/18/2023]
Abstract
We discuss hypotheses researchers have put forth to explain how outcomes of socially mobile and immobile individuals might differ and/or how mobility experiences are related to outcomes of interest. Next, we examine the methodological literature on this topic, culminating in the development of the diagonal mobility model (DMM, also called the diagonal reference model in some studies), the primary tool of use since the 1980's. We then discuss some of the many applications of the DMM. Although the model was proposed to examine the effects of social mobility on outcomes of interest, the estimated relationships between mobility and outcomes that researchers have called mobility effects are more appropriately regarded as partial associations. When mobility is not associated with outcomes, as is often found in empirical work, the outcomes of movers from origin o to destination d are a weighted average of the outcomes of individuals who remained in states o and d respectively, and the weights capture the relative salience of origins and destinations in the acculturation process. In light of this attractive feature of the model, we briefly develop several generalizations of the current DMM that future researchers should also find useful. Finally, we propose new estimands of mobility effects, based on the explicit notion that a unit effect of mobility is a comparison of an individual with herself under two conditions, one in which she is mobile, the other in which she is immobile, and we discuss some of the challenges in identifying such effects.
Collapse
Affiliation(s)
- Emma Zang
- Department of Sociology, Yale University, USA.
| | | | - Liying Luo
- Department of Sociology and Criminology, Pennsylvania State University, USA
| |
Collapse
|
9
|
Kohori Segawa H, Uematsu H, Dorji N, Wangdi U, Dorjee C, Yangchen P, Kunisawa S, Sakamoto R, Imanaka Y. Social and behavioral factors related to blood pressure measurement: A cross-sectional study in Bhutan. PLoS One 2022; 17:e0271914. [PMID: 35976922 PMCID: PMC9385017 DOI: 10.1371/journal.pone.0271914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/08/2022] [Indexed: 11/19/2022] Open
Abstract
Cardiovascular disease is a leading cause of death in the Kingdom of Bhutan, and early detection of hypertension is critical for preventing cardiovascular disease. However, health-seeking behavior, including blood pressure measurement, is infrequently investigated in Bhutan. Therefore, this study investigated factors related to blood pressure measurement in Bhutan. We performed a secondary data analysis of a target population of 1,962 individuals using data from the “2014 Bhutan STEPS survey data”as a cross-sectional study. Approximately 26% of those with hypertension who were detected during the STEPS survey had never had their blood pressure measured. Previous blood pressure measurement was significantly associated with age and working status in men (self-employed [odds ratio (OR): 0.219, 95% CI: 0.133–0.361], non-working [OR: 0.114, 95% CI: 0.050–0.263], employee [OR: 1.000]). Previous blood pressure measurement was significantly associated with higher income in women (Quartile-2 [OR: 1.984, 95% CI: 1.209–3.255], Quartile-1 [OR: 2.161, 95% CI: 1.415–3.299], Quartile-4 [OR: 1.000]). A family history of hypertension (OR: 2.019, 95% CI: 1.549–2.243) increased the likelihood of having experienced a blood pressure measurement in both men and women. Multivariate logistic regression showed that people with unhealthy lifestyles (high salt intake [adjusted odds ratio (AOR): 0.247, 95% confidence interval (CI): 0.068–0.893], tobacco use [AOR: 0.538, 95% CI: 0.380–0.761]) had a decreased likelihood of previous blood pressure measurement. To promote the early detection of hypertension in Bhutan, we suggest that more attention be paid to low-income women, non-working, self-employed, and low-income men, and a reduction of barriers to blood pressure measurement. Before the STEPS survey, a substantial number of hypertensive people had never had their blood pressure measured or were unconcerned about their health. As a result, we propose that early blood pressure monitoring and treatment for people with hypertension or at higher risk of hypertension be given increased emphasis.
Collapse
Affiliation(s)
- Hiromi Kohori Segawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
- Kokoro Research Center, Kyoto University, Kyoto City, Kyoto, Japan
| | - Hironori Uematsu
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Nidup Dorji
- Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Kingdom of Bhutan
| | - Ugyen Wangdi
- Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Kingdom of Bhutan
| | - Chencho Dorjee
- Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Kingdom of Bhutan
| | - Pemba Yangchen
- Non-Communicable Diseases Division, Ministry of Health in Bhutan, Thimphu, Kingdom of Bhutan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Ryota Sakamoto
- Centre for Southeast Asian Studies, Kyoto University, Kyoto City, Kyoto, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
- * E-mail:
| |
Collapse
|
10
|
Chen X, Yan B, Gill TM. Childhood Circumstances and Health Inequality in Old Age: Comparative Evidence from China and the USA. SOCIAL INDICATORS RESEARCH 2022; 160:689-716. [PMID: 35359349 PMCID: PMC8963775 DOI: 10.1007/s11205-020-02436-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/06/2020] [Indexed: 06/14/2023]
Abstract
This paper estimates the extent to which childhood circumstances contribute to health inequality in old age and evaluates the importance of major domains of childhood circumstances to health inequalities in the USA and China. We link two waves of the China Health and Retirement Longitudinal Study in 2013 and 2015 with the newly released 2014 Life History Survey, and two waves of the Health and Retirement Study in 2014 and 2016 with the newly released 2015 Life History Mail Survey in the USA, to quantify health inequality due to childhood circumstances for which they have little control. Using the Shapley value decomposition approach, we show that childhood circumstances may explain 7-16 and 14-30% of health inequality in old age in China and the USA, respectively. Specifically, the contribution of childhood circumstances to health inequality is larger in the USA than in China for self-rated health, mental health, and physical health. Examining domains of childhood circumstance, regional and rural/urban status contribute more to health inequality in China, while family socioeconomic status contributes more to health inequality in the USA. Our findings support the value of a life course approach in identifying the key determinants of health in old age. Distinguishing sources of health inequality and rectifying inequality due to early childhood circumstances should be the basis of policy promoting health equity.
Collapse
Affiliation(s)
- Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, New Haven, USA
- Department of Economics, Yale University, New Haven, USA
| | - Binjian Yan
- College of Economics and Management, Nanjing Agricultural University, Nanjing, China
| | - Thomas M Gill
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, USA
| |
Collapse
|
11
|
O'Brien R, Bair EF, Venkataramani AS. Death by Robots? Automation and Working-Age Mortality in the United States. Demography 2022; 59:607-628. [PMID: 35195250 DOI: 10.1215/00703370-9774819] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The decline of manufacturing employment is frequently invoked as a key cause of worsening U.S. population health trends, including rising mortality due to "deaths of despair." Increasing automation-the use of industrial robots to perform tasks previously done by human workers-is one structural force driving the decline of manufacturing jobs and wages. In this study, we examine the impact of automation on age- and sex-specific mortality. Using exogenous variation in automation to support causal inference, we find that increases in automation over the period 1993-2007 led to substantive increases in all-cause mortality for both men and women aged 45-54. Disaggregating by cause, we find evidence that automation is associated with increases in drug overdose deaths, suicide, homicide, and cardiovascular mortality, although patterns differ by age and sex. We further examine heterogeneity in effects by safety net program generosity, labor market policies, and the supply of prescription opioids.
Collapse
Affiliation(s)
- Rourke O'Brien
- Department of Sociology and Institution for Social and Policy Studies, Yale University, New Haven, CT, USA
| | - Elizabeth F Bair
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | |
Collapse
|
12
|
Hackman DA, Suthar H, Palmer Molina A, Dawson WC, Putnam-Hornstein E. Neighborhood poverty, intergenerational mobility, and early developmental health in a population birth cohort. Health Place 2022; 74:102754. [PMID: 35151183 DOI: 10.1016/j.healthplace.2022.102754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 11/25/2022]
Abstract
Living in a neighborhood with high levels of intergenerational mobility is associated with better childhood cognition and behavior as well as adult health. Nevertheless, it is unclear if such differences originate earlier, and thus if neighborhood intergenerational mobility is associated with health differences at birth. To address this question, we examined whether neighborhood intergenerational mobility, independent of neighborhood poverty, was associated with low birth weight (LBW) in a population-based cohort of singleton children born in California in 2017 (n = 426,873). Although increased neighborhood mobility was associated with a decreased likelihood of LBW, it was no longer associated with LBW (OR = 0.98, CI = 0.96, 1.00) after adjusting for neighborhood poverty. Meanwhile, neighborhood poverty was associated with LBW (OR = 1.04, CI = 1.02, 1.05) after accounting for mobility, with the odds of LBW 9.4% higher among children born where neighborhood poverty was in the 90th percentile compared with children born where neighborhood poverty was in the 10th percentile. Findings indicate that neighborhood poverty, but not intergenerational mobility, is a robust and independent correlate of increased LBW births, and thus early developmental health. These findings also suggest that the role of neighborhood intergenerational mobility in child and adult health outcomes may emerge later in development, independent of LBW, or that the role of neighborhood intergenerational mobility in LBW may be indirectly mediated through exposure to neighborhood poverty.
Collapse
Affiliation(s)
- Daniel A Hackman
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA.
| | - Himal Suthar
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Abigail Palmer Molina
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - William C Dawson
- School of Social Welfare, California Child Welfare Indicators Project, University of California, Berkeley, CA, USA
| | - Emily Putnam-Hornstein
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
13
|
Daza S, Palloni A. Early Exposure to County Income Mobility and Adult Individual Health in the United States. J Gerontol B Psychol Sci Soc Sci 2022; 77:S199-S208. [PMID: 35106575 PMCID: PMC9154259 DOI: 10.1093/geronb/gbab240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES Previous research in the United States suggests contextual income mobility may play a role in explaining the disparities between life expectancy in the United States and peer countries. This article aims to extend previous research by estimating the consequences of average individual exposure to mobility regimes during childhood and adolescence on adult health. METHODS This study draws its data from two longitudinal datasets that track the county of residence of respondents during childhood and adolescence, the Panel Study of Income Dynamics and the National Longitudinal Survey of Youth 1997. We implement marginal structural models to assess the association of the average exposure to county income mobility on five health outcomes and behaviors. RESULTS The results are only partially consistent with a systematic association between exposure to income mobility and health outcomes. Evidence obtained from the National Longitudinal Survey of Youth suggests less income mobility might increase the probability of smoking by age 30. DISCUSSION The paper provides a precise assessment of the hypothesis that childhood exposure to income mobility regimes may influence health status through behavior later in life and contribute to longevity gaps. Only partial evidence on smoking suggests an association between income mobility and health, so we discuss potential reasons for the disparities in results with previous research.
Collapse
Affiliation(s)
- Sebastian Daza
- Address correspondence to: Sebastian Daza, PhD, Center for Demography and Ecology, University of Wisconsin–Madison, Madison, WI 53706, USA. E-mail:
| | - Alberto Palloni
- Center for Demography and Ecology, University of Wisconsin–Madison, Madison, Wisconsin, USA,Institute of Economy Geography and Demography, CSIC-CCHS, Madrid, Spain
| |
Collapse
|
14
|
Hargrove TW, Gaydosh L, Dennis AC. Contextualizing Educational Disparities in Health: Variations by Race/Ethnicity, Nativity, and County-Level Characteristics. Demography 2022; 59:267-292. [PMID: 34964867 PMCID: PMC9190239 DOI: 10.1215/00703370-9664206] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Educational disparities in health are well documented, yet the education-health relationship is inconsistent across racial/ethnic and nativity groups. These inconsistencies may arise from characteristics of the early life environments in which individuals attain their education. We evaluate this possibility by investigating (1) whether educational disparities in cardiometabolic risk vary by race/ethnicity and nativity among Black, Hispanic, and White young adults; (2) the extent to which racial/ethnic-nativity differences in the education-health relationship are contingent on economic, policy, and social characteristics of counties of early life residence; and (3) the county characteristics associated with the best health at higher levels of education for each racial/ethnic-nativity group. Using data from the National Longitudinal Study of Adolescent to Adult Health, we find that Black young adults who achieve high levels of education exhibit worse health across a majority of contexts relative to their White and Hispanic counterparts. Additionally, we observe more favorable health at higher levels of education across almost all contexts for White individuals. For all other racial/ethnic-nativity groups, the relationship between education and health depends on the characteristics of the early life counties of residence. Findings highlight place-based factors that may contribute to the development of racial/ethnic and nativity differences in the education-health relationship among U.S. young adults.
Collapse
Affiliation(s)
- Taylor W. Hargrove
- Department of Sociology, Carolina Population Center, University of North Carolina at Chapel Hill
| | - Lauren Gaydosh
- Department of Sociology, Population Research Center, University of Texas at Austin
| | - Alexis C. Dennis
- Department of Sociology, Carolina Population Center, University of North Carolina at Chapel Hill
| |
Collapse
|
15
|
Santos FNAD, Pinto LLT, Silva MSDP, Bomfim ES, Lino RDS, Lagares LS, de Almeida LAB, Santos CPCD. The Relation Between the Socioeconomic Levels, Quality of Life Related to Health, Body Self-Image, and Level of Physical Activity in Obese Adults After Bariatric Surgery. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2021.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Felipe Nunes Almeida dos Santos
- Research Group on Metabolic Diseases, Physical Exercise and Health Technologies, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Lélia Lessa Teixeira Pinto
- Study and Research Group in Health and Human Performance, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Mariana Sousa de Pina Silva
- Research Group on Metabolic Diseases, Physical Exercise and Health Technologies, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Eric Simas Bomfim
- Research Group on Metabolic Diseases, Physical Exercise and Health Technologies, Bahiana School of Medicine and Public Health, Salvador, Brazil
- Department of Physical Education, Obesity Treatment and Surgery Center, Salvador, Brazil
| | - Ramon de Souza Lino
- Research Group on Metabolic Diseases, Physical Exercise and Health Technologies, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Laura Souza Lagares
- Research Group on Metabolic Diseases, Physical Exercise and Health Technologies, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Luiz Alberto Bastos de Almeida
- Research Group on Metabolic Diseases, Physical Exercise and Health Technologies, Bahiana School of Medicine and Public Health, Salvador, Brazil
- Laboratory of Physical Activity, Feira de Santana State University, Feira de Santana, Brazil
| | | |
Collapse
|
16
|
Gugushvili A. Equality of opportunity and health in post-COVID world. PUBLIC HEALTH IN PRACTICE 2021; 2:100135. [PMID: 34514450 PMCID: PMC8417456 DOI: 10.1016/j.puhip.2021.100135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022] Open
Abstract
Links between equality of opportunity and health in post-COVID world must be an issue of general interest to academic, health, and policy audiences in the developed countries and other parts of the world. We already know that COVID-19 disproportionally affects most vulnerable and marginalised groups, while their positions in social hierarchy are strongly shaped by intergenerational transmission of advantages and disadvantages. Further, recent evidence from the United States and Europe also suggests that inequality of opportunity has significant negative consequences for health. This correspondence end with a call that decision makers, while rebuilding the post-COVID social model, should remember that equality of opportunity is not only fair but it is also good for health.
Collapse
Affiliation(s)
- Alexi Gugushvili
- Department of Sociology and Human Geography, University of Oslo, Postboks 1096 Blindern, 0317, Oslo, Norway.,Nuffield College, University of Oxford, Oxford, UK.,Institute of Philosophy and Sociology, Polish Academy of Sciences, Warsaw, Poland
| |
Collapse
|
17
|
Zang E, Kim N. Intergenerational upward mobility and racial differences in mortality among young adults: Evidence from county-level analyses. Health Place 2021; 70:102628. [PMID: 34280713 PMCID: PMC8328956 DOI: 10.1016/j.healthplace.2021.102628] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/21/2022]
Abstract
Inspired by the influential "deaths of despair" narrative, which emphasizes the role of worsening economic opportunity in driving the increasing mortality for non-Hispanic Whites in the recent decades, a rising number of studies have provided suggestive evidence that upward mobility levels across counties may partly explain variations in mortality rates. A gap in the literature is the lack of life-course studies examining the relationship between early-life upward mobility and later-life mortality across counties. Another gap is the lack of studies on how the relationship between upward mobility and mortality across counties varies across diverse sociodemographic populations. This study examines differences across race and sex in the relationship between early-life intergenerational upward mobility and early adulthood mortality at the county level. We use administrative data on upward mobility and vital statistics data on mortality across 3030 counties for those born between 1978 and 1983. We control for a variety of county-level socioeconomic variables in a model with fixed effects for state and year. Subgroup analyses by educational attainment and urban status were also performed for each race-sex combination. Results show strong negative relationships between early-life upward mobility and early adulthood mortality across racial-sex combinations, with a particularly greater magnitude for non-Hispanic Black males. In addition, individuals without a college degree and living in urban counties are particularly affected by early life upward mobility. The findings of this study highlight the vulnerability of less-educated, young urban Black males, due to the intersecting effects of the urban context, education, race, and sex.
Collapse
Affiliation(s)
- Emma Zang
- Department of Sociology, Yale University, New Haven, CT, USA.
| | - Nathan Kim
- Institution for Social and Policy Studies, Yale University, New Haven, CT, USA
| |
Collapse
|
18
|
Gaydosh L, McLanahan S. Youth academic achievement, social context, and body mass index. SSM Popul Health 2021; 13:100708. [PMID: 33354615 PMCID: PMC7744949 DOI: 10.1016/j.ssmph.2020.100708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 01/22/2023] Open
Abstract
This study assesses the relationship between academic achievement and body mass index for age (BMI) trajectories across childhood and adolescence, and investigates how this relationship is moderated by social context. Specifically, we test the hypothesis that academic achievement is not associated with improved BMI among youth from disadvantaged social contexts. We test for differences by race/ethnicity, and examine the role of county-level economic mobility in shaping these patterns. We use data from the longitudinal Fragile Families and Child Wellbeing Study (FFCWS), an ongoing birth cohort study representative of children born in large US cities in 2000, and measure BMI, academic achievement, and social context at Years 5, 9, and 15. Estimating multilevel random effects linear regression models of BMI from childhood to adolescence, we find that youth who were exposed to social advantage displayed a negative association between academic achievement and BMI. In contrast, youth exposed to social disadvantage displayed no association between academic achievement and BMI. This difference was observed regardless of race/ethnicity. County-level economic mobility modified the observed relationship, such that youth living in places with low levels of mobility displayed higher BMI associated with high academic performance. The results suggest that the health costs of academic achievement among disadvantaged youth are concentrated in areas with low institutional support for upward mobility. The findings demonstrate that the unequal benefits of educational attainment begin early in life, while living in places that promote upward mobility can help individuals realize the health benefits of their own educational attainment.
Collapse
|
19
|
Yan B, Chen X, Gill TM. Health Inequality among Chinese Older Adults: The Role of Childhood Circumstances. JOURNAL OF THE ECONOMICS OF AGEING 2020; 17:10.1016/j.jeoa.2020.100237. [PMID: 32064224 PMCID: PMC7021249 DOI: 10.1016/j.jeoa.2020.100237] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This paper examines the extent to which childhood circumstances contribute to health inequality in old age and how the contributions may vary across key dimensions of health. We link the China Health and Retirement Longitudinal Study (CHARLS) in 2013 and 2015 with its Life History Survey in 2014 to quantify health inequality due to childhood circumstances for which they have little control. We evaluate comprehensive dimensions of health ranging from cognitive health, mental health, physical health, self-rated health to mortality. Our analytic sample includes about 8,000 Chinese persons age above 60. Using the Shapley value decomposition approach, we first show that childhood circumstances may explain 1-23 percent of health inequality in old age across multiple health outcomes. Second, while both direct health-related circumstances and indirect health-related circumstances contribute significantly to health inequality, the latter tends to be more sizable. Our findings support the value of a life course approach in identifying the key determinants of health in old age.
Collapse
Affiliation(s)
- Binjian Yan
- College of Economics and Management, Nanjing Agricultural University and Department of Health Policy and Management, Yale School of Public Health
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health and Department of Economics, Yale University
| | - Thomas M Gill
- Department of Internal Medicine, School of Medicine, Yale University
| |
Collapse
|
20
|
Venkataramani AS, O’Brien R, Whitehorn GL, Tsai AC. Economic influences on population health in the United States: Toward policymaking driven by data and evidence. PLoS Med 2020; 17:e1003319. [PMID: 32877406 PMCID: PMC7467305 DOI: 10.1371/journal.pmed.1003319] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Atheendar S. Venkataramani and colleagues discuss economic factors and population health in the United States.
Collapse
Affiliation(s)
- Atheendar S. Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Rourke O’Brien
- Department of Sociology, Yale University, New Haven, Connecticut, United States of America
| | - Gregory L. Whitehorn
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Alexander C. Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Mbarara University of Science and Technology, Mbarara, Uganda
| |
Collapse
|
21
|
Stenberg E, Mohseni S, Cao Y, Näslund E. Limited Effect of Beta-blockade on Postoperative Outcome After Laparoscopic Gastric Bypass Surgery. Obes Surg 2020; 30:139-145. [PMID: 31346982 DOI: 10.1007/s11695-019-04108-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The benefit of beta-blockade on postoperative outcome remains controversial, though recent studies have suggested a role during major non-cardiac surgery. The benefit of beta-blockade during minimally invasive gastric bypass surgery remains unclear. The aim of the present study was to evaluate the possible association between preoperative beta-blocker therapy and postoperative outcome after laparoscopic gastric bypass surgery. METHODS Patients operated with primary laparoscopic gastric bypass surgery in Sweden between 2007 and 2017 were identified through the Scandinavian Obesity Surgery Registry. The dataset was linked to the Swedish National Patient Registry, the Swedish Prescribed Drug Registry, and Statistics Sweden. The main outcome was serious postoperative complication within 30 days of surgery; with postoperative complication, 90-day and 1-year mortality, and weight loss at 2 years after surgery as secondary endpoints. The Poisson regression model was used to evaluate primary and secondary categorical outcomes. A general mixed model was performed to evaluate 2-year weight loss. RESULTS In all, 50281 patients were included in the study. No difference was seen between patients on beta-blockade and the control group regarding postoperative complications (adjusted incidence rate ratio 1.04 (95%CI 0.93-1.15), p = 0.506), serious postoperative complication (adjusted IRR 1.06 95%CI 0.89-1.27), p = 0.515), 90-day mortality (adjusted IRR 0.71 (95%CI 0.24-2.10), p = 0.537), and 1-year mortality (adjusted IRR 1.26 (95%CI 0.67-2.36), p = 0.467). Weight loss 2 years after surgery was slightly greater in patients on beta-blockade (adjusted coefficient 0.53 (95%CI 0.19-0.87), p = 0.002). CONCLUSIONS Beta-blockade has limited impact on postoperative outcome after laparoscopic gastric bypass surgery.
Collapse
Affiliation(s)
- Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-70185, Örebro, Sweden.
| | - Shahin Mohseni
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-70185, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Erik Näslund
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
22
|
School academic climate and oral health (tooth loss) in adolescents. PLoS One 2020; 15:e0233505. [PMID: 32437411 PMCID: PMC7241719 DOI: 10.1371/journal.pone.0233505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/06/2020] [Indexed: 11/19/2022] Open
Abstract
Background Preventing tooth loss depends on oral health maintenance behaviors. This study hypothesized that adolescents with educational aspirations have greater motivation to invest in the future, including maintenance of oral health status. Aim To analyze the association between a school academic climate of educational aspirations and tooth loss (first permanent molars) among adolescents. Methods A cross-sectional study was designed to include 2,500 adolescents (aged 14–19 years) enrolled in public high schools of Olinda located in Northeast Brazil. Multilevel Poisson regression random intercept models were conducted with tooth loss (first permanent molars) as the outcome. The primary cohort of interest was school academic climate, as measured by the proportion of students taking the national high school exams. Results Tooth loss of the first permanent molars (assessed by clinical exam) was more prevalent in adolescents from more disadvantaged backgrounds (receiving family allowance, low maternal education). However, after controlling for a wide range of individual characteristics, adolescents enrolled in schools with lower academic climate had a higher prevalence of tooth loss (PR 1.42, 95%CI: 1.09,1.85). Conclusion The school academic climate is associated with tooth loss, suggesting that educational aspirations are linked to adolescent oral health maintenance behaviors.
Collapse
|
23
|
van der Pol S, Postma MJ, Jansen DEMC. School health in Europe: a review of workforce expenditure across five countries. BMC Health Serv Res 2020; 20:206. [PMID: 32164689 PMCID: PMC7068946 DOI: 10.1186/s12913-020-05077-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/05/2020] [Indexed: 02/08/2023] Open
Abstract
Background Most European countries have implemented a form of school health services (SHS) to provide young children and adolescents with various types of healthcare. No estimations on SHS expenditure for European countries have been published until now. We estimated SHS workforce expenditure in Europe, expected to serve as the main driver of school healthcare costs. Methods Using two networks of experts on healthcare provision for children we contacted various country representatives to provide data on the number of professionals working in SHS and salaries. These data were used, together with publicly available data, to estimate annual SHS workforce expenditure on the national level. Results We received sufficient data for five European countries, and estimated the SHS workforce expenditure. Nurses were the most widely reported professionals working in this field, followed by doctors and psychologists. Our SHS expenditure estimations ranged from €43,000 for Estonia to €195,300 in Norway (per 1000 pupils). For Norway, Estonia, Finland and Iceland, school nurses were the main drivers of SHS expenditure, mainly due to their large numbers, while in Austria, school doctors played the largest role in SHS expenditure. Conclusions We estimated the spending on SHS workforce for five European countries, which comprises relatively minor parts of total healthcare spending (0.16 to 0.69%). Many questions regarding SHS spending in Europe remain, due to a general lack of data on national levels.
Collapse
Affiliation(s)
- Simon van der Pol
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands.
| | - Maarten J Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands.,Department of Economics, Econometrics and Finance, University of Groningen, Groningen, the Netherlands
| | - Danielle E M C Jansen
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands.,Department of Sociology, Interuniversity Center for Social Science Theory and Methodology (ICS), University of Groningen, Groningen, the Netherlands
| |
Collapse
|
24
|
Venkataramani A, Daza S, Emanuel E. Association of Social Mobility With the Income-Related Longevity Gap in the United States: A Cross-Sectional, County-Level Study. JAMA Intern Med 2020; 180:429-436. [PMID: 31961379 PMCID: PMC6990844 DOI: 10.1001/jamainternmed.2019.6532] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
IMPORTANCE Despite substantial research, the drivers of the widening gap in life expectancy between rich and poor individuals in the United States-known as the longevity gap-remain unknown. The hypothesis of this study is that social mobility may play an important role in explaining the longevity gap. OBJECTIVE To assess whether social mobility is associated with income-related differences in life expectancy in the United States. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, ecological study used data from 1559 counties in the United States to assess the association of social mobility with average life expectancy at age 40 years by sex and income quartile among adult men and women over the period of January 2000 through December 2014. Bayesian generalized linear multilevel regression models were used to estimate the association, with adjustment for a range of socioeconomic, demographic, and health care system characteristics. EXPOSURES County-level social mobility, here operationalized as the association of the income rank of individuals born during the period of January 1980 through December 1982 (based on tax record data, averaged over the period January 2010 through December 2012) with the income ranks of their parents (averaged over the period January 1996 through December 2000) using the location where the parent first claimed the child as a dependent at age 15 years to identify counties. MAIN OUTCOMES AND MEASURES The main outcome was life expectancy at age 40 years by sex and income quartile. RESULTS The sample consisted of 1559 counties, which represented 93% of the US population in 2000. Each 1-SD increase in social mobility-equivalent to the difference between a low-mobility state, such as Alabama (ranked 49th on this measure), and a higher-mobility state, such as Massachusetts (ranked 23rd on this measure)-was associated with a 0.38-year (95% credible interval [CrI], 0.29-0.47) and a 0.29-year (95% CrI, 0.21-0.38) increase in county-level life expectancy among men and women, respectively, in the lowest income quartile. Estimates for life expectancies among county residents in the highest income quartile were smaller in magnitude and not robust to covariate adjustment (men: 0.10-year [95% CrI, -0.02 to 0.22] increase; women: 0.08-year [95% CrI, -0.05 to 0.20] increase). Increasing social mobility in all counties to the value of the highest social mobility county was associated with decreases in the life expectancy gap between the highest and lowest income quartiles by 1.4 (95% CrI, 0.7-2.1) years for men and 1.1 (95% CrI, 0.5-1.6) years for women nationally, representing a 20% decrease. CONCLUSIONS AND RELEVANCE In this cross-sectional study, higher county-level social mobility was associated with smaller county-level gaps in life expectancy by income. These findings motivate further investigation of causal relationships between policies that shift social mobility and health outcomes.
Collapse
Affiliation(s)
- Atheendar Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Sebastian Daza
- Center for Demography and Ecology, University of Wisconsin-Madison.,Department of Sociology, University of Wisconsin-Madison
| | - Ezekiel Emanuel
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| |
Collapse
|
25
|
Kim D. Social determinants of health in relation to firearm-related homicides in the United States: A nationwide multilevel cross-sectional study. PLoS Med 2019; 16:e1002978. [PMID: 31846474 PMCID: PMC6917210 DOI: 10.1371/journal.pmed.1002978] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/11/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Gun violence has shortened the average life expectancy of Americans, and better knowledge about the root causes of gun violence is crucial to its prevention. While some empirical evidence exists regarding the impacts of social and economic factors on violence and firearm homicide rates, to the author's knowledge, there has yet to be a comprehensive and comparative lagged, multilevel investigation of major social determinants of health in relation to firearm homicides and mass shootings. METHODS AND FINDINGS This study used negative binomial regression models and geolocated gun homicide incident data from January 1, 2015, to December 31, 2015, to explore and compare the independent associations of key state-, county-, and neighborhood-level social determinants of health-social mobility, social capital, income inequality, racial and economic segregation, and social spending-with neighborhood firearm-related homicides and mass shootings in the United States, accounting for relevant state firearm laws and a variety of state, county, and neighborhood (census tract [CT]) characteristics. Latitude and longitude coordinates on firearm-related deaths were previously collected by the Gun Violence Archive, and then linked by the British newspaper The Guardian to CTs according to 2010 Census geographies. The study population consisted of all 74,134 CTs as defined for the 2010 Census in the 48 states of the contiguous US. The final sample spanned 70,579 CTs, containing an estimated 314,247,908 individuals, or 98% of the total US population in 2015. The analyses were based on 13,060 firearm-related deaths in 2015, with 11,244 non-mass shootings taking place in 8,673 CTs and 141 mass shootings occurring in 138 CTs. For area-level social determinants, lag periods of 3 to 17 years were examined based on existing theory, empirical evidence, and data availability. County-level institutional social capital (levels of trust in institutions), social mobility, income inequality, and public welfare spending exhibited robust relationships with CT-level gun homicide rates and the total numbers of combined non-mass and mass shooting homicide incidents and non-mass shooting homicide incidents alone. A 1-standard deviation (SD) increase in institutional social capital was linked to a 19% reduction in the homicide rate (incidence rate ratio [IRR] = 0.81, 95% CI 0.73-0.91, p < 0.001) and a 17% decrease in the number of firearm homicide incidents (IRR = 0.83, 95% CI 0.73-0.95, p = 0.01). Upward social mobility was related to a 25% reduction in the gun homicide rate (IRR = 0.75, 95% CI 0.66-0.86, p < 0.001) and a 24% decrease in the number of homicide incidents (IRR = 0.76, 95% CI 0.67-0.87, p < 0.001). Meanwhile, 1-SD increases in the neighborhood percentages of residents in poverty and males living alone were associated with 26%-27% and 12% higher homicide rates, respectively. Study limitations include possible residual confounding by factors at the individual/household level, and lack of disaggregation of gun homicide data by gender and race/ethnicity. CONCLUSIONS This study finds that the rich-poor gap, level of citizens' trust in institutions, economic opportunity, and public welfare spending are all related to firearm homicide rates in the US. Further establishing the causal nature of these associations and modifying these social determinants may help to address the growing gun violence epidemic and reverse recent life expectancy declines among Americans.
Collapse
Affiliation(s)
- Daniel Kim
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, United States of America
| |
Collapse
|
26
|
Gugushvili A, Kaiser C. Equality of opportunity is linked to lower mortality in Europe. J Epidemiol Community Health 2019; 74:151-157. [PMID: 31690589 PMCID: PMC6993020 DOI: 10.1136/jech-2019-212540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/28/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022]
Abstract
Background This study investigates if intergenerational equality of opportunity is linked to mortality in 30 European countries. Equality of opportunity may lead to greater returns on health investments and, consequently, improved health outcomes. In turn, a perceived lack of fairness in the distribution of life chances and limited possibilities for upward intergenerational mobility can cause anxiety among individuals and gradually compromise their health. Methods We used information on 163 467 individuals’ and their parents’ Socio-Economic Index of Occupational Status from a large survey data set—the European Social Survey—to generate three complementary measures of equality of opportunity. We then linked these to administrative data on total, gender-specific and cause-specific mortality rates assembled by Eurostat from the national statistical offices. Results We found that lower equality of opportunity, measured by the attainment of individuals from the lowest and highest quartiles of socioeconomic status and by the overall intergenerational correlation in socioeconomic status, was related to higher mortality rates, particularly in relation to diseases of the nervous system and the sense organs, diseases of the respiratory system and external causes of mortality. Our measures of equality of opportunity were more consistently linked with mortality of men than women. Conclusion Equality of opportunity may be an important explanation of mortality that warrants further research. Measures that aim at facilitating intergenerational social mobility can be justified not only via normative considerations of equality of opportunity but also in terms of individuals’ chances to enjoy healthy lives.
Collapse
Affiliation(s)
- Alexi Gugushvili
- Department of Social Policy and Intervention and Nuffield College, University of Oxford, Oxford, UK .,Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Caspar Kaiser
- Department of Social Policy and Intervention and Nuffield College, University of Oxford, Oxford, UK
| |
Collapse
|
27
|
Bauer UE. Community Health and Economic Prosperity: An Initiative of the Office of the Surgeon General. Public Health Rep 2019; 134:472-476. [PMID: 31419208 DOI: 10.1177/0033354919867727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ursula E Bauer
- 1 Office of the Surgeon General, US Department of Health and Human Services, Washington, DC, USA
| |
Collapse
|
28
|
de Boer WIJ, Buskens E, Koning RH, Mierau JO. Neighborhood Socioeconomic Status and Health Care Costs: A Population-Wide Study in the Netherlands. Am J Public Health 2019; 109:927-933. [PMID: 30998412 DOI: 10.2105/ajph.2019.305035] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objectives. To identify disparities in several types of insured health care costs in the Netherlands across neighborhoods with different socioeconomic statuses and to assess the room for improvement. Methods. We used 2015 Dutch whole-population registry data to estimate the age- and gender-specific cost structure by neighborhood for total, specialist, pharmaceutical, and mental health care. Classifying neighborhoods by the quintile of their neighborhood socioeconomic status (NSES), we determined differences in observed and expected health care costs for several scenarios of NSES improvement. Results. From low to high NSES, we found a clear downward gradient in health care costs. Total health care costs would drop by 7.3% if each neighborhood's cost structure was equal to that of the most affluent neighborhoods. The potential for cost reduction appeared highest for females, for age groups between 40 and 60 years, and for pharmaceutical care. Conclusions. Low NSES is associated with relatively high health care costs, and represents considerable potential for cost savings in health care. Public Health Implications. Our research suggests that policies aimed at improving the socioeconomic determinants of health locally may be pivotal in containing health care costs.
Collapse
Affiliation(s)
- Willem I J de Boer
- All of the authors are with the Faculty of Economics and Business, University of Groningen, Groningen, the Netherlands. Willem I. J. de Boer is also with the Institute of Sport and Exercise Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands. Erik Buskens is also with the University Medical Center Groningen. Jochen O. Mierau is also with the Aletta Jacobs School of Public Health, University of Groningen
| | - Erik Buskens
- All of the authors are with the Faculty of Economics and Business, University of Groningen, Groningen, the Netherlands. Willem I. J. de Boer is also with the Institute of Sport and Exercise Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands. Erik Buskens is also with the University Medical Center Groningen. Jochen O. Mierau is also with the Aletta Jacobs School of Public Health, University of Groningen
| | - Ruud H Koning
- All of the authors are with the Faculty of Economics and Business, University of Groningen, Groningen, the Netherlands. Willem I. J. de Boer is also with the Institute of Sport and Exercise Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands. Erik Buskens is also with the University Medical Center Groningen. Jochen O. Mierau is also with the Aletta Jacobs School of Public Health, University of Groningen
| | - Jochen O Mierau
- All of the authors are with the Faculty of Economics and Business, University of Groningen, Groningen, the Netherlands. Willem I. J. de Boer is also with the Institute of Sport and Exercise Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands. Erik Buskens is also with the University Medical Center Groningen. Jochen O. Mierau is also with the Aletta Jacobs School of Public Health, University of Groningen
| |
Collapse
|
29
|
Okamoto S, Avendano M, Kawachi I. Intergenerational income mobility and health in Japan: A quasi-experimental approach. Soc Sci Med 2019; 230:37-48. [PMID: 30959305 DOI: 10.1016/j.socscimed.2019.03.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 03/07/2019] [Accepted: 03/28/2019] [Indexed: 11/26/2022]
Abstract
Studies across Europe and the US report that childhood socioeconomic disadvantage is associated with poorer health in adulthood. By contrast, a study in Japan suggests that childhood socioeconomic disadvantage may be positive for adult health. In this paper, we assess the association between intergenerational income mobility and self-rated health in Japan, using detailed childhood income data for 1610 men and 1885 women aged 30-49 years. We use an instrumental variable approach to identify the causal effect of upward income mobility on adult health. We find that low father's income during childhood is associated with smoking and alcohol consumption in adult life for both men and women. For men, upward income mobility was associated with worse health. Certain behavioural choices related to income mobility, such as long working hours, may have detrimental health effects.
Collapse
Affiliation(s)
- Shohei Okamoto
- Graduate School of Economics, Keio University, Tokyo, Japan; Department of Global Health and Social Medicine, King's College London, London, UK; Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
| | - Mauricio Avendano
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Ichiro Kawachi
- Department of Society and Behavioural Science, Harvard School of Public Health, Boston, USA
| |
Collapse
|
30
|
Stenberg E, Persson C, Näslund E, Ottosson J, Sundbom M, Szabo E, Näslund I. The impact of socioeconomic factors on the early postoperative complication rate after laparoscopic gastric bypass surgery: A register-based cohort study. Surg Obes Relat Dis 2019; 15:575-581. [DOI: 10.1016/j.soard.2019.01.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/23/2018] [Accepted: 01/28/2019] [Indexed: 12/24/2022]
|
31
|
Venkataramani AS, Shah SJ, O'Brien R, Kawachi I, Tsai AC. Health consequences of the US Deferred Action for Childhood Arrivals (DACA) immigration programme: a quasi-experimental study. LANCET PUBLIC HEALTH 2017; 2:e175-e181. [PMID: 29253449 DOI: 10.1016/s2468-2667(17)30047-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/11/2017] [Accepted: 02/20/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The effects of changes in immigration policy on health outcomes among undocumented immigrants are not well known. We aimed to examine the physical and mental health effects of the Deferred Action for Childhood Arrivals (DACA) programme, a 2012 US immigration policy that provided renewable work permits and freedom from deportation for a large number of undocumented immigrants. METHODS We did a retrospective, quasi-experimental study using nationally representative, repeated cross-sectional data from the US National Health Interview Survey (NHIS) for the period January, 2008, to December, 2015. We included non-citizen, Hispanic adults aged 19-50 years in our analyses. We used a difference-in-differences strategy to compare changes in health outcomes among individuals who met key DACA eligibility criteria (based on age at immigration and at the time of policy implementation) before and after programme implementation versus changes in outcomes for individuals who did not meet these criteria. We additionally restricted the sample to individuals who had lived in the USA for at least 5 years and had completed high school or its equivalent, in order to hold fixed two other DACA eligibility criteria. Our primary outcomes were self-reported overall health (measured on a 5 point Likert scale) and psychological distress (Kessler 6 [K6] scale), the latter was administered to a random subset of NHIS respondents. FINDINGS Our final sample contained 14 973 respondents for the self-reported health outcome and 5035 respondents for the K6 outcome. Of these individuals, 3972 in the self-reported health analysis and 1138 in the K6 analysis met the DACA eligibility criteria. Compared with people ineligible for DACA, the introduction of DACA was associated with no significant change among DACA-eligible individuals in terms of self-reported overall health (b=0·056, 95% CI -0·024 to 0·14, p=0·17) or the likelihood of reporting poor or fair health (adjusted odds ratio [aOR] 0·98, 95% CI 0·66-1·44, p=0·91). However, DACA-eligible individuals experienced a reduction in K6 score compared with DACA-ineligible individuals (adjusted incident risk ratio 0·78, 95% CI 0·56-0·95, p=0·020) and were less likely to meet screening criteria for moderate or worse psychological distress (aOR 0·62, 95% CI 0·41-0·93, p=0·022). INTERPRETATION Economic opportunities and protection from deportation for undocumented immigrants, as offered by DACA, could confer large mental health benefits to such individuals. Health consequences should be considered by researchers and policy makers in evaluations of the broader welfare effects of immigration policy. FUNDING None.
Collapse
Affiliation(s)
- Atheendar S Venkataramani
- Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Sachin J Shah
- Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rourke O'Brien
- La Follette School of Public Affairs, University of Wisconsin-Madison, Madison, WI, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Alexander C Tsai
- Chester M Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
32
|
Tsai AC, Mendenhall E, Trostle JA, Kawachi I. Co-occurring epidemics, syndemics, and population health. Lancet 2017; 389:978-982. [PMID: 28271848 PMCID: PMC5972361 DOI: 10.1016/s0140-6736(17)30403-8] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 12/07/2016] [Accepted: 12/16/2016] [Indexed: 01/19/2023]
Affiliation(s)
- Alexander C Tsai
- Chester M Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA; Harvard Center for Population and Development Studies, Harvard University, Boston, MA, USA; Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Emily Mendenhall
- Edmund A Walsh School of Foreign Service, Georgetown University, Washington, DC, USA
| | - James A Trostle
- Department of Anthropology, Trinity College, Hartford, CT, USA; School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Ichiro Kawachi
- Harvard Medical School, Harvard University, Boston, MA, USA; Harvard Center for Population and Development Studies, Harvard University, Boston, MA, USA; Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| |
Collapse
|
33
|
Katikireddi SV. Economic opportunity: a determinant of health? Lancet Public Health 2016; 1:e4-e5. [PMID: 29253378 DOI: 10.1016/s2468-2667(16)30004-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/19/2016] [Indexed: 02/02/2023]
|