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Dowd JB, Doniec K, Zhang L, Tilstra A. US exceptionalism? International trends in midlife mortality. Int J Epidemiol 2024; 53:dyae024. [PMID: 38508869 PMCID: PMC10954513 DOI: 10.1093/ije/dyae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/29/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Rising midlife mortality in the USA has raised concerns, particularly the increase in 'deaths of despair' (due to drugs, alcohol and suicide). Life expectancy is also stalling in other countries such as the UK, but how trends in midlife mortality are evolving outside the USA is less understood. We provide a synthesis of cause-specific mortality trends in midlife (25-64 years of age) for the USA and the UK as well as other high-income and Central and Eastern European (CEE) countries. METHODS We document trends in midlife mortality in the USA, UK and a group of 13 high-income countries in Western Europe, Australia, Canada and Japan, as well as seven CEE countries from 1990 to 2019. We use annual mortality data from the World Health Organization Mortality Database to analyse sex- and age-specific (25-44, 45-54 and 55-64 years) age-standardized death rates across 15 major cause-of-death categories. RESULTS US midlife mortality rates have worsened since 1990 for several causes of death including drug-related, alcohol-related, suicide, metabolic diseases, nervous system diseases, respiratory diseases and infectious/parasitic diseases. Deaths due to homicide, transport accidents and cardiovascular diseases have declined since 1990 but saw recent increases or stalling of improvements. Midlife mortality also increased in the UK for people aged 45-54 year and in Canada, Poland and Sweden among for those aged 25-44 years. CONCLUSIONS The USA is increasingly falling behind not only high-income, but also CEE countries, some of which were heavily impacted by the post-socialist mortality crisis of the 1990s. Although levels of midlife mortality in the UK are substantially lower than those in the USA overall, there are signs that UK midlife mortality is worsening relative to that in Western Europe.
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Affiliation(s)
- Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Nuffield College, University of Oxford, Oxford, UK
| | - Katarzyna Doniec
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Nuffield College, University of Oxford, Oxford, UK
| | - Luyin Zhang
- Office of Population Research, Princeton University, Princeton, USA
| | - Andrea Tilstra
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Nuffield College, University of Oxford, Oxford, UK
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Affiliation(s)
- Antonino Polizzi
- Department of Sociology, University of Oxford, OxfordOX1 1JD, United Kingdom
- Leverhulme Centre for Demographic Science, University of Oxford, OxfordOX1 1JD, United Kingdom
- Nuffield College, University of Oxford, OxfordOX1 1NF, United Kingdom
- Nuffield Department of Population Health, University of Oxford, OxfordOX3 7LF, United Kingdom
| | - Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, University of Oxford, OxfordOX1 1JD, United Kingdom
- Nuffield College, University of Oxford, OxfordOX1 1NF, United Kingdom
- Nuffield Department of Population Health, University of Oxford, OxfordOX3 7LF, United Kingdom
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Dowd JB, Angus C, Zajacova A, Tilstra AM. Comparing trends in mid-life 'deaths of despair' in the USA, Canada and UK, 2001-2019: is the USA an anomaly? BMJ Open 2023; 13:e069905. [PMID: 37591647 PMCID: PMC10441077 DOI: 10.1136/bmjopen-2022-069905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 07/27/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVES In recent years, 'deaths of despair' due to drugs, alcohol and suicide have contributed to rising mid-life mortality in the USA. We examine whether despair-related deaths and mid-life mortality trends are also changing in peer countries, the UK and Canada. DESIGN Descriptive analysis of population mortality rates. SETTING The USA, UK (and constituent nations England and Wales, Northern Ireland and Scotland) and Canada, 2001-2019. PARTICIPANTS Full population aged 35-64 years. OUTCOME MEASURES We compared all-cause and 'despair'-related mortality trends at mid-life across countries using publicly available mortality data, stratified by three age groups (35-44, 45-54 and 55-64 years) and by sex. We examined trends in all-cause mortality and mortality by causes categorised as (1) suicides, (2) alcohol-specific deaths and (3) drug-related deaths. We employ several descriptive approaches to visually inspect age, period and cohort trends in these causes of death. RESULTS The USA and Scotland both saw large relative increases and high absolute levels of drug-related deaths. The rest of the UK and Canada saw relative increases but much lower absolute levels in comparison. Alcohol-specific deaths showed less consistent trends that did not track other 'despair' causes, with older groups in Scotland seeing steep declines over time. Suicide deaths trended slowly upward in most countries. CONCLUSIONS In the UK, Scotland has suffered increases in drug-related mortality comparable with the USA, while Canada and other UK constituent nations did not see dramatic increases. Alcohol-specific and suicide mortalities generally follow different patterns to drug-related deaths across countries and over time, questioning the utility of a cohesive 'deaths of despair' narrative.
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Affiliation(s)
- Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford, UK
- Nuffield College, University of Oxford, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anna Zajacova
- University of Western Ontario, London, Ontario, Canada
| | - Andrea M Tilstra
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford, UK
- Nuffield College, University of Oxford, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Piltch-Loeb R, James R, Albrecht SS, Buttenheim AM, Dowd JB, Kumar A, Jones M, Leininger LJ, Simanek A, Aronowitz S. What Were the Information Voids? A Qualitative Analysis of Questions Asked by Dear Pandemic Readers between August 2020-August 2021. J Health Commun 2023; 28:25-33. [PMID: 37390014 DOI: 10.1080/10810730.2023.2214986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
In the current infodemic, how individuals receive information (channel), who it is coming from (source), and how it is framed can have an important effect on COVID-19 related mitigation behaviors. In light of these challenges presented by the infodemic, Dear Pandemic (DP) was created to directly address persistent questions related to COVID-19 and other health topics in the online environment. This is a qualitative analysis of 3806 questions that were submitted by DP readers to a question box on the Dear Pandemic website between August 30, 2020 and August 29, 2021. Analyses resulted in four themes: the need for clarification of other sources; lack of trust in information; recognition of possible misinformation; and questions on personal decision-making. Each theme reflects an unmet informational need of Dear Pandemic readers, which may be reflective of the broader informational gaps in our science communication efforts.This study highlights the role of an ad hoc risk communication platform in the current environment and uses questions submitted to the Dear Pandemic question box to identify informational needs of DP readers over the course of the COVID-19 pandemic. These findings may help clarify how organizations addressing health misinformation in the digital space can contribute to timely, responsive science communication and improve future communication efforts.
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Affiliation(s)
- Rachael Piltch-Loeb
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- DearPandemic.org, Madison, Philadelphia, PA, USA
| | | | - Sandra S Albrecht
- DearPandemic.org, Madison, Philadelphia, PA, USA
- Department of Epidemiology, Mailman School of Public Health at Columbia University, New York, NY, USA
| | - Alison M Buttenheim
- DearPandemic.org, Madison, Philadelphia, PA, USA
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Jennifer Beam Dowd
- DearPandemic.org, Madison, Philadelphia, PA, USA
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford, UK
| | - Aparna Kumar
- DearPandemic.org, Madison, Philadelphia, PA, USA
- Thomas Jefferson University College of Nursing, Philadelphia, PA, USA
| | - Malia Jones
- DearPandemic.org, Madison, Philadelphia, PA, USA
- Department of Community & Environmental Sociology, University of Wisconsin-Madison, Madison, WI, USA
| | - Lindsey J Leininger
- DearPandemic.org, Madison, Philadelphia, PA, USA
- Tuck School of Business at Dartmouth College, Hanover, NH, USA
| | - Amanda Simanek
- DearPandemic.org, Madison, Philadelphia, PA, USA
- Department of Foundational Sciences, Chicago Medical School and Michael Reese Foundation Center for Health Equity Research, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Shoshana Aronowitz
- DearPandemic.org, Madison, Philadelphia, PA, USA
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Noppert GA, Stebbins RC, Dowd JB, Aiello AE. Socioeconomic and race/ethnic differences in immunosenescence: Evidence from the Health and Retirement Study. Brain Behav Immun 2023; 107:361-368. [PMID: 36347419 PMCID: PMC9636606 DOI: 10.1016/j.bbi.2022.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/20/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has highlighted the urgent need to understand variation in immunosenescence at the population-level. Thus far, population patterns of immunosenescence have not well described. METHODS We characterized measures of immunosenescence from the 2016 Venous Blood Study from the nationally representative U.S Health and Retirement Study (HRS) of individuals ages 50 years and older. RESULTS Median values of the CD8+:CD4+, EMRA:Naïve CD4+ and EMRA:Naïve CD8+ ratios were higher among older participants and were lower in those with additional educational attainment. Generally, minoritized race and ethnic groups had immune markers suggestive of a more aged immune profile: Hispanics had a CD8+:CD4+ median value of 0.37 (95 % CI: 0.35, 0.39) compared to 0.30 in non-Hispanic Whites (95 % CI: 0.29, 0.31). Non-Hispanic Blacks had the highest median value of the EMRA:Naïve CD4+ ratio (0.08; 95 % CI: 0.07, 0.09) compared to non-Hispanic Whites (0.03; 95 % CI: 0.028, 0.033). In regression analyses, race/ethnicity and education were associated with large differences in the immune ratio measures after adjustment for age and sex. CONCLUSIONS Lower educational attainment and minoritized racial ethnic status were associated with higher levels of immunosenescence. This population variation may have important implications for both risk of age-related disease and vulnerability to emerging pathogens (e.g., SARS-CoV-2).
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Affiliation(s)
- Grace A Noppert
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - Rebecca C Stebbins
- Social, Genetic, & Developmental Psychiatry Centre, Institute for Psychiatry, Psychology, and Neuroscience; King's College London, London, UK.
| | - Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, Department of Sociology, University of Oxford, UK
| | - Allison E Aiello
- Department of Epidemiology and Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, NY, USA.
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Golos AM, Guntuku SC, Piltch-Loeb R, Leininger LJ, Simanek AM, Kumar A, Albrecht SS, Dowd JB, Jones M, Buttenheim AM. Dear Pandemic: A topic modeling analysis of COVID-19 information needs among readers of an online science communication campaign. PLoS One 2023; 18:e0281773. [PMID: 36996093 PMCID: PMC10062627 DOI: 10.1371/journal.pone.0281773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 02/01/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic was accompanied by an "infodemic"-an overwhelming excess of accurate, inaccurate, and uncertain information. The social media-based science communication campaign Dear Pandemic was established to address the COVID-19 infodemic, in part by soliciting submissions from readers to an online question box. Our study characterized the information needs of Dear Pandemic's readers by identifying themes and longitudinal trends among question box submissions. METHODS We conducted a retrospective analysis of questions submitted from August 24, 2020, to August 24, 2021. We used Latent Dirichlet Allocation topic modeling to identify 25 topics among the submissions, then used thematic analysis to interpret the topics based on their top words and submissions. We used t-Distributed Stochastic Neighbor Embedding to visualize the relationship between topics, and we used generalized additive models to describe trends in topic prevalence over time. RESULTS We analyzed 3839 submissions, 90% from United States-based readers. We classified the 25 topics into 6 overarching themes: 'Scientific and Medical Basis of COVID-19,' 'COVID-19 Vaccine,' 'COVID-19 Mitigation Strategies,' 'Society and Institutions,' 'Family and Personal Relationships,' and 'Navigating the COVID-19 Infodemic.' Trends in topics about viral variants, vaccination, COVID-19 mitigation strategies, and children aligned with the news cycle and reflected the anticipation of future events. Over time, vaccine-related submissions became increasingly related to those surrounding social interaction. CONCLUSIONS Question box submissions represented distinct themes that varied in prominence over time. Dear Pandemic's readers sought information that would not only clarify novel scientific concepts, but would also be timely and practical to their personal lives. Our question box format and topic modeling approach offers science communicators a robust methodology for tracking, understanding, and responding to the information needs of online audiences.
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Affiliation(s)
- Aleksandra M Golos
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Sharath Chandra Guntuku
- Department of Computer and Information Science, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Rachael Piltch-Loeb
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
- Emergency Preparedness Research Evaluation and Practice Program, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
| | - Lindsey J Leininger
- Tuck School of Business, Dartmouth College, Hanover, NH, United States of America
| | - Amanda M Simanek
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America
| | - Aparna Kumar
- College of Nursing, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Sandra S Albrecht
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford, United Kingdom
- Department of Sociology, University of Oxford, Oxford, United Kingdom
- Nuffield College, University of Oxford, Oxford, United Kingdom
| | - Malia Jones
- Applied Population Laboratory, Department of Community and Environmental Sociology, College of Agricultural and Life Sciences, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Alison M Buttenheim
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, United States of America
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7
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Aburto JM, Tilstra AM, Floridi G, Dowd JB. Significant impacts of the COVID-19 pandemic on race/ethnic differences in US mortality. Proc Natl Acad Sci U S A 2022; 119:e2205813119. [PMID: 35998219 PMCID: PMC9436308 DOI: 10.1073/pnas.2205813119] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022] Open
Abstract
The coronavirus 2019 (COVID-19) pandemic triggered global declines in life expectancy. The United States was hit particularly hard among high-income countries. Early data from the United States showed that these losses varied greatly by race/ethnicity in 2020, with Hispanic and Black Americans suffering much larger losses in life expectancy compared with White people. We add to this research by examining trends in lifespan inequality, average years of life lost, and the contribution of specific causes of death and ages to race/ethnic life-expectancy disparities in the United States from 2010 to 2020. We find that life expectancy in 2020 fell more for Hispanic and Black males (4.5 and 3.6 y, respectively) compared with White males (1.5 y). These drops nearly eliminated the previous life-expectancy advantage for the Hispanic compared with the White population, while dramatically increasing the already large gap in life expectancy between Black and White people. While the drops in life expectancy for the Hispanic population were largely attributable to official COVID-19 deaths, Black Americans saw increases in cardiovascular diseases and "deaths of despair" over this period. In 2020, lifespan inequality increased slightly for Hispanic and White populations but decreased for Black people, reflecting the younger age pattern of COVID-19 deaths for Hispanic people. Overall, the mortality burden of the COVID-19 pandemic hit race/ethnic minorities particularly hard in the United States, underscoring the importance of the social determinants of health during a public health crisis.
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Affiliation(s)
- José Manuel Aburto
- Leverhulme Centre for Demographic Science, Department of Sociology, and Nuffield College, University of Oxford, Oxford, OX1 1JD, United Kingdom
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark; Odense 5000, Denmark
| | - Andrea M. Tilstra
- Leverhulme Centre for Demographic Science, Department of Sociology, and Nuffield College, University of Oxford, Oxford, OX1 1JD, United Kingdom
- University of Colorado Population Center, Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO 80302
| | - Ginevra Floridi
- Leverhulme Centre for Demographic Science, Department of Sociology, and Nuffield College, University of Oxford, Oxford, OX1 1JD, United Kingdom
| | - Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, Department of Sociology, and Nuffield College, University of Oxford, Oxford, OX1 1JD, United Kingdom
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Abstract
Background The COVID-19 pandemic has highlighted the urgent need to understand variation in immunosenescence at the population-level. Thus far, population patterns of immunosenescence are not well described. Methods We characterized measures of immunosenescence from newly released venous blood data from the nationally representative U.S Health and Retirement Study (HRS) of individuals ages 56 years and older. Findings Median values of the CD8+:CD4+, EMRA:Nave CD4+ and EMRA:Nave CD8+ ratios were higher among older participants and were lower in those with additional educational attainment. Generally, minoritized race and ethnic groups had immune markers suggestive of a more aged immune profile: Hispanics had a CD8+:CD4+ median value of 0.37 (95% CI: 0.35, 0.39) compared to 0.30 in Whites (95% CI: 0.29, 0.31). Blacks had the highest median value of the EMRA:Nave CD4+ ratio (0.08; 95% CI: 0.07, 0.09) compared to Whites (0.03; 95% CI: 0.028, 0.033). In regression analyses, race/ethnicity and education were associated with large differences in the immune ratio measures after adjustment for age and sex. For example, each additional level of education was associated with roughly an additional decade of immunological age, and the racial/ethnic differences were associated with two to four decades of additional immunological age. Interpretation Our study provides novel insights into population variation in immunosenescence. This has implications for both risk of age-related disease and vulnerability to novel pathogens (e.g., SARS-CoV-2). Funding This study was partially funded by the U.S. National Institutes of Health, National Institute on Aging R00AG062749. AEA and GAN acknowledge support from the National Institutes of Health, National Institute on Aging R01AG075719. JBD acknowledges support from the Leverhulme Trust (Centre Grant) and the European Research Council grant ERC-2021-CoG-101002587. Research in context Evidence before this study: Alterations in immunity with chronological aging have been consistently demonstrated across human populations. Some of the hallmark changes in adaptive immunity associated with aging, termed immunosenescence, include a decrease in nave T-cells, an increase in terminal effector memory cells, and an inverted CD8:CD4 T cell ratio. Several studies have shown that social and psychosocial exposures can alter aspects of immunity and lead to increased susceptibility to infectious diseases.Add value of this study: While chronological age is known to impact immunosenescence, there are no studies examining whether social and demographic factors independently impact immunosenescence. This is important because immunosenescence has been associated with greater susceptibility to disease and lower immune response to vaccination. Identifying social and demographic variability in immunosenescence could help inform risk and surveillance efforts for preventing disease in older age. To our knowledge, we present one of the first large-scale population-based investigations of the social and demographic patterns of immunosenescence among individuals ages 50 and older living in the US. We found differences in the measures of immunosenescence by age, sex, race/ethnicity, and education, though the magnitude of these differences varied across immune measures and sociodemographic subgroup. Those occupying more disadvantaged societal positions (i.e., minoritized race and ethnic groups and individuals with lower educational attainment) experience greater levels of immunosenescence compared to those in less disadvantaged positions. Of note, the magnitude of effect of sociodemographic factors was larger than chronological age for many of the associations.Implications for practice or policy and future research: The COVID-19 pandemic has highlighted the need to better understand variation in adaptive and innate immunity at the population-level. While chronological age has traditionally been thought of as the primary driver of immunological aging, the magnitude of differences we observed by sociodemographic factors suggests an important role for the social environment in the aging human immune system.
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Affiliation(s)
- Grace A Noppert
- Institute for Social Research, University of Michigan, Ann Arbor, MI USA
| | - Rebecca C Stebbins
- Social, Genetic, & Developmental Psychiatry Centre; Institute for Psychiatry, Psychology, and Neuroscience; King's College London, London, UK
| | - Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, Department of Sociology, University of Oxford
| | - Allison E Aiello
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Carolina Population Center, University of North Carolina, Chapel Hill, NC
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Albrecht SS, Aronowitz SV, Buttenheim AM, Coles S, Dowd JB, Hale L, Kumar A, Leininger L, Ritter AZ, Simanek AM, Whelan CB, Jones M. Lessons Learned From Dear Pandemic, a Social Media-Based Science Communication Project Targeting the COVID-19 Infodemic. Public Health Rep 2022; 137:449-456. [PMID: 35238241 PMCID: PMC9066238 DOI: 10.1177/00333549221076544] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The World Health Organization has identified excessive COVID-19 pandemic-related information as a public health crisis, calling it an "infodemic." Social media allows misinformation to spread quickly and outcompete scientifically grounded information delivered via other methods. Dear Pandemic is an innovative, multidisciplinary, social media-based science communication project whose mission is to educate and empower individuals to successfully navigate the overwhelming amount of information circulating during the pandemic. This mission has 2 primary objectives: (1) to disseminate trustworthy, comprehensive, and timely scientific content about the pandemic to lay audiences via social media and (2) to promote media literacy and information-hygiene practices, equipping readers to better manage the COVID-19 infodemic within their own networks. The volunteer team of scientists publishes 8-16 posts per week on pandemic-relevant topics. Nearly 2 years after it launched in March 2020, the project has a combined monthly reach of more than 4 million unique views across 4 social media channels, an email newsletter, and a website. We describe the project's guiding principles, lessons learned, challenges, and opportunities. Dear Pandemic has emerged as an example of a promising new paradigm for public health communication and intervention. The contributors deliver content in ways that are personal, practical, actionable, responsive, and native to social media platforms. The project's guiding principles are a model for public health communication targeting future infodemics and can bridge the chasm between the scientific community and the practical daily decision-making needs of the general public.
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Affiliation(s)
- Sandra S. Albrecht
- Department of Epidemiology, Mailman
School of Public Health at Columbia University, New York, NY, USA,Sandra S. Albrecht, PhD, MPH, Columbia
University Mailman School of Public Health, Department of Epidemiology, 722 West
168th St, New York, NY 10032, USA.
| | - Shoshana V. Aronowitz
- Department of Family and Community
Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Alison M. Buttenheim
- Department of Family and Community
Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Sarah Coles
- Department of Family, Community and
Preventive Medicine, University of Arizona College of Medicine–Phoenix, Phoenix, AZ,
USA
| | - Jennifer Beam Dowd
- Leverhulme Centre for Demographic
Science, University of Oxford, Oxford, United Kingdom
| | - Lauren Hale
- Department of Family, Population, and
Preventive Medicine, Program in Public Health, Stony Brook University, Stony Brook,
NY, USA
| | - Aparna Kumar
- Thomas Jefferson University College of
Nursing, Philadelphia, PA, USA
| | | | - Ashley Z. Ritter
- National Clinician Scholar Program,
University of Pennsylvania, Philadelphia, PA, USA
| | - Amanda M. Simanek
- Joseph J. Zilber School of Public
Health, University of Wisconsin–Milwaukee, Milwaukee, WI, USA
| | | | - Malia Jones
- Applied Population Laboratory,
University of Wisconsin–Madison, Madison, WI, USA
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Herd P, Mills MC, Dowd JB. Reconstructing Sociogenomics Research: Dismantling Biological Race and Genetic Essentialism Narratives. J Health Soc Behav 2021; 62:419-435. [PMID: 34100668 DOI: 10.1177/00221465211018682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We detail the implications of sociogenomics for social determinants research. We focus on education and race because of how early twentieth-century scientific eugenic thinking facilitated a range of racist and eugenic policies, most of which helped justify and pattern racial and educational morbidity and mortality disparities that remain today, and are central to sociological research. Consequently, we detail the implications of sociogenomics research by unpacking key controversies and opportunities in sociogenomics as they pertain to the understanding of racial and educational inequalities. We clarify why race is not a valid biological or genetic construct, the ways that environments powerfully shape genetic influence, and risks linked to this field of research. We argue that sociologists can usefully engage in genetics research, a domain dominated by psychologists and behaviorists who, given their focus on individuals, have mostly not examined the role of history and social structure in shaping genetic influence.
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Aburto JM, Kashyap R, Schöley J, Angus C, Ermisch J, Mills MC, Dowd JB. Estimating the burden of the COVID-19 pandemic on mortality, life expectancy and lifespan inequality in England and Wales: a population-level analysis. J Epidemiol Community Health 2021. [PMID: 33468602 DOI: 10.1101/2020.07.16.20155077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Deaths directly linked to COVID-19 infection may be misclassified, and the pandemic may have indirectly affected other causes of death. To overcome these measurement challenges, we estimate the impact of the COVID-19 pandemic on mortality, life expectancy and lifespan inequality from week 10 of 2020, when the first COVID-19 death was registered, to week 47 ending 20 November 2020 in England and Wales through an analysis of excess mortality. METHODS We estimated age and sex-specific excess mortality risk and deaths above a baseline adjusted for seasonality with a systematic comparison of four different models using data from the Office for National Statistics. We additionally provide estimates of life expectancy at birth and lifespan inequality defined as the SD in age at death. RESULTS There have been 57 419 (95% prediction interval: 54 197, 60 752) excess deaths in the first 47 weeks of 2020, 55% of which occurred in men. Excess deaths increased sharply with age and men experienced elevated risks of death in all age groups. Life expectancy at birth dropped 0.9 and 1.2 years for women and men relative to the 2019 levels, respectively. Lifespan inequality also fell over the same period by 5 months for both sexes. CONCLUSION Quantifying excess deaths and their impact on life expectancy at birth provide a more comprehensive picture of the burden of COVID-19 on mortality. Whether mortality will return to-or even fall below-the baseline level remains to be seen as the pandemic continues to unfold and diverse interventions are put in place.
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Affiliation(s)
- Jose Manuel Aburto
- Leverhulme Centre for Demographic Science, Department of Sociology and Nuffield College, University of Oxford, Oxford, UK
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Ridhi Kashyap
- Leverhulme Centre for Demographic Science, Department of Sociology and Nuffield College, University of Oxford, Oxford, UK
| | - Jonas Schöley
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Colin Angus
- ScHARR, University of Sheffield, Sheffield, UK
| | - John Ermisch
- Leverhulme Centre for Demographic Science, Department of Sociology and Nuffield College, University of Oxford, Oxford, UK
| | - Melinda C Mills
- Leverhulme Centre for Demographic Science, Department of Sociology and Nuffield College, University of Oxford, Oxford, UK
| | - Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, Department of Sociology and Nuffield College, University of Oxford, Oxford, UK
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13
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Aburto JM, Kashyap R, Schöley J, Angus C, Ermisch J, Mills MC, Dowd JB. Estimating the burden of the COVID-19 pandemic on mortality, life expectancy and lifespan inequality in England and Wales: a population-level analysis. J Epidemiol Community Health 2021; 75:735-740. [PMID: 33468602 PMCID: PMC7818788 DOI: 10.1136/jech-2020-215505] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/08/2020] [Accepted: 12/16/2020] [Indexed: 12/03/2022]
Abstract
BACKGROUND Deaths directly linked to COVID-19 infection may be misclassified, and the pandemic may have indirectly affected other causes of death. To overcome these measurement challenges, we estimate the impact of the COVID-19 pandemic on mortality, life expectancy and lifespan inequality from week 10 of 2020, when the first COVID-19 death was registered, to week 47 ending 20 November 2020 in England and Wales through an analysis of excess mortality. METHODS We estimated age and sex-specific excess mortality risk and deaths above a baseline adjusted for seasonality with a systematic comparison of four different models using data from the Office for National Statistics. We additionally provide estimates of life expectancy at birth and lifespan inequality defined as the SD in age at death. RESULTS There have been 57 419 (95% prediction interval: 54 197, 60 752) excess deaths in the first 47 weeks of 2020, 55% of which occurred in men. Excess deaths increased sharply with age and men experienced elevated risks of death in all age groups. Life expectancy at birth dropped 0.9 and 1.2 years for women and men relative to the 2019 levels, respectively. Lifespan inequality also fell over the same period by 5 months for both sexes. CONCLUSION Quantifying excess deaths and their impact on life expectancy at birth provide a more comprehensive picture of the burden of COVID-19 on mortality. Whether mortality will return to-or even fall below-the baseline level remains to be seen as the pandemic continues to unfold and diverse interventions are put in place.
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Affiliation(s)
- Jose Manuel Aburto
- Leverhulme Centre for Demographic Science, Department of Sociology and Nuffield College, University of Oxford, Oxford, UK
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Ridhi Kashyap
- Leverhulme Centre for Demographic Science, Department of Sociology and Nuffield College, University of Oxford, Oxford, UK
| | - Jonas Schöley
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Colin Angus
- ScHARR, University of Sheffield, Sheffield, UK
| | - John Ermisch
- Leverhulme Centre for Demographic Science, Department of Sociology and Nuffield College, University of Oxford, Oxford, UK
| | - Melinda C Mills
- Leverhulme Centre for Demographic Science, Department of Sociology and Nuffield College, University of Oxford, Oxford, UK
| | - Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, Department of Sociology and Nuffield College, University of Oxford, Oxford, UK
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14
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Ritter AZ, Aronowitz S, Leininger L, Jones M, Dowd JB, Albrecht S, Buttenheim AM, Simanek AM, Hale L, Kumar A. Dear Pandemic: Nurses as key partners in fighting the COVID-19 infodemic. Public Health Nurs 2021; 38:603-609. [PMID: 33876450 PMCID: PMC8251166 DOI: 10.1111/phn.12903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 12/29/2022]
Abstract
The COVID‐19 pandemic and subsequent proliferation of misinformation have created parallel public health crises. Social media offers a novel platform to amplify evidence‐based communication to broader audiences. This paper describes the application of science communication engagement on social media platforms by an interdisciplinary team of female scientists in a campaign called Dear Pandemic. Nurses are trusted professionals trained in therapeutic communication and are central to this effort. The Dear Pandemic campaign now has more than 97,000 followers with international and multilingual impact. Public health strategies to combat misinformation and guide individual behavior via social media show promise, and require further investment to support this novel dissemination of science communication.
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Affiliation(s)
- Ashley Z Ritter
- National Clinician Scholar Program, University of Pennsylvania, Philadelphia, PA, USA
| | - Shoshana Aronowitz
- National Clinician Scholar Program, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Malia Jones
- Applied Population Laboratory, University of Wisconsin-Madison, Madison, WI, USA
| | - Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford, UK
| | - Sandra Albrecht
- Department of Epidemiology, Mailman School of Public Health at Columbia University, New York, NY, USA
| | - Alison M Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Amanda M Simanek
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Lauren Hale
- Program in Public Health Department of Family, Population, and Preventative Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Aparna Kumar
- College of Nursing, Thomas Jefferson University, Philadelphia, PA, USA
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15
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Dowd JB, Block P, Rotondi V, Mills MC. Dangerous to claim "no clear association" between intergenerational relationships and COVID-19. Proc Natl Acad Sci U S A 2020; 117:25975-25976. [PMID: 32994352 PMCID: PMC7585024 DOI: 10.1073/pnas.2016831117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford OX1 1JD, United Kingdom;
- Nuffield College, University of Oxford, Oxford OX1 1NF, United Kingdom
| | - Per Block
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford OX1 1JD, United Kingdom
- Nuffield College, University of Oxford, Oxford OX1 1NF, United Kingdom
| | - Valentina Rotondi
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford OX1 1JD, United Kingdom
- Nuffield College, University of Oxford, Oxford OX1 1NF, United Kingdom
| | - Melinda C Mills
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford OX1 1JD, United Kingdom
- Nuffield College, University of Oxford, Oxford OX1 1NF, United Kingdom
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16
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Gaye B, Khoury S, Cene CW, Kingue S, N'Guetta R, Lassale C, Baldé D, Diop IB, Dowd JB, Mills MC, Jouven X. Socio-demographic and epidemiological consideration of Africa's COVID-19 response: what is the possible pandemic course? Nat Med 2020; 26:996-999. [PMID: 32528153 DOI: 10.1038/s41591-020-0960-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Bamba Gaye
- The African Research Network, Kumasi, Ghana. .,Université de Paris, Integrative Epidemiology of Cardiovascular Diseases, Paris Cardiovascular Research Center-INSERM U970, Paris, France.
| | - Stéphanie Khoury
- The African Research Network, Kumasi, Ghana.,Université de Paris, Integrative Epidemiology of Cardiovascular Diseases, Paris Cardiovascular Research Center-INSERM U970, Paris, France
| | - Crystal W Cene
- The African Research Network, Kumasi, Ghana.,Department of Medicine, Division of General Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill School of Medicine, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Samuel Kingue
- The African Research Network, Kumasi, Ghana.,University of Yaoundé, Ministry of Public Health, Yaoundé, Cameroon
| | - Roland N'Guetta
- The African Research Network, Kumasi, Ghana.,Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
| | - Camille Lassale
- CIBER of Pathophysiology of Obesity and Nutrition, Instituto de Salud Carlos III, Madrid, Spain
| | - Dadhi Baldé
- The African Research Network, Kumasi, Ghana.,Department of Cardiology, University Hospital of Conakry, Conakry, Guinea
| | - Ibrahima Bara Diop
- The African Research Network, Kumasi, Ghana.,Cardiology Department, University Hospital of Fann, Dakar, Senegal
| | - Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford, UK
| | - Melinda C Mills
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford, UK
| | - Xavier Jouven
- The African Research Network, Kumasi, Ghana.,Université de Paris, Integrative Epidemiology of Cardiovascular Diseases, Paris Cardiovascular Research Center-INSERM U970, Paris, France.,Cardiology Department, Georges-Pompidou European Hospital, Paris, France
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17
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Verhagen MD, Brazel DM, Dowd JB, Kashnitsky I, Mills MC. Forecasting spatial, socioeconomic and demographic variation in COVID-19 health care demand in England and Wales. BMC Med 2020; 18:203. [PMID: 32594909 PMCID: PMC7321716 DOI: 10.1186/s12916-020-01646-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/20/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND COVID-19 poses one of the most profound public health crises for a hundred years. As of mid-May 2020, across the world, almost 300,000 deaths and over 4 million confirmed cases were registered. Reaching over 30,000 deaths by early May, the UK had the highest number of recorded deaths in Europe, second in the world only to the USA. Hospitalization and death from COVID-19 have been linked to demographic and socioeconomic variation. Since this varies strongly by location, there is an urgent need to analyse the mismatch between health care demand and supply at the local level. As lockdown measures ease, reinfection may vary by area, necessitating a real-time tool for local and regional authorities to anticipate demand. METHODS Combining census estimates and hospital capacity data from ONS and NHS at the Administrative Region, Ceremonial County (CC), Clinical Commissioning Group (CCG) and Lower Layer Super Output Area (LSOA) level from England and Wales, we calculate the number of individuals at risk of COVID-19 hospitalization. Combining multiple sources, we produce geospatial risk maps on an online dashboard that dynamically illustrate how the pre-crisis health system capacity matches local variations in hospitalization risk related to age, social deprivation, population density and ethnicity, also adjusting for the overall infection rate and hospital capacity. RESULTS By providing fine-grained estimates of expected hospitalization, we identify areas that face higher disproportionate health care burdens due to COVID-19, with respect to pre-crisis levels of hospital bed capacity. Including additional risks beyond age-composition of the area such as social deprivation, race/ethnic composition and population density offers a further nuanced identification of areas with disproportionate health care demands. CONCLUSIONS Areas face disproportionate risks for COVID-19 hospitalization pressures due to their socioeconomic differences and the demographic composition of their populations. Our flexible online dashboard allows policy-makers and health officials to monitor and evaluate potential health care demand at a granular level as the infection rate and hospital capacity changes throughout the course of this pandemic. This agile knowledge is invaluable to tackle the enormous logistical challenges to re-allocate resources and target susceptible areas for aggressive testing and tracing to mitigate transmission.
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Affiliation(s)
- Mark D Verhagen
- Leverhulme Centre for Demographic Science, University of Oxford & Nuffield College, Oxford, UK.
| | - David M Brazel
- Leverhulme Centre for Demographic Science, University of Oxford & Nuffield College, Oxford, UK
| | - Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, University of Oxford & Nuffield College, Oxford, UK
| | - Ilya Kashnitsky
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark.,National Research University Higher School of Economics, Oxford, Russia
| | - Melinda C Mills
- Leverhulme Centre for Demographic Science, University of Oxford & Nuffield College, Oxford, UK.
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18
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Dowd JB, Andriano L, Brazel DM, Rotondi V, Block P, Ding X, Mills MC. Reply to Nepomuceno et al.: A renewed call for detailed social and demographic COVID-19 data from all countries. Proc Natl Acad Sci U S A 2020; 117:13884-13885. [PMID: 32576711 PMCID: PMC7321999 DOI: 10.1073/pnas.2009408117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
| | - Liliana Andriano
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
| | - David M Brazel
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
| | - Valentina Rotondi
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
| | - Per Block
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
| | - Xuejie Ding
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
| | - Melinda C Mills
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
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19
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Block P, Hoffman M, Raabe IJ, Dowd JB, Rahal C, Kashyap R, Mills MC. Social network-based distancing strategies to flatten the COVID-19 curve in a post-lockdown world. Nat Hum Behav 2020; 4:588-596. [DOI: 10.1038/s41562-020-0898-6] [Citation(s) in RCA: 272] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/18/2020] [Indexed: 01/19/2023]
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20
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Dowd JB, Andriano L, Brazel DM, Rotondi V, Block P, Ding X, Liu Y, Mills MC. Demographic science aids in understanding the spread and fatality rates of COVID-19. Proc Natl Acad Sci U S A 2020. [PMID: 32300018 DOI: 10.1101/2020.03.15.20036293] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Governments around the world must rapidly mobilize and make difficult policy decisions to mitigate the coronavirus disease 2019 (COVID-19) pandemic. Because deaths have been concentrated at older ages, we highlight the important role of demography, particularly, how the age structure of a population may help explain differences in fatality rates across countries and how transmission unfolds. We examine the role of age structure in deaths thus far in Italy and South Korea and illustrate how the pandemic could unfold in populations with similar population sizes but different age structures, showing a dramatically higher burden of mortality in countries with older versus younger populations. This powerful interaction of demography and current age-specific mortality for COVID-19 suggests that social distancing and other policies to slow transmission should consider the age composition of local and national contexts as well as intergenerational interactions. We also call for countries to provide case and fatality data disaggregated by age and sex to improve real-time targeted forecasting of hospitalization and critical care needs.
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Affiliation(s)
- Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
| | - Liliana Andriano
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
| | - David M Brazel
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
| | - Valentina Rotondi
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
| | - Per Block
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
| | - Xuejie Ding
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
| | - Yan Liu
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
| | - Melinda C Mills
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
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21
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Dowd JB, Andriano L, Brazel DM, Rotondi V, Block P, Ding X, Liu Y, Mills MC. Demographic science aids in understanding the spread and fatality rates of COVID-19. Proc Natl Acad Sci U S A 2020; 117:9696-9698. [PMID: 32300018 PMCID: PMC7211934 DOI: 10.1073/pnas.2004911117] [Citation(s) in RCA: 469] [Impact Index Per Article: 117.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Governments around the world must rapidly mobilize and make difficult policy decisions to mitigate the coronavirus disease 2019 (COVID-19) pandemic. Because deaths have been concentrated at older ages, we highlight the important role of demography, particularly, how the age structure of a population may help explain differences in fatality rates across countries and how transmission unfolds. We examine the role of age structure in deaths thus far in Italy and South Korea and illustrate how the pandemic could unfold in populations with similar population sizes but different age structures, showing a dramatically higher burden of mortality in countries with older versus younger populations. This powerful interaction of demography and current age-specific mortality for COVID-19 suggests that social distancing and other policies to slow transmission should consider the age composition of local and national contexts as well as intergenerational interactions. We also call for countries to provide case and fatality data disaggregated by age and sex to improve real-time targeted forecasting of hospitalization and critical care needs.
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Affiliation(s)
- Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
| | - Liliana Andriano
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
| | - David M Brazel
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
| | - Valentina Rotondi
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
| | - Per Block
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
| | - Xuejie Ding
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
| | - Yan Liu
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
| | - Melinda C Mills
- Leverhulme Centre for Demographic Science, Nuffield College, University of Oxford, Oxford OX1 3UQ, United Kingdom
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22
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Steptoe A, Hiltl TJ, Dowd JB, Hamer M. Socioeconomic status and central adiposity as determinants of stress-related biological responses relevant to cardiovascular disease risk. Brain Behav Immun 2019; 77:16-24. [PMID: 30468859 PMCID: PMC6417991 DOI: 10.1016/j.bbi.2018.11.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 12/17/2022] Open
Abstract
Stress-related processes have been implicated in the associations between lower socioeconomic status (SES), central adiposity, and cardiovascular disease risk. This study analysed the impact of SES and central adiposity on cardiovascular, inflammatory and neuroendocrine stress responses, and associations with cytomegalovirus (CMV) infection in a sample of 537 men and women aged 53-76 years (mean 62.89 years). SES was defined by grade of employment (higher, intermediate, and lower categories), and central adiposity was indexed by waist-hip ratio (WHR). Cardiovascular, inflammatory and cortisol responses were monitored during administration of a standardized mental stress testing protocol and salivary cortisol was measured repeatedly over the day. Lower SES was associated with raised systolic and diastolic blood pressure (BP), plasma interleukin (IL-6), fibrinogen, C-reactive protein, and salivary cortisol, and a large WHR accentuated SES differences in fibrinogen, C-reactive protein, and likelihood of CMV seropositivity, independently of general adiposity indexed by body mass index. During mental stress testing, return to resting levels (recovery) following behavioural challenge in systolic and diastolic BP and heart rate was impaired among lower SES participants, particularly those with large WHR. Lower SES participants had greater cortisol concentrations across the day, but this pattern did not vary with WHR. These findings extend the evidence relating lower SES to stress-related biological risk factors for cardiovascular disease, and indicate that central adiposity may augment these effects.
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Affiliation(s)
- Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK.
| | - Tanja-Julia Hiltl
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Jennifer Beam Dowd
- Department of Global Health and Social Medicine, King's College London, London WC2R 2LS, UK
| | - Mark Hamer
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK; School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire LE11 3TU, UK
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Abstract
PURPOSE OF THE REVIEW As the science of the microbiome advances, social epidemiologists can contribute to understanding how the broader social environment shapes the microbiome over the life course. This review summarizes current research and describes potential mechanisms of the social epidemiology of the microbiome. RECENT FINDINGS Most existing literature linking the social environment and the microbiome comes from animal models, focused on the impact of social interactions and psychosocial stress. Suggestive evidence of the importance of early life exposures, health behaviors, and the built environment also point to the importance of the social environment for the microbiome in humans. SUMMARY Social epidemiology as a field is well poised to contribute expertise in theory and measurement of the broader social environment to this new area, and to consider both the upstream and downstream mechanisms by which this environment gets "under the skin" and "into the gut." As population-level microbiome data becomes increasingly available, we encourage investigation of the multi-level determinants of the microbiome and how the microbiome may link the social environment and health.
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Affiliation(s)
- Jennifer Beam Dowd
- Department of Global Health and Social Medicine, King’s College London, The Strand, London, WC2R 2LS UK
- Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, 55 W 125th St, New York, NY 10027 USA
| | - Audrey Renson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27599 USA
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24
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Chang VW, Alley DE, Dowd JB. Trends in the Relationship Between Obesity and Disability, 1988-2012. Am J Epidemiol 2017; 186:688-695. [PMID: 28486588 DOI: 10.1093/aje/kwx092] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 10/25/2016] [Indexed: 12/14/2022] Open
Abstract
Rising obesity rates, coupled with population aging, have elicited serious concern over the impact of obesity on disability in later life. Prior work showed a significant increase in the association between obesity and disability from 1988 to 2004, calling attention to disability as a cost of longer lifetime exposure to obesity. It is not known whether this trend has continued. We examined functional impairment and impairment in activities of daily living (ADL) (defined as severe or moderate to severe) for adults aged 60 years or older (n = 16,770) over 3 time periods in the National Health and Nutrition Examination Survey. The relative odds of impairment for obese individuals versus normal-weight individuals significantly increased from period 1 (1988-1994) to period 2 (1999-2004) for all outcomes. In period 3 (2005-2012), this association remained stable for functional and severe ADL impairment and decreased for moderate-to-severe ADL impairment. The fraction of population disability attributable to obesity followed a similar trend. The trend of an increasing association between obesity and disability has leveled off in more recent years, and is even improving for some measures. These findings suggest that public health and policy concerns that obesity would continue to become more disabling over time have not been borne out.
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Affiliation(s)
- Virginia W Chang
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, New York
- Department of Population Health, School of Medicine, New York University, New York, New York
| | - Dawn E Alley
- Center for Medicare and Medicaid Innovation, Baltimore, Maryland
| | - Jennifer Beam Dowd
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, New York
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Dowd JB, Hamoudi A. Life Expectancy and Education. Am J Public Health 2014; 105:e1. [PMID: 25393170 DOI: 10.2105/ajph.2014.302320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jennifer Beam Dowd
- Jennifer Beam Dowd is with Department of Epidemiology and Biostatistics, the City University of New York (CUNY) School of Public Health and the CUNY Institute for Demographic Research, New York, NY. Amar Hamoudi is with the Sanford School of Public Policy and Duke Population Research Institute, Duke University, Durham. NC
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Affiliation(s)
- Jennifer Beam Dowd
- Department of Epidemiology and Biostatistics, Hunter College, School of Public Health, City University of New York, New York, NY 10035
| | - Anna Zajacova
- Department of Sociology, College of Arts and Sciences, University of Wyoming, Laramie, WY 82071
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Zajacova A, Walsemann KM, Dowd JB. The Long Arm of Adolescent Health Among Men and Women: Does Attained Status Explain Its Association with Mid-Adulthood Health? Popul Res Policy Rev 2014. [DOI: 10.1007/s11113-014-9327-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
OBJECTIVES Economic security around retirement age may be an important determinant of psychological and cognitive well-being of older adults. This study examines the impact of the dramatic increase in housing prices from the mid-1990s to the mid-2000s on psychological and cognitive outcomes among Americans born between 1924 and 1960. METHOD Our quasi-experimental empirical strategy exploits geographic differences in housing market price trends during the housing boom (from the mid-1990s until 2006). We use individual-level data from the Health and Retirement Study (HRS) and estimates of housing values from DataQuick, a California-based real estate consultancy firm, to estimate the association of housing price increases with psychological and cognitive outcomes at follow-up. RESULTS Greater housing appreciation over the follow-up period was associated with a significantly lower risk of anxiety (for women) and an improved performance on some but not all cognitive tasks. Effects for depressive symptoms, positive and negative affect, and life satisfaction were all in the beneficial direction but not statistically significant. The effects of price run-ups were concentrated on homeowners, as opposed to renters, suggestive of wealth-driven effects. DISCUSSION Housing market volatility may influence the psychological and cognitive health of older adults, highlighting potential health consequences of pro-home ownership policies, which may be especially important in light of recent dramatic housing price declines.
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Affiliation(s)
- Amar Hamoudi
- Correspondence should be addressed to Jennifer Beam Dowd, Epidemiology and Biostatistics at Hunter College, CUNY School of Public Health, CUNY Institute for Demographic Research, New York 10010. E-mail:
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Dowd JB, Palermo T, Brite J, McDade TW, Aiello A. Seroprevalence of Epstein-Barr virus infection in U.S. children ages 6-19, 2003-2010. PLoS One 2013; 8:e64921. [PMID: 23717674 PMCID: PMC3661547 DOI: 10.1371/journal.pone.0064921] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 04/20/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Epstein-Barr virus (EBV) is a common herpesvirus linked to infectious mononucleosis and multiple cancers. There are no national estimates of EBV seroprevalence in the United States. Our objective was to estimate the overall prevalence and sociodemographic predictors of EBV among U.S. children and adolescents aged 6-19. METHODS We calculated prevalence estimates and prevalence ratios for EBV seroprevalence using data from the 2003-2010 U.S. National Health and Nutrition Examination Survey (NHANES) for children aged 6-19 (n = 8417). Poisson regression was used to calculate multivariable-adjusted prevalence ratios across subgroup categories (sex, race/ethnicity, parental education, household income, household size, foreign-born, BMI, and household smoking). FINDINGS Overall EBV seroprevalence was 66.5% (95% CI 64.3%-68.7%.). Seroprevalence increased with age, ranging from 54.1% (95% CI 50.2%-57.9%) for 6-8 year olds to 82.9% (95% CI 80.0%-85.9%) for 18-19 year olds. Females had slightly higher seroprevalence (68.9%, 95% CI 66.3%-71.6%) compared to males (64.2%, 95% CI 61.7%-66.8%). Seroprevalence was substantially higher for Mexican-Americans (85.4%, 95% CI 83.1%-87.8%) and Non-Hispanic Blacks (83.1%, 95% CI 81.1%-85.1%) than Non-Hispanic Whites (56.9%, 95% CI 54.1%-59.8%). Large differences were also seen by family income, with children in the lowest income quartile having 81.0% (95% CI 77.6%-84.5%) seroprevalence compared to 53.9% (95% CI 50.5%-57.3%) in the highest income quartile, with similar results for parental education level. These results were not explained by household size, BMI, or parental smoking. Among those who were seropositive, EBV antibody titers were significantly higher for females, Non-Hispanic Blacks and Mexican-Americans, with no association found for socioeconomic factors. CONCLUSIONS In the first nationally representative U.S. estimates, we found substantial socioeconomic and race/ethnic differences in the seroprevalence of EBV across all ages for U.S. children and adolescents. These estimates can help researchers and clinicians identify groups most at risk, inform research on EBV-cancer etiology, and motivate potential vaccine development.
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Affiliation(s)
- Jennifer Beam Dowd
- Epidemiology and Biostatistics, CUNY School of Public Health at Hunter College, New York, New York, United States of America.
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Hamoudi A, Dowd JB. Physical health effects of the housing boom: quasi-experimental evidence from the health and retirement study. Am J Public Health 2013; 103:1039-45. [PMID: 23597343 DOI: 10.2105/ajph.2012.301205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the impact of the dramatic increases in housing prices in the United States in the 1990s and early 2000s on physical health outcomes among a representative sample of middle-aged and older Americans. METHODS Using a quasi-experimental design, we exploited geographic and time variation in housing prices using third-party valuation estimates of median single-family detached houses from 1988 to 2007 in each of 2400 zip codes combined with Health and Retirement Study data from 1992 to 2006 to test the impact of housing appreciation on physical health outcomes. RESULTS Respondents living in communities in which home values appreciated more rapidly had fewer functional limitations, performed better on interviewer-administered physical tasks, and had smaller waist circumference. CONCLUSIONS Our results indicate that increases in housing wealth were associated with better health outcomes for homeowners in late middle age and older. The recent sharp decline in housing values for this group may likewise be expected to have important implications for health and should be examined as data become available.
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Affiliation(s)
- Amar Hamoudi
- Amar Hamoudi is with the Sanford School of Public Policy and the Duke Population Research Institute, Duke University, Durham, NC, USA
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Hale L, Parente V, Dowd JB, Sands M, Berger JS, Song Y, Martin LW, Allison MA. Fibrinogen may mediate the association between long sleep duration and coronary heart disease. J Sleep Res 2012; 22:305-14. [DOI: 10.1111/jsr.12020] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 10/24/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Megan Sands
- Center for Sleep and Circadian Neurobiology; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Jeffrey S. Berger
- Divisions of Cardiology and Hematology, New York University Medical Center; New York University; New York NY USA
| | - Yiqing Song
- Division of Preventive Medicine, Brigham Women's Hospital; Brigham and Women's Hospital; Boston MA USA
| | - Lisa W. Martin
- Cardiology, George Washington University School of Medicine and Health Sciences; George Washington University; Washington DC USA
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Dowd JB. Whiners, deniers, and self-rated health: What are the implications for measuring health inequalities? A commentary on Layes, et al. Soc Sci Med 2012; 75:10-3. [DOI: 10.1016/j.socscimed.2012.01.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 01/31/2012] [Indexed: 11/27/2022]
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Abstract
General self-rated health (SRH) is widely used to study trends and inequalities in population health. Recently, there has been an increased interest in understanding the measurement properties of SRH. This study evaluated for the first time the test-retest reliability of SRH among US adults. Analyses were based on a nationally representative sample of 9,235 adults interviewed in the 2005-2008 National Health and Nutrition Examination Survey (NHANES). Respondents reported SRH on 2 occasions (about 1 month apart). Kappa statistics, polyserial correlations, and agreement tabulations were used to assess reliability across population subgroups; regression models tested the association of sociodemographic factors and the stability of the rating. Nearly 40% of respondents changed their health rating between interviews, indicating moderate test-retest reliability of SRH. Reliability differed significantly by sociodemographic characteristics: Racial/ethnic minorities and adults with less education had lower reliability of SRH judgments. Health events between interviews did not influence consistency, but conditional on a rating change, they increased the odds of downgrading one's health. The results suggest that 1) there is a substantial amount of error in individuals' self-assessment of health and 2) reliability is worse for disadvantaged sociodemographic groups, potentially biasing estimates of health inequalities among US adults.
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Affiliation(s)
- Anna Zajacova
- Department of Sociology, College of Arts and Sciences, University of Wyoming, Laramie, WY 82071-2000, USA.
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Dowd JB, Goldman N, Weinstein M. Sleep duration, sleep quality, and biomarkers of inflammation in a Taiwanese population. Ann Epidemiol 2011; 21:799-806. [PMID: 21889359 DOI: 10.1016/j.annepidem.2011.07.004] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 07/18/2011] [Accepted: 07/19/2011] [Indexed: 12/12/2022]
Abstract
PURPOSE Short and long sleep duration and sleep quality are associated with health including all-cause mortality, cardiovascular disease, diabetes, and obesity. Inflammation may play a role in mediating these associations. METHODS We examined associations between inflammation and self-reported sleep characteristics in 1020 respondents of the 2000 and 2006 Social Environment and Biomarkers of Aging Study, a nationally representative survey of Taiwanese adults ages 53 and over. Regression models were used to estimate cross-sectional relationships between inflammation (interleukin-6, C-reactive protein, fibrinogen, e-selectin, soluble intercellular adhesion molecule-1, albumin, and white blood cell count) and a modified Pittsburgh Sleep Quality Index, index subcomponents, and self-reported sleep duration. Change in inflammatory markers between 2000 and 2006 was also used to predict long or short sleep duration in 2006. RESULTS Inflammation was not related to the overall index of sleep quality. However, longer sleep (>8 hr) was associated with higher levels of inflammation. These associations remained after adjustment for waist circumference, self-reported health decline, diabetes, arthritis/rheumatism, heart disease, and depressive symptoms. Increases in inflammation between 2000 and 2006 were associated with long but not short sleep duration in 2006 for several markers. CONCLUSIONS Long sleep duration may be a marker of underlying inflammatory illness in older populations. Future studies should explore whether inflammation explains observed relationships between long sleep and mortality.
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Affiliation(s)
- Jennifer Beam Dowd
- CUNY School of Public Health, Hunter College, City University of New York, USA.
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Dowd JB, Todd M. Does self-reported health bias the measurement of health inequalities in U.S. adults? Evidence using anchoring vignettes from the Health and Retirement Study. J Gerontol B Psychol Sci Soc Sci 2011; 66:478-89. [PMID: 21666144 DOI: 10.1093/geronb/gbr050] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Measurement of health inequalities based on self-reports may be biased if individuals use response scales in systematically different ways. We use anchoring vignettes to test and adjust for reporting differences by education, race/ethnicity, and gender in self-reported health in 6 domains (pain, sleep, mobility, memory, shortness of breath, and depression). METHOD Using data from the 2006 U.S. Health and Retirement Study (HRS) and the 2007 Disability Vignette Survey, we estimated generalized ordered probit models of the respondent's rating of each vignette character's health problem, allowing cut-points to vary by age, gender, education, and race/ethnicity. We then used one-step hierarchical ordered probit (HOPIT) models to jointly estimate the respondent's cut-points from the vignettes and the severity of the respondent's own health problems based on these vignette cut-points. RESULTS We found strong evidence of reporting differences by age, gender, education, and race/ethnicity, with the magnitude depending on the specific health domain. Overall, traditional models not accounting for reporting differences underestimated the magnitude of health inequalities by education and race/ethnicity. DISCUSSION These results suggest caution in relying on self-reported health measures to quantify and explain health disparities by socioeconomic status and race/ethnicity/ethnicity in the United States. The findings support expansion of the use of anchoring vignettes to properly account for reporting differences in self-reports of health.
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Affiliation(s)
- Jennifer Beam Dowd
- School of Public Health, Hunter College, City University of New York (CUNY), NY 10010, USA.
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Rees Clayton EM, Todd M, Dowd JB, Aiello AE. The impact of bisphenol A and triclosan on immune parameters in the U.S. population, NHANES 2003-2006. Environ Health Perspect 2011; 119:390-6. [PMID: 21062687 PMCID: PMC3060004 DOI: 10.1289/ehp.1002883] [Citation(s) in RCA: 201] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 11/09/2010] [Indexed: 05/20/2023]
Abstract
BACKGROUND Exposure to environmental toxicants is associated with numerous disease outcomes, many of which involve underlying immune and inflammatory dysfunction. OBJECTIVES To address the gap between environmental exposures and immune dysfunction, we investigated the association of two endocrine-disrupting compounds (EDCs) with markers of immune function. METHODS Using data from the 2003-2006 National Health and Nutrition Examination Survey, we compared urinary bisphenol A (BPA) and triclosan levels with serum cytomegalovirus (CMV) antibody levels and diagnosis of allergies or hay fever in U.S. adults and children ≥ 6 years of age. We used multivariate ordinary least squares linear regression models to examine the association of BPA and triclosan with CMV antibody titers, and multivariate logistic regression models to investigate the association of these chemicals with allergy or hay fever diagnosis. Statistical models were stratified by age (< 18 years and ≥ 18 years). RESULTS In analyses adjusted for age, sex, race, body mass index, creatinine levels, family income, and educational attainment, in the ≥ 18-year age group, higher urinary BPA levels were associated with higher CMV antibody titers (p < 0.001). In the < 18-year age group, lower levels of BPA were associated with higher CMV antibody titers (p < 0.05). However, triclosan, but not BPA, showed a positive association with allergy or hay fever diagnosis. In the < 18-year age group, higher levels of triclosan were associated with greater odds of having been diagnosed with allergies or hay fever (p < 0.01). CONCLUSIONS EDCs such as BPA and triclosan may negatively affect human immune function as measured by CMV antibody levels and allergy or hay fever diagnosis, respectively, with differential consequences based on age. Additional studies should be done to investigate these findings.
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Affiliation(s)
- Erin M. Rees Clayton
- Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Megan Todd
- Institute for Demographic Research, City University of New York, New York, New York, USA
- Woodrow Wilson School of Public and International Affairs and Office of Population Research, Princeton University, Princeton, New Jersey, USA
| | - Jennifer Beam Dowd
- Institute for Demographic Research, City University of New York, New York, New York, USA
- School of Public Health, Hunter College, City University of New York, New York, New York, USA
| | - Allison E. Aiello
- Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Address correspondence to A.E. Aiello, Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, 1415 Washington Heights, Room 3663, Ann Arbor, MI 48109-2029 USA. Telephone: (734) 615-9213. Fax: (734) 763-5706. E-mail:
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Zajacova A, Dowd JB, Burgard SA. Overweight adults may have the lowest mortality--do they have the best health? Am J Epidemiol 2011; 173:430-7. [PMID: 21228416 PMCID: PMC3900866 DOI: 10.1093/aje/kwq382] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 10/11/2010] [Indexed: 12/25/2022] Open
Abstract
Numerous recent studies have found that overweight adults experience lower overall mortality than those who are underweight, normal-weight, or obese. These highly publicized findings imply that overweight may be the optimal weight category for overall health via its association with longevity-a conclusion with important public health implications. In this study, the authors examined the association between body mass index (BMI; (weight (kg)/height (m)(2))) and 3 markers of health risks using a nationally representative sample of US adults aged 20-80 years (n = 9,255) from the National Health and Nutrition Examination Survey (2005-2008). Generalized additive models, a type of semiparametric regression model, were used to examine the relations between BMI and biomarkers of inflammation, metabolic function, and cardiovascular function (C-reactive protein, hemoglobin A(1c), and high density lipoprotein cholesterol, respectively). The association between BMI and each biomarker was monotonic, with higher BMI being consistently associated with worse health risk profiles at all ages, in contrast to the U-shaped relation between BMI and mortality. Prior results suggesting that the overweight BMI category corresponds to the lowest risk of mortality may not be generalizable to indicators of health risk.
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Affiliation(s)
- Anna Zajacova
- Department of Sociology, College of Arts and Sciences, University of Wyoming, Laramie, USA.
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Dowd JB, Zajacova A. Does self-rated health mean the same thing across socioeconomic groups? Evidence from biomarker data. Ann Epidemiol 2010; 20:743-9. [PMID: 20816313 DOI: 10.1016/j.annepidem.2010.06.007] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 06/14/2010] [Accepted: 06/21/2010] [Indexed: 11/16/2022]
Abstract
PURPOSE Self-rated health (SRH) is widely used to study health inequalities by socioeconomic status (SES), but concern has arisen that SRH may not correspond to objective health in the same way for different SES groups. We test whether levels of biological risk differ by SES for those with the same SRH. METHODS We analyzed a U.S. nationally representative sample of 13,877 adults aged 25 to 80 years. We tested whether education modifies the association between SRH and 14 biomarkers representing metabolic, cardiovascular, inflammatory, and organ function using both interaction models and models stratified by four levels of SRH. Estimated education coefficients in the stratified models indicated whether biomarker levels varied by educational attainment within a given self-rated health category. RESULTS Significant variation in biological risk by education within the same self-rated health category was found, especially at higher levels of SRH. In general, respondents with more education had healthier levels of biomarkers for the same level of SRH. CONCLUSIONS The results suggest that the relation of self-reported health to objective health, as measured by biological risk factors, differs by socioeconomic status. Caution should be exercised when using SRH to compare health risks across SES groups.
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Affiliation(s)
- Jennifer Beam Dowd
- Epidemiology and Biostatistics, School of Public Health, Hunter College, City University of New York, NY 10010, USA.
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Dowd JB, Zajacova A, Aiello AE. Predictors of inflammation in U.S. children aged 3-16 years. Am J Prev Med 2010; 39:314-20. [PMID: 20837281 PMCID: PMC2952932 DOI: 10.1016/j.amepre.2010.05.014] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 03/31/2010] [Accepted: 05/28/2010] [Indexed: 01/26/2023]
Abstract
BACKGROUND Little is known about the correlates of low-grade inflammation in U.S. children. PURPOSE This study describes the factors associated with increased levels of C-reactive protein (CRP) in U.S. children and tests whether differences in CRP emerge in childhood because of socioeconomic factors. METHODS Data were analyzed in 2009 from 6004 children aged 3-16 years from the National Health and Nutrition Examination Survey, 1999-2004, a representative sample of the U.S. non-institutionalized population. Tobit regression models are used to evaluate associations between predictors, including BMI-for-age, skinfold body fat measures, chronic infections, environmental tobacco exposure, low birth weight, and sociodemographics and continuous high-sensitivity CRP in milligrams per liter. RESULTS CRP levels were higher in U.S. children with lower family income, and these differences were largely accounted for by differences in adiposity and recent illness. Mexican-American children had higher levels of CRP compared to both whites and blacks, but these differences were not explained by measured physical risk factors. CONCLUSIONS Increased adiposity is associated with higher CRP concentrations in U.S children aged 3-16 years, and both socioeconomic and racial/ethnic differences exist in systemic inflammation in U.S. children. Increased childhood obesity and low-grade inflammation may contribute to later life chronic disease risk.
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Affiliation(s)
- Jennifer Beam Dowd
- Department of Epidemiology and Biostatistics, Hunter College, School of Public Health, City University of New York, New York, New York 10010, USA.
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Roberts ET, Haan MN, Dowd JB, Aiello AE. Roberts et al. respond to "Human CMV, inflammation, and mortality". Am J Epidemiol 2010; 172:375-6. [PMID: 20660118 DOI: 10.1093/aje/kwq176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Eric T Roberts
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48104-2548, USA
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Roberts ET, Haan MN, Dowd JB, Aiello AE. Cytomegalovirus antibody levels, inflammation, and mortality among elderly Latinos over 9 years of follow-up. Am J Epidemiol 2010; 172:363-71. [PMID: 20660122 DOI: 10.1093/aje/kwq177] [Citation(s) in RCA: 198] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study examined the relation between immune response to cytomegalovirus (CMV) and all-cause and cardiovascular disease (CVD) mortality, and possible mediating mechanisms. Data were derived from the Sacramento Area Latino Study on Aging, a population-based study of older Latinos (aged 60-101 years) in California followed in 1998-2008. CMV immunoglobulin G (IgG), tumor necrosis factor, and interleukin-6 were assayed from baseline blood draws. Data on all-cause and CVD mortality were abstracted from death certificates. Analyses included 1,468 of 1,789 participants. For individuals with CMV IgG antibody titers in the highest quartile compared with lower quartiles, fully adjusted models showed that all-cause mortality was 1.43 times (95% confidence interval: 1.14, 1.79) higher over 9 years. In fully adjusted models, the hazard of CVD mortality was also elevated (hazard ratio = 1.35, 95% confidence interval: 1.01, 1.80). A composite measure of tumor necrosis factor and interleukin-6 mediated a substantial proportion of the association between CMV and all-cause (18.9%, P < 0.001) and CVD (29.0%, P = 0.02) mortality. This study is the first known to show that high CMV IgG antibody levels are significantly related to mortality and that the relation is largely mediated by interleukin-6 and tumor necrosis factor. Further studies investigating methods for reducing IgG antibody response to CMV are warranted.
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Affiliation(s)
- Eric T Roberts
- Department of Epidemiology, 3659 SPH Tower, 109 Observatory, Ann Arbor, MI 48104-2548, USA
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Zajacova A, Dowd JB, Schoeni RF, Wallace RB. Consistency and precision of cancer reporting in a multiwave national panel survey. Popul Health Metr 2010; 8:20. [PMID: 20579346 PMCID: PMC2905337 DOI: 10.1186/1478-7954-8-20] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 06/25/2010] [Indexed: 11/21/2022] Open
Abstract
Background Many epidemiological studies rely on self-reported information, the accuracy of which is critical for unbiased estimates of population health. Previously, accuracy has been analyzed by comparing self-reports to other sources, such as cancer registries. Cancer is believed to be a well-reported condition. This paper uses novel panel data to test the consistency of cancer reports for respondents with repeated self-reports. Methods Data come from 978 adults who reported having been diagnosed with cancer in at least one of four waves of the Panel Study of Income Dynamics, 1999-2005. Consistency of cancer occurrence reports and precision of timing of onset were studied as a function of individual and cancer-related characteristics using logistic and ordered logistic models. Results Almost 30% of respondents gave inconsistent cancer reports, meaning they said they never had cancer after having said they did have cancer in a previous interview; 50% reported the year of diagnosis with a discrepancy of two or more years. More recent cancers were reported with a higher consistency and timing precision; cervical cancer was reported more inaccurately than other cancer types. Demographic and socio-economic factors were only weak predictors of reporting quality. Conclusions Results suggest that retrospective reports of cancer contain significant measurement error. The errors, however, are fairly random across different social groups, meaning that the results based on the data are not systematically biased by socio-economic factors. Even for health events as salient as cancer, researchers should exercise caution about the presumed accuracy of self-reports, especially if the timing of diagnosis is an important covariate.
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Affiliation(s)
- Anna Zajacova
- Department of Sociology, University of Wyoming, Laramie, WY, USA.
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Abstract
BACKGROUND Lower socioeconomic status (SES) is strongly linked to health outcomes, though the mechanisms are poorly understood. Little is known about the role of the immune system in creating and sustaining health disparities. Here we test whether SES is related to cell-mediated immunity, as measured by the host's ability to keep persistent cytomegalovirus (CMV) antibody levels in a quiescent state. METHODS Censored regression models were used to test the cross-sectional relationship of education, income, and race/ethnicity with antibody response to CMV, using a nationally representative sample of 9721 respondents aged 25 years and older in the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). RESULTS Among CMV-seropositive respondents, those with less education, lower income, and nonwhite race/ethnicity had higher levels of CMV antibodies at all ages. On average, each additional year of age was associated with CMV antibody levels that were 0.03 units higher (95% confidence interval = 0.03 to 0.04), whereas each additional year of education was associated with antibody levels that were 0.05 units lower (0.02 to 0.09). A doubling of family income was associated with antibody levels that were 0.25 units lower (0.11 to 0.39), the equivalent of 8 fewer years of age-related CMV antibody response. These relationships remained strong after controlling for baseline health conditions, smoking status, and BMI. CONCLUSIONS SES is associated with an indirect marker of cell-mediated immunity in a nationally representative sample. SES differences in immune control over CMV may have fundamental implications for health disparities over the life course.
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Affiliation(s)
- Jennifer Beam Dowd
- Hunter College, School of Health Sciences, City University of New York (CUNY), New York, NY, USA
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Simanek AM, Dowd JB, Aiello AE. Persistent pathogens linking socioeconomic position and cardiovascular disease in the US. Int J Epidemiol 2009; 38:775-87. [PMID: 19109247 PMCID: PMC2689394 DOI: 10.1093/ije/dyn273] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2008] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Numerous studies have documented a strong inverse association between cardiovascular disease and socioeconomic position (SEP). Several infections are associated with both cardiovascular disease and SEP; hence infection may form an important link between SEP and cardiovascular disease. This study examines whether seropositivity to cytomegalovirus (CMV), to herpes simplex virus type-1 (HSV-1), and/or to both pathogens mediates the relationship between SEP and cardiovascular disease history in a nationally representative sample of the United States. METHODS We conducted a cross-sectional study of subjects > or =45 years of age, who were tested for seropositivity to CMV, HSV-1 or both pathogens and assessed for cardiovascular disease history in the National Health and Nutrition Examination Survey III. Cardiovascular disease history was defined as history of stroke, heart attack and/or congestive heart failure and SEP as education level. RESULTS SEP was associated with CMV, HSV-1 and seropositivity to both pathogens. CMV seropositivity was associated with cardiovascular disease history even after adjusting for confounders as well as SEP. The odds of reporting a history of cardiovascular disease for those with less than a high school education compared with those with more than a high school education decreased by 7.7% after adjusting for CMV (Sobel mediation test for CMV, P = 0.0006). In contrast, neither seropositivity to HSV-1 nor to both pathogens was associated with cardiovascular disease history after adjusting for SEP. CONCLUSIONS Persistent pathogens such as CMV infection may explain a portion of the relationship between SEP and cardiovascular disease in the United States. Further studies examining additional pathogens and sociobiological mechanisms are warranted.
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Affiliation(s)
- Amanda M Simanek
- Center for Social Epidemiology & Population Health School of Public Health-University of Michigan, Ann Arbor, MI 48109-2029, USA
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Abstract
There is a strong relation between socioeconomic position and health outcomes, although the mechanisms are poorly understood. The authors used data from 1,503 California participants in the 1998-1999 Sacramento Area Latino Study on Aging aged 60-100 years to ask whether socioeconomic position is related to immune function as measured by the body's ability to keep latent herpesvirus antibody levels in a quiescent state. Individuals with lower educational levels had significantly higher levels of immunoglobulin G antibodies to cytomegalovirus and herpes simplex virus type 1. The odds ratio for being in a higher tertile of cytomegalovirus antibodies was 1.54 (95% confidence interval: 1.18, 2.01) for those in the lowest educational group, and the odds ratio for being in a higher tertile of herpes simplex virus type 1 was 1.63 (95% confidence interval: 1.25, 2.13). The relation between education and cytomegalovirus and herpes simplex virus type 1 antibody levels remained strong after controlling for baseline health conditions, smoking status, and body mass index. This is the first study known to show a relation between socioeconomic position and immune response to latent infection. It provides suggestive evidence that modulation of the immune system via latent infections may play a role in the observed associations between socioeconomic position and disease.
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Affiliation(s)
- Jennifer Beam Dowd
- Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, MI 48104-2548, USA
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Dowd JB, Zajacova A. Does the predictive power of self-rated health for subsequent mortality risk vary by socioeconomic status in the US? Int J Epidemiol 2007; 36:1214-21. [PMID: 17971388 DOI: 10.1093/ije/dym214] [Citation(s) in RCA: 225] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The purpose of this study is to test whether the predictive power of an individual's self-rated health (SRH) on subsequent mortality risk differs by socioeconomic status (SES) in the United States. METHODS We use the National Health Interview Survey 1986-94 linked to Multiple Cause of Death Files 1986-97 (NHIS-MCD). Analyses are based on non-Hispanic Black and White adults 25 and older (n = 358,388). Cox proportional hazard models are used to estimate the effect of SRH on mortality risk during follow-up. Interactions of SRH and level of education and SRH and level of income are used to assess differences in the predictive power of SRH for subsequent mortality risk. RESULTS The effect of SRH on subsequent mortality risk differs by level of education and level of income. Lower health ratings are more strongly associated with mortality for adults with higher education and/or higher income relative to their lower SES counterparts. CONCLUSIONS Our findings suggest that individuals with different education or income levels may evaluate their health differently with respect to the traditional five-point SRH scale, and hence their subjective health ratings may not be directly comparable. These results have important implications for research that tries to quantify and explain socioeconomic inequalities in health based on self-rated health.
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Affiliation(s)
- Jennifer Beam Dowd
- Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor, MI 48104-2548, USA.
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Abstract
Several recent studies in the US, Canada, and the UK have demonstrated a positive relationship between family income and child health, though the mechanisms underlying this relationship are poorly understood. Using data from the 1988 US National Maternal and Infant Health Survey and the 1991 follow-up, this paper tests whether maternal health status and health behaviors during pregnancy and early infancy can explain the relationship between family income and subjective health status at age 3. We find that, while a detailed set of controls for health risk factors including maternal smoking, drinking, and vitamin use during pregnancy, as well as breastfeeding and secondhand smoke exposure after birth, are significantly related to family income and maternal education, they do not explain the relationship between family income and maternal-assessed health of the child. We suggest that these results point to either more salient pathways through which family income impacts child health, such as maternal stress, or to the possibility that differences in subjective health status do not correspond to differences in objective health status in the same way for higher- and lower-income respondents.
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Abstract
Health care providers are under tremendous pressure to meet consumer demands in order to compete in the rapidly changing health care arena. Through evaluating patient satisfaction, health care providers can learn what the consumer wants from the health care system. This article informs the reader of issues surrounding patient satisfaction data collection instruments, especially the problem of lack of standardization. That is, each instrument measures satisfaction according to different standards. This article presents a case study analysis of one patient satisfaction data collection instrument entitled the Picker-Commonwealth Survey on Patient-Centered Care. Suggestions for revision and further work are addressed.
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Affiliation(s)
- M E Ryan
- University of Massachusetts Medical Center
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