Structural Bias in the Completeness of Death Investigations for Sudden Unexpected Infant Deaths (SUIDs)

OBJECTIVE

To assess sudden unexpected infant death (SUID) investigations for structural inequities by race/ethnicity and geography.

METHODS

The SUID Case Registry compiles data on death investigations. We analyzed cases from 2015 to 2018 (N = 3847) to examine likelihood of an incomplete death investigation, defined as missing autopsy, missing scene investigation, or missing detailed information about where and how the body was found. We also analyzed which specific components of death investigations led to the greatest number of incomplete investigations.

RESULTS

Twenty-four percent of SUIDs had incomplete death investigations. Death scenes in rural places had 1.51 times the odds of incomplete death investigations (95% confidence interval [CI], 1.19-1.92) compared with urban areas. Scene investigations led by law enforcement were more likely to result in incomplete death investigations (odds ratio [OR] = 1.49; 95% CI, 1.18-1.88) than those led by medical examiners. American Indian/Alaska Native SUIDs were more likely than other racial groups to have an incomplete investigation (OR = 1.49; 95% CI, 0.92-2.42), more likely to occur in rural places ( P = .055), and more likely to be investigated by law enforcement ( P < .001). If doll reenactments had been performed, 358 additional cases would have had complete investigations, and if SUID investigation forms had been performed, 243 additional cases would have had complete investigations. American Indian/Alaska Native SUIDs were also more likely to be missing specific components of death investigations.

CONCLUSION

To produce equitable public health surveillance data used in prevention efforts, it is crucial to improve SUID investigations, especially in rural areas and among American Indian/Alaska Native babies.

The association between playing professional American football and longevity

Recent research concludes that professional American football players (hereafter, "football players") live longer than American men in general, despite experiencing higher rates of chronic traumatic encephalopathy (CTE) and cardiovascular disease (CVD). This suggests that the longevity-enhancing benefits of playing football (e.g., physical fitness, money) outweigh the costs associated with CTE, CVD, and other longevity detriments of playing football. However, these surprising results may be the consequence of flawed research design. To investigate, we conducted two analyses. In analysis 1, we compared a) all professional American football players whose first season was 1986 or between 1988 and 1995 to b) a random sample of same-age American men observed as part of the National Health Interview Surveys in those same years selected on good health, at least 3 y of college, and not being poor. The exposure consists of playing one or more games of professional football; the outcome is risk of death within 25 y. In analysis 2, we use data on 1,365 men drafted to play in the (American) National Football League in the 1950s-906 of whom ultimately played professional football, and 459 of whom never played a game in any professional league. We estimate the association between playing football and survival through early 2023. In both analyses, we investigate differences between linemen and other position players. In contrast to most prior research, in both analyses, we find that linemen died earlier than otherwise similar men; men who played other positions died no earlier (or later).

Family deaths in the early life course and their association with later educational attainment in a longitudinal cohort study

Due to structural racism and pathways between racism and health, Black and Native American people die at younger ages than white people. This means that those groups are likely to experience deaths of family members at younger ages. Evidence is mixed about whether family deaths affect educational attainment. We aim to 1) estimate the prevalence of family deaths by age and race 2) estimate the effect of a family death on later educational attainment and 3) analyze whether the effect of a family death varies by age, socioeconomic status, gender, and race. The National Longitudinal Study of Adolescent to Adult Health (Add Health) is a nationally representative sample of U.S. adolescents in grades 7-12 at baseline in 1994-1995. Add Health has a large and racially diverse sample and records family deaths across the entire life course starting from birth. Participants were included in this analysis if they reported their educational attainment in Wave IV (N = 14,796). The racial group with the lowest proportion experiencing a sibling or parent death in the first 23 years of their lives was white participants (11.7%), followed by Asian (12.5%), Hispanic (15.0%), Black (24.3%) and Native American participants (30.3%). In adjusted models, those who experienced a family death had 0.60 times the odds (95% CI 0.51-0.71) of achieving a bachelor's degree compared to those without a family death. Mother deaths, father deaths, and sibling deaths were each harmful for obtaining a college degree and their effects were similar in magnitude. The age range when the effect of a family death was strongest was 10-13 years old (OR = 0.52 95% CI 0.40-0.67). The effect of a family death on college degree attainment did not vary by baseline parent education, participant sex, or race/ethnicity.

Early life exposure to cigarette smoking and adult and old-age male mortality: Evidence from linked US full-count census and mortality data

BACKGROUND

Smoking is a leading cause of premature death across contemporary developed nations, but few longitudinal individual-level studies have examined the long-term health consequences of exposure to smoking.

OBJECTIVE

We examine the effect of fetal and infant exposure to exogenous variation in smoking, brought about by state-level cigarette taxation, on adulthood and old-age mortality (ages 55-73) among cohorts of boys born in the United States during the 1920s and 1930s.

METHODS

We use state-of-the-art methods of record linkage to match 1930 and 1940 US full-count census records to death records, identifying early life exposure to the implementation of state-level cigarette taxes through contemporary sources. We examine a population of 2.4 million boys, estimating age at death by means of OLS regression, with post-stratification weights to account for linking selectivity.

RESULTS

Fetal or infant exposure to the implementation of state cigarette taxation delayed mortality by about two months. Analyses further indicate heterogenous effects that are consistent with theoretical expectations; the largest benefits are enjoyed by individuals with parents who would have been affected most by the tax implementation.

CONCLUSIONS

Despite living in an era of continuously increasing cigarette consumption, cohorts exposed to a reduction in cigarette smoking during early life enjoyed a later age at death. While it is not possible to comprehensively assess the treatment effect on the treated, the magnitude of the effect should not be underestimated, as it is larger than the difference between having parents belonging to the highest and lowest socioeconomic groups.

CONTRIBUTION

The study provides the first estimates of long-run health effects from early life exposure to cigarette smoking.

Describing and explaining age, period, and cohort trends in Americans' vocabulary knowledge

For a quarter of a century researchers have been documenting and trying to explain trends in Americans' vocabulary knowledge using data from the General Social Survey (GSS) and its WORDSUM test. Trends in Americans' vocabulary knowledge have important practical implications-for example, for educational policy and practice-and speak to the American workforce's competitiveness in the global knowledge economy. We contribute to this debate by analyzing 1978-2018 GSS data using an improved analytical approach that is consistent with theoretical notions of cohort effects and that permits simultaneously estimating inter-cohort average differences and intra-cohort life-course changes. We find that WORDSUM scores peak around age 35 and gradually decline in older ages; the scores were significantly lower in the 1980s and higher in the late 2000s and 2010s; and the 1940-1954 birth cohorts and the 1965 and later birth cohorts had notably higher and lower scores, respectively, than the expectation based on age and period main effects. We provide new evidence that such cohort differences tend to persist over the life course. Interestingly, the effects of increasing educational attainment and decreasing reading behaviors seemed to cancel out, leading to a relatively flat overall period trend. Trends in television viewing and word obsolescence did not appear to affect age, period, or cohort trends in WORDSUM scores.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11113-023-09771-5.

Estimating the Long-Term Causal Effects of Attending Historically Black Colleges or Universities on Depressive Symptoms

Racism is embedded in society, and higher education is an important structure for patterning economic and health outcomes. Historically Black Colleges and Universities (HBCUs) were founded on antiracism while predominantly White institutions (PWIs) were often founded on white supremacy. This contrast provides an opportunity to study the association between structural racism and health among Black Americans. We used the National Longitudinal Study of Adolescent to Adult Health (Add Health) to estimate the long-term causal effect of attending an HBCU (vs. PWI) on depressive symptoms among Black students in the United States from 1994-2018. While we found no overall association with attending an HBCU (vs. PWI) on depressive symptoms, we found that this association varied by baseline mental health and region, and across time. For example, among those who attended high school outside of the South, HBCU attendance was protective against depressive symptoms 7 years later, and the association was strongest for those with higher baseline depressive symptoms. We recommend equitable state and federal funding for HBCUs, and that PWIs implement and evaluate antiracist policies to improve mental health of Black students.

Childhood lead exposure is associated with lower cognitive functioning at older ages

The Flint, Michigan water crisis renewed concern about lead toxicity in drinking water. While lead in drinking water has been shown to negatively affect cognition among children, much less is known about its long-term consequences for late-life cognition. Using a nationally representative sample of U.S. older adults linked to historical administrative data from 1940, we find that older adults who lived as children in cities with lead pipes and acidic or alkaline water-the conditions required for lead to leach into drinking water-had worse cognitive functioning but not steeper cognitive decline. About a quarter of the association between lead and late-life cognition was accounted for by educational attainment. Within the next 10 years, American children exposed to high levels of lead during the 1970s will enter older ages. Our evidence highlights the need for stronger actions to identify interventions to mitigate long-term damage among people at high risk.

The Validity and Reliability of Retrospective Measures of Childhood Socioeconomic Status in the Health and Retirement Study: Evidence From the 1940 U.S. Census

OBJECTIVES

Retrospective measures of childhood socioeconomic status (SES) in cohort studies of aging that first observe people late in life-such as the Health and Retirement Study (HRS)-are widely used. However, their measurement validity and reliability are unknown. We assess the reliability and validity of the HRS's retrospective measures of parental education and childhood family finances.

METHODS

We use records for 6,343 HRS sample members who were children in 1940 that have been linked to records from the complete-count 1940 U.S. Census. We assess interrater reliability by comparing (a) retrospective reports of childhood SES collected from sample members in the 1992-2018 HRS to (b) prospective measures of parallel concepts collected from HRS sample members' parents in the 1940 Census. We assess predictive validity by comparing the results of analyses that model later-life outcomes as a function of childhood SES as measured both prospectively and retrospectively.

RESULTS

Interrater reliabilities of retrospective measures of parental education are high; however, the same is not true of the retrospective measure of childhood family finances. Both retrospective and prospective measures of childhood SES are predictive of later-life outcomes, and with similar strengths and directions of associations for most outcomes.

DISCUSSION

Researchers who rely on retrospective indicators of childhood SES from the HRS should be aware of their measurement properties. They are measured with error, and that error modestly attenuates estimates of their associations with later-life outcomes. However, prospective and retrospective measures of childhood SES have similar predictive validity. These findings should reassure researchers who rely on retrospective measures of childhood SES in the HRS and similarly designed surveys.

Does participating in a long-term cohort study impact research subjects’ longevity? Experimental evidence from the Wisconsin Longitudinal Study

There is considerable evidence that the act of participating in a survey can alter participants' attitudes, behaviors, and other outcomes in meaningful ways. Considering findings that this form of panel conditioning also impacts health behaviors and outcomes, we investigated the effect of participating in an intensive half-century-long cohort study on participants’ longevity. To do so, we used data from a 1957 survey of more than 33,000 Wisconsin high school seniors linked to mortality records. One third of those people were selected at random to participate in the Wisconsin Longitudinal Study (WLS); the other two thirds were never again contacted. Our survival models show no evidence of panel conditioning effects on longevity: People selected at random to participate in the WLS had the same mortality outcomes as their peers who were not selected. This finding holds for the full sample, for women, for men, for population subgroups defined by family socioeconomic origins and educational experiences, and for treatment compliers.

•

Participating in a health-focused cohort study for half a century does not impact participants' longevity.

•

This is true across groups defined by socioeconomic background and adolescent educational plans and accomplishments.

•

Research uses a true experimental design, thus enhancing internal validity.

Long-Term Effects of Local-Area New Deal Work Relief in Childhood on Educational, Economic, and Health Outcomes Over the Life Course: Evidence From the Wisconsin Longitudinal Study

The economic characteristics of one's childhood neighborhood have been found to determine long-term well-being. Policies enacted during childhood may change neighborhood trajectories and thus impact long-term outcomes for children. We use individual-level data from the Wisconsin Longitudinal Study to examine the enduring consequences of childhood exposure to local-area New Deal emergency employment work-relief activity. Our outcomes include adolescent cognition, educational attainment, midlife income, health behaviors, late-life cognition, and mortality. We find that children (ages 0-3) living in neighborhoods with moderate work-relief activity in 1940 had higher adolescent IQ scores, had higher class rank, and were more likely to obtain at least a bachelor's degree. We find enduring benefits for midlife income and late-life cognition for males who grew up in areas with a moderate amount of work relief. We find mixed results for males who grew up in the most disadvantaged areas with the highest levels of work-relief activity. These children had similar educational outcomes as those in the most advantaged districts with the lowest work-relief activity but had higher adult smoking rates. Our findings provide some of the first evidence of the long-term consequences of New Deal policies on children's long-term life course outcomes.

Association of Weight at Different Ages and All-Cause Mortality Among Older Adults in the US

Objective: Assess the association of BMI and BMI change with mortality. Methods: Using data from the Wisconsin Longitudinal Study (WLS) on participants born mainly in 1939 (n=4922), we investigated the associations between various measures of BMI across the life course (age 54 BMI; age 65 BMI; age 72 BMI; lifetime maximum BMI; BMI change between ages 54 and 65; BMI change between ages 65 and 72) and mortality. We also assessed whether these associations are mediated by late life health. Results: BMI at age 54 was more strongly associated with late life mortality than BMI at older ages. The association between BMI change and mortality varied based on the timing of weight change. Health at age 72, particularly self-rated health, diabetes, and physical functioning, mediated the observed associations. Conclusion: Knowing older people's weight at midlife and how their weight has changed may be more important in assessing late life mortality risk than their current weight.

"You're Not from Around Here:" Regional Naming and Life Outcomes

We examine the socioeconomic consequences of discrimination against people of Southern origins during the U.S. Great Migration of the first half of the 20th century. We ask whether people living in the American North and Midwest in 1940 fared worse with respect to education, occupation, and income if they were perceived to be of Southern origins. We also assess variation in these effects across racial groups and across actual region of origin groups. Using linked data from the 1920 and 1940 U.S. Censuses, we compare the life outcomes of about half a million pairs of brothers who differed with respect to the regional origin implied by their first names. For both whites and blacks, we find statistically significant associations between outcomes and the regional origin implied by names; regardless of where they were born, men living in the North or Midwest in 1940 did worse if their names implied Southern origins. However, these associations are entirely confounded by family-specific cultural, socioeconomic, and other factors that shaped both family naming practices and life outcomes. This finding-that regional discrimination in the early 20th century U.S. did not happen based on names-contrasts sharply with findings from research in more recent years that uses names as proxies for people's risk of exposure to various forms of discrimination. Whereas names are a basis for discrimination in modern times, they were not a basis for regional discrimination in an era in which people had more immediate and direct evidence about regional origins.

Childhood Growth and Socioeconomic Outcomes in Early Adulthood Evidence from the Inter-War United States

Childhood malnutrition and its later life effects were important concerns in European and North American social policy in the early twentieth century. However, there have been few studies of the long-term socioeconomic consequences of malnutrition in childhood. We use a unique longitudinal dataset to provide credible causal estimates of the effects of childhood nutrition on early-adult educational and employment outcomes. Our dataset includes 2,499 children in Saint Paul, Minnesota who were weighed and measured in a national children's health survey in 1918/1919 at 0-6 years of age. We observe those same people in the 1920, 1930 and 1940 U.S. censuses allowing us to measure childhood socioeconomic status (1920), adolescent school attendance (1930) and early-adult wages, and employment and educational attainment (1940). Examining variation between biological siblings, we are able to obtain credibly causal estimates of the relationship between childhood stature and weight and later life outcomes, largely canceling out the bias otherwise resulting from their joint correlation with genes and socioeconomic background. Because the initial survey located children within households, we identify the effect of differences in early childhood nutrition from differences between male siblings. Consistent with contemporary evidence from developing countries we find that being taller and heavier in early childhood is associated with better educational and labor market outcomes. Identifying all effects within families to control for socioeconomic background and family structure we find a standard deviation increase in BMI in early childhood was associated with a 3% increase in weekly earnings and that boys who were heavier for their age at the initial survey were 10% less likely to be unemployed in 1940. Taken together, these results confirm the importance of investments in early life health for later-life outcomes.

Effect of childhood proximity to lead mining on late life cognition

INTRODUCTION

Lead exposure negatively affects cognitive functioning among children. However, there is limited evidence about whether exposure to lead in early life impairs later life cognitive functioning.

METHODS

Participants in the prospective Wisconsin Longitudinal Study cohort (N = 8583) were linked to the 1940 Census, which was taken when they were young children. We estimated the effect of living near a lead mine in childhood on late life memory/attention and language/executive function in 2004 (mean age 64) and 2011 (mean age 71).

RESULTS

Lead-exposed children had significantly steeper memory/attention decline between 2004 and 2011 and worse language/executive function at baseline in late life. These long-term effects of lead were not mediated through adolescent IQ or late life SES and health factors.

DISCUSSION

Proximity to lead mining in childhood had long-term effects on late life memory/attention decline and language/executive function, reflecting a possible latent influence of lead exposure. More research is needed to understand behavioral and biological pathways underlying this relationship.

Childhood Lead Exposure and Cognitive Functioning Among Older Adults: Evidence From the Health and Retirement Study

Many children born in the early 20th century were exposed to water-borne lead, a neurotoxin that negatively impacts brain development. While lead exposure has been linked to poor cognition among children and young adults, no population-level research has examined the long-term implications of lead exposure for cognitive functioning in later life. Our study is the first to address this gap by utilizing novel data linkages between the 1940 U.S. Census and the Health and Retirement Study (HRS). Our sample includes respondents who were under age 17 (born 1924-1940) by the time of the decennial enumeration on April 1, 1940. Given that the dominant source of lead exposure was water during this period, we assessed lead exposure by using water chemistry and piping material data for each HRS respondent’s city of residence in 1940. Late-life cognitive functioning for HRS participants (observed 1998-2016) was measured using the Telephone Interview for Cognitive Status. We find that lead exposure during childhood is significantly and negatively associated with cognitive functioning in later life. HRS participants who lived in cities with lead pipes and acidic or alkaline water—the conditions required for lead to leech into municipal water—showed lower levels of cognitive functioning decades later as compared to other participants. This association persisted net of race, gender, childhood socioeconomic status and childhood health. However, the association was largely accounted for by adjusting for educational attainment. This implies that childhood lead exposure impacts later-life cognition via its effect on educational attainment.

Continuing Education and Stratification at Midlife

We ask whether patterns of racial/ethnic and socioeconomic stratification in educational attainment are amplified or attenuated when we take a longer view of educational careers. We propose a model of staged advantage to understand how educational inequalities evolve over the life course. Distinct from cumulative advantage, staged advantage asserts that inequalities in education ebb and flow over the life course as the population at risk of making each educational transition changes along with the constraints they confront in seeking more education. Results based on data from the 2014 follow-up of the sophomore cohort of High School and Beyond offer partial support for our hypotheses. The educational attainment process was far from over for our respondents as they aged through their 30s and 40s: more than six of ten continued their formal training during this period and four of ten earned an additional credential. Patterns of educational stratification at midlife became more pronounced in some ways, as women pulled further ahead of men in their educational attainments and parental education (but not income), and high school academic achievement continued to shape educational trajectories at the bachelor's degree level and beyond. However, African American respondents gained on White respondents during this life phase through continued formal (largely academic) training and slightly greater conditional probabilities of graduate or professional degree attainment; social background fails to predict earning an associate degree. These results, showing educational changes and transitions far into adulthood, have implications for our understanding of the complex role of education in stratification processes.

The importance of STEM: High school knowledge, skills and occupations in an era of growing inequality

Science, Technology, Engineering and Mathematics (STEM) jobs have grown in importance in the labor market in recent decades, and they are widely seen as the jobs of the future. Using data from the U.S. Census and American Community Survey, we first investigate the role of employment in STEM occupations when it comes to recent changes in the occupational employment distribution in the U.S. labor market. Next, with data from the High School and Beyond sophomore cohort (Class of 1982) recent midlife follow-up, we investigate the importance of high school students' mathematics and science coursework, knowledge, and skills for midlife occupations. The Class of 1982 completed high school prior to technological changes altering the demand for labor. We find that individuals who took more advanced levels of high school mathematics coursework enjoyed occupations with a higher percentile rank in the average wage distribution and were more likely to hold STEM-related occupations. Findings suggest that the mathematics coursework enabled workers to adapt and navigate changing labor market demands.

The Prevalence of Cognitive Impairment Is Not Increasing in the United States: A Critique of Hale et al. (2020)

Previous research based on the longitudinal Health and Retirement Study (HRS) has argued that the prevalence of cognitive impairment has declined in recent years in the United States. A recent article published in Epidemiology by Hale et al., however, suggests this finding is biased by unmeasured panel conditioning (improvement in cognitive scores resulting from repeat assessment). After adjusting for test number, Hale and colleagues found that the prevalence of cognitive impairment had actually increased between 1996 and 2014. In this commentary, we argue that simply adjusting for test number is not an appropriate way to handle panel conditioning in this instance because it fails to account for selective attrition (the tendency for cognitively high-functioning respondents to remain in the sample for a longer time). We reanalyze HRS data using models that simultaneously adjust for panel conditioning and selective attrition. Contrary to Hale et al., we find that the prevalence of cognitive impairment has indeed declined in the United States in recent decades.

A Short, Valid, and Flexible Web-Based Screener for Mild Cognitive Impairment

Clinical assessments for identifying mild cognitive impairment (MCI) can be costly and time-consuming. Few screeners for MCI exist that can be implemented quickly and outside of the clinic using flexible, cost-effective methods, such as web-based, mobile device-friendly assessments. Using data from middle-aged, racially and ethnically diverse Offspring Study participants (N=34 with MCI, N=54 without MCI; mean age: 53.9±3.4), we analyzed the sensitivity and specificity of several web- and telephone-based measures to identify MCI, after accounting for age and education. Web assessments included the Verbal Paired Associates (PA) and Visual PA tests. Phone assessments included the Number Series, Letter and Category Fluency, Number Span Forward & Backward, the AD8, and self-reported memory complaints. The discriminant ability of the web-based Visual PA test for MCI (ROC Area = .69) was comparable to phone-based measures, including the Category Fluency (ROC Area = .69), Number Span Forward (ROC Area = .61) and Backward (ROC Area = .67), and Letter Fluency (ROC Area = .68). Visual PA strongly predicted MCI, with a 98% reduction in the odds of MCI for every additional correct answer (OR=0.02), but our results are imprecise (95%CI: .000 to .76). A web-based Visual PA measure appears comparable to phone assessments in detection of MCI, although substantial uncertainty in its diagnostic precision remains. However, it is short, easily administered on a large-scale, and our evidence suggests that it can provide a sensitive and specific test to refer racially and ethnically diverse individuals for more thorough clinical assessment.

Association of Job Expectations Among High School Students With Early Death During Adulthood

Importance

Deaths from self-injury are increasing. Understanding the sources of risk is important for prevention and treatment.

Objective

To estimate the risks of suicide and drug poisoning deaths among adult men whose adolescent occupational expectations were not met in adulthood.

Design, Setting, and Participants

This cohort study included a sample of men interviewed as part of the High School and Beyond study, a nationally representative study of US high school sophomores and seniors in 1980, who were interviewed every 2 years through 1986; those who were sophomores in 1980 were reinterviewed in 1992. Men who survived to 1992 and reported occupational expectations were included in the present study. Death records prior to 2018 were linked to mortality databases and released in 2019. Data analysis was conducted from May to October 2020.

Exposure

Occupational expectations.

Main Outcomes and Measures

Survival or death by suicide, drug poisoning, chronic liver disease, heart disease, cancer, or some other cause, categorized from International Classification of Diseases, Ninth Revision and Tenth Revision codes. Competing risk Fine-Gray survival models regressed cause of death on adolescent occupational expectations and covariates.

Results

The 11 680 men in the High School and Beyond cohort study had a median (interquartile range) age of 29 (28-30) years in 1992, when the analysis of their future mortality began. Most men survived until 2015 (11 060 [weighted percentage, 95.0%]). Reported causes of death were suicide (60 [weighted percentage, 0.5%]), drug poisoning (40 [weighted percentage, 0.4%]), chronic liver disease (20 [weighted percentage, 0.2%]), heart disease (130 [weighted percentage, 1.0%]), cancer (100 [weighted percentage, 1.0%]), and other (280 [weighted percentage, 2.0%]). Subhazard ratios for death by suicide and drug poisoning were 2.91 (95% CI, 1.07-7.88; P = .04) and 2.62 (95% CI, 1.15-5.94; P = .02) times higher, respectively, among those who in 1980 expected to hold a subbaccalaureate occupation that later declined in labor market share compared with those with professional occupational expectations. The actual job held by men did not attenuate the hazards of deaths from suicide and drug poisoning.

Conclusions and Relevance

In this cohort study, men whose occupational expectations were not met because of labor market declines were at a higher risk of death from suicide or drug poisoning than men with different occupational expectations. Interventions to mitigate labor market changes should account for individuals' expectational ideals.

School performance and mortality: The mediating role of educational attainment and work and family trajectories across the life course

Evidence of a strong negative correlation between adolescent academic performance and mortality points to the importance of not only cognitive, but also non-cognitive, skills in predicting survival. We integrated two bodies of research to evaluate expectations regarding the role of educational attainment and trajectories of employment and marriage experience in mediating relationships between high school class rank and longevity. In particular, we used data from the Wisconsin Longitudinal Study (n = 9,232) to fit parametric mortality models from age 55 to age 77. Multiple mediator models allowed for quantification of the degree to which the association between high school class rank and mortality is mediated by life trajectories and educational attainment. Our results show that high school class rank is a statistically significant and substantively meaningful predictor of survival beyond age 55 and that this relationship is partially, but not fully, mediated by trajectories of employment and marriage experience across the life course. Higher educational attainment also mediates a substantial part of the relationship, but to varying degrees for men and women.

Which Aspects of Education Matter for Early Adult Mortality? Evidence from the High School and Beyond Cohort

What dimensions of education matter for people's chances of surviving young adulthood? Do cognitive skills, non-cognitive skills, course taking patterns, and school social contexts matter for young adult mortality, even net of educational attainment? We analyze data from High School & Beyond-a nationally representative cohort of ~25,000 high school students first interviewed in 1980. Many dimensions of education are associated with young adult mortality, and high school students' math course taking retain their associations with mortality net of educational attainment. Our work draws on theories and measures from sociological and educational research and enriches public health, economic, and demographic research on educational gradients in mortality that has almost exclusively relied on ideas of human capital accumulation and measures of degree attainment. Our findings also call on social and education researchers to engage together in research on the life-long consequences of educational processes, school structures, and inequalities in opportunities to learn.

Late-Stage Educational Inequality: Can Selection on Noncognitive Skills Explain Waning Social Background Effects?

Past research finds that the effect of socioeconomic origin on the probability of making educational transitions decreases over the educational career from primary to graduate school. Some have argued that this pattern of waning is the result of selective attrition, since those of modest social origins who make a given transition may have exceptional cognitive or noncognitive skills while more advantaged individuals may rely less heavily on these skills to continue their education. We study a sample of American 10th graders from 1980 to assess how much the pattern of waning effects is due to selective attrition along noncognitive skills for this cohort. We find that controlling for noncognitive skills does not make the effect of socioeconomic origin more stable across transitions. Still, socioeconomic advantage does not decline uniformly across transitions, and it appears most pronounced at the transition into college, whether accounting for noncognitive skills or not. Our results suggest that origins continue to drive educational attainment even among those who make it to postsecondary transitions.

Unauthorized Immigration to the United States: Annual Estimates and Components of Change, by State, 1990 to 2010

We describe a method for producing annual estimates of the unauthorized immigrant population in the United Sates and components of population change, for each state and D.C., for 1990 to 2010. We quantify a sharp drop in the number of unauthorized immigrants arriving since 2000, and we demonstrate the role of departures from the population (emigration, adjustment to legal status, removal by the Department of Homeland Security (DHS), and deaths) in reducing population growth from one million in 2000 to population losses in 2008 and 2009. The number arriving in the U.S. peaked at more than one million in 1999 to 2001, and then declined rapidly through 2009. We provide evidence that population growth stopped after 2007 primarily because entries declined and not because emigration increased during the economic crisis. Our estimates of the total unauthorized immigrant population in the U.S. and in the top ten states are comparable to those produced by DHS and the Pew Hispanic Center. For the remaining states and D.C., our data and methods produce estimates with smaller ranges of sampling error.

Tracking Health Inequalities from High School to Midlife

Educational gradients in health status, morbidity, and mortality are well established, but which aspects of schooling produce those gradients is only partially understood. We draw on newly available data from the midlife follow-up of the High School and Beyond sophomore cohort to analyze the relationship between students' level of coursework in high school and their long-term health outcomes. We additionally evaluate the mediating roles of skill development, postsecondary attendance and degree attainment, and occupational characteristics. We find that students who took a medium- to high-level course of study in high school have better self-reported health and physical functioning in midlife, even net of family background, adolescent health, baseline skills, and school characteristics. The association partially operates through pathways into postsecondary education. Our findings have implications for both educational policy and research on the educational gradient in health.

Panel Conditioning in the General Social Survey

Does participation in one wave of a survey have an effect on respondents' answers to questions in subsequent waves? In this article, we investigate the presence and magnitude of "panel conditioning" effects in one of the most frequently used data sets in the social sciences: the General Social Survey (GSS). Using longitudinal records from the 2006, 2008, and 2010 surveys, we find evidence that at least some GSS items suffer from this form of bias. To rule out the possibility of contamination due to selective attrition and/or unobserved heterogeneity, we strategically exploit a series of between-person comparisons across time-in-survey groups. This methodology, which can be implemented whenever researchers have access to at least three waves of rotating panel data, is described in some detail so as to facilitate future applications in data sets with similar design elements.

Family structure and childhood anthropometry in Saint Paul, Minnesota in 1918

Concern with childhood nutrition prompted numerous surveys of children's growth in the United States after 1870. The Children's Bureau's 1918 "Weighing and Measuring Test" measured two million children to produce the first official American growth norms. Individual data for 14,000 children survives from the Saint Paul, Minnesota survey whose stature closely approximated national norms. As well as anthropometry the survey recorded exact ages, street address and full name. These variables allow linkage to the 1920 census to obtain demographic and socioeconomic information. We matched 72% of children to census families creating a sample of nearly 10,000 children. Children in the entire survey (linked set) averaged 0.74 (0.72) standard deviations below modern WHO height-for-age standards, and 0.48 (0.46) standard deviations below modern weight-for-age norms. Sibship size strongly influenced height-for-age, and had weaker influence on weight-for-age. Each additional child six or underreduced height-for-age scores by 0.07 standard deviations (95% CI: -0.03, 0.11). Teenage siblings had little effect on height-forage. Social class effects were substantial. Children of laborers averaged half a standard deviation shorter than children of professionals. Family structure and socio-economic status had compounding impacts on children's stature.

Do inferences about mortality rates and disparities vary by source of mortality information?

PURPOSE

Researchers who study mortality among survey participants have multiple options for obtaining information about which participants died (and when and how they died). Some use public record and commercial databases; others use the National Death Index; some use the Social Security Death Master File; and still others triangulate sources and use Internet searches and genealogic methods. We ask how inferences about mortality rates and disparities depend on the choice of source of mortality information.

METHODS

Using data on a large, nationally representative cohort of people who were first interviewed as high school sophomores in 1980 and for whom we have extensive identifying information, we describe mortality rates and disparities through about age 50 using four separate sources of mortality data. We rely on cross-tabular and multivariate logistic regression models.

RESULTS

These sources of mortality information often disagree about which of our panelists died by about age 50 and also about overall mortality rates. However, differences in mortality rates (i.e., by sex, race/ethnicity, education) are similar across of sources of mortality data.

CONCLUSION

Researchers' source of mortality information affects estimates of overall mortality rates but not estimates of differential mortality by sex, race and/or ethnicity, or education.

Socioeconomic Achievements of Siblings in the Life Course

About 8,500 graduates of Wisconsin high schools and a randomly selected brother or sister have been followed from 1957 through the early 1990s. Data include multiple measures of social background, cognitive ability, schooling, and occupations held from career entry to midlife. The authors have analyzed occupational standing across the life course, using complementary measures of occupational education and occupational income. The analysis is based on structural equation models of sibling resemblance. The models estimate the effects of social background, cognitive ability, and schooling—both within and between families—across the life course of women and men. Across families, educational attainment levels are determined largely by cognitive ability and, to a lesser degree, by social background; family levels of occupational standing are determined largely by family education levels. Within families, cognitive ability also affects occupational standing primarily through schooling. Occupational inequalities and the effects of educational attainment on those inequalities both tend to decline across the life course.

Does Growing Childhood Socioeconomic Inequality Mean Future Inequality in Adult Health?

Over the past half century, American children have experienced increasingly unequal childhoods. The goal of this article is to begin to understand the implications of recent trends in social and economic inequalities among children for the future of inequalities in health among adults. The relative importance of many of the causal pathways linking childhood social and economic circumstances to adult health remains underexplored, and we know even less about how these causal pathways have changed over time. I combine a series of original analyses with reviews of relevant literature in a number of fields to inform a discussion of what growing childhood inequalities might mean for future inequalities in adult health. In the end, I argue that there is good reason to suppose that growing inequalities in children's social and economic circumstances will lead to greater heterogeneity in adults' morbidity and mortality.

The Impact of Work and Family Life Histories on Economic Well-Being at Older Ages

Motivated by theoretical and empirical research in life course sociology, we examine relationships between trajectories of work and family roles across the life course and four measures of economic well-being in later adulthood. Using data from the Wisconsin Longitudinal Study (WLS), and multiple trajectory-generating methods, we first identify latent trajectories of work and family roles between late adolescence and age 65. We then model economic well-being (at age 65) as a function of these trajectories and contemporaneously measured indicators of older adults' work, family, and health statuses. Our central finding is that trajectories of work and family experiences across the life course have direct effects on later-life economic well-being, as well as indirect effects that operate through more proximate measures of work, family, and other characteristics. We argue that these findings have important implications for how social scientists conceptualize and model the relationship between later-life economic outcomes and people's work and family experiences across the life course.

The Future of NCES's Longitudinal Student Surveys: Balancing Bold Vision and Realism

The National Center for Education Statistics' (NCES) longitudinal student surveys have long been exceptionally useful for many purpose. Despite their many virtues, however, these surveys cannot be used to monitor trends at short time intervals, they do not allow for flexible changes to survey content, they cannot generally be used to infer policy effects, they are not useful for international comparisons, and they are of limited value to local stakeholders. NCES should consider doing to its longitudinal students surveys what the Census Bureau did to the decennial census long form and what NORC has long done for the General Social Survey: Move to annual rotating panels and allow outside investigators to field (and fund) supplemental topical modules. NCES should also continue to work with the research community to explore new survey content areas and modes of observation, improve the quality of spatial measures, and pursue record linkage to administrative data.

Potential Data Sources for a New Study of Social Mobility in the United States

In this article I define the main criteria that ought to be considered in evaluating the costs and benefits of various data resources that might be used for a new study of social and economic mobility in the United States. These criteria include population definition and coverage, sample size, topical coverage, temporal issues, spatial issues, sustainability, financial expense, and privacy and data access. I use these criteria to evaluate the strengths and weakness of several possible data resources for a new study of mobility, including existing smaller-scale surveys, the Current Population Survey, the American Community Survey, linked administrative data, and a new stand-alone survey. No option is perfect, and all involve trade-offs. I conclude by recommending five possible designs that are particularly strong on the criteria listed above.

Making Full Use of the Longitudinal Design of the Current Population Survey: Methods for Linking Records Across 16 Months

Data from the Current Population Survey (CPS) are rarely analyzed in a way that takes advantage of the CPS's longitudinal design. This is mainly because of the technical difficulties associated with linking CPS files across months. In this paper, we describe the method we are using to create unique identifiers for all CPS person and household records from 1989 onward. These identifiers-available along with CPS basic and supplemental data as part of the on-line Integrated Public Use Microdata Series (IPUMS)-make it dramatically easier to use CPS data for longitudinal research across any number of substantive domains. To facilitate the use of these new longitudinal IPUMS-CPS data, we also outline seven different ways that researchers may choose to link CPS person records across months, and we describe the sample sizes and sample retention rates associated with these seven designs. Finally, we discuss a number of unique methodological challenges that researchers will confront when analyzing data from linked CPS files.

Patterns and Trends in Grade Retention Rates in the United States, 1995-2010

Although grade retention may be consequential for a number of important educational and socioeconomic outcomes, we know surprisingly little about the actual rate at which students are made to repeat grades. We build on Hauser, Frederick, and Andrew's (2007) measure of grade retention using data from the 1995 through 2010 Current Population Surveys. We make technical improvements to their measure; provide more recent estimates; and validate the measure against external criteria. Our measure describes large disparities in grade retention rates by sex, race/ethnicity, geographic locale, and students' socioeconomic circumstances. However, both absolute retention rates and disparities in retention rates have declined markedly since 2005. We conclude by describing how our measures might be used to model the impact of economic and policy contexts on grade retention rates.

Labor market penalties for foreign degrees among college educated immigrants

Are college degrees earned abroad worth less in the American economy than degrees earned in the United States? Do the labor market penalties associated with holding a foreign degree vary as a function of the country or region in which it was earned? Do these processes differ for men and women? We use data on 18,361 college-educated immigrants from the National Survey of College Graduates (NSCG) to address these questions. Female immigrants with foreign degrees are less likely to be employed than immigrant women who earned their degrees in the US. When employed, both female and male immigrants with foreign degrees are less likely to work in a job related to their highest college degree. Among employed female immigrants, the wage returns to foreign degrees are about 17% less than for US degrees; among male immigrants, this figure is about 11%. For both female and male immigrants, the labor market penalties associated with holding a foreign degree vary as a function of the region from which the foreign degree was obtained.

First through Eighth Grade Retention Rates for All 50 States: A New Method and Initial Results

How many students repeat a grade each year? How do retention rates vary across states and over time? Despite extensive research on the predictors and consequences of grade retention, there is no systematic way to quantify state-level retention rates; even national estimates rely on imperfect proxy measures. We present a conceptually simple method-based on publicly available data that are routinely collected each year-that describes retention rates at the state and national levels. After describing and validating this method, we employ it to report first through eighth grade public school retention rates for 2002-003 through 2008-09 for the entire country and for each state.

Socioeconomic Status and Health across the Life Course: A Test of the Social Causation and Health Selection Hypotheses

This research investigates the merits of the "social causation" and "health selection" explanations for associations between socioeconomic status and self-reported overall health, musculoskeletal health and depression. Using data that include information about individuals' SES and health from childhood through late adulthood, I employ structural equation models that account for errors in measured variables and that allow for explicit tests of various hypotheses about how SES and health are related. For each outcome and for both women and men the results provide no support for the health selection hypothesis. SES affects each health outcome at multiple points in the life course, but the reverse is not true.

Changes in Health between Ages 54 and 65: The Role of Job Characteristics and Socioeconomic Status

We model the relationships between socioeconomic status (SES), the conditions of paid employment, and changes between ages 54 and 65 in a variety of health outcomes: self-reported overall health, musculoskeletal health, and depression. To what extent is SES associated with changes in these health outcomes net of the conditions of paid employment? At the same time, to what extent are the conditions of paid employment independently associated with these outcomes net of SES? To address these questions we use unique data collected from a single cohort of men and women to model changes in these health outcomes between ages 54 and 65. Although results vary across outcomes, it is clear that there are some circumstances in which associations between SES and changes in health can be (at least partly) attributed to working conditions, and that there are other circumstances in which associations between working conditions and changes in health can be (at least partly) attributed to SES. We conclude that the largely disconnected literatures on health disparities (in the social sciences and public health) and job design (in occupational stress and ergonomics) could and should be fruitfully connected.

Did socioeconomic inequalities in morbidity and mortality change in the United States over the course of the twentieth century?

In this article we present two sets of empirical analyses that consider the extent to which socioeconomic gradients in self-assessed health and child mortality changed since the beginning of the twentieth century in the United States. This empirical issue has important and wide-ranging research and policy implications. In particular, our results speak to the value of considering the role of broader social, economic, and political inequalities in generating and maintaining socioeconomic disparities in morbidity and mortality. Despite dramatic declines in morbidity and mortality rates in the United States across the twentieth century, we find that socioeconomic-status gradients in morbidity and mortality declined only modestly (if at all) during that period.

Job characteristics as mediators in SES–health relationships

We focus on physical and psychosocial job characteristics as mediators in the relationship between socioeconomic status (SES) and health. From sociological research on the stratification of employment outcomes we expect that people with less education, lower earnings, and lower levels of occupational standing have more physically and psychosocially demanding jobs. From the occupational stress, ergonomics, and job design literatures, we expect that people with more physically and psychosocially demanding jobs have less favorable health outcomes. Consequently, we expect to find that job characteristics play an important mediating role in associations between SES and self-assessed overall health and cardiovascular and musculoskeletal health problems. To address these hypotheses, we use data from the Wisconsin Longitudinal Study (WLS). We find support for our hypotheses, although the extent to which job characteristics mediate SES-health relationships varies across health outcomes and by sex.

How to measure "what people do for a living" in research on the socioeconomic correlates of health

PURPOSE

Recent evidence suggests that occupational standing is not independently associated with health outcomes when occupations are ranked using socioeconomic criteria. In this study we ask two questions. First, is occupational standing associated with health outcomes when health-related criteria are used to establish the relative standing of occupations? Second, are job characteristics more closely related to health outcomes than occupational characteristics?

METHODS

We use data from the Wisconsin Longitudinal Study-that includes a unique combination of occupational, job, and health measures-and estimate a series of logistic regression models of the effects of education and job/occupational characteristics on several health outcomes.

RESULTS

We find few independent relationships between occupational standing and health, using socioeconomic or health-related criteria. However, we do find some significant relationships between job characteristics and health outcomes.

CONCLUSIONS

We conclude that what people do for a living does matter for their health, even beyond the effects of educational attainment, but that to assess the relationships between what people do for a living and their health outcomes we should measure the characteristics of their jobs, not of their occupations.

Evaluation of the Vitek 2 system for rapid identification of clinical isolates of gram-negative bacilli and members of the family Streptococcaceae

Accuracy of the Vitek 2 automated system (bioMérieux Vitek, USA) for rapid identification of bacteria was evaluated using a collection of 858 epidemiologically unrelated gram-negative and 99 gram-positive clinical isolates. Isolates were tested after subculturing to ensure purity. Conventional agar-based biochemical tests (Steers replicator) were used as a reference method of identification. Gram-negative bacteria were identified to the species level with 95.3% accuracy by the system ( Enterobacteriaceae, 95.9%; and non- Enterobacteriaceae, 92.5%), and gram-positive isolates with 72% accuracy. Although Vitek 2 identified routine clinical isolates of gram-negative bacilli and Enterococcus faecalis and Enterococcus faecium reliably, rapidly, and reproducibly, improvement is required in the identification of less common species of enterococci and viridans group streptococci.

Automated attention flags in chronic disease care planning

OBJECTIVES

To assess the value of computerised decision support in the management of chronic respiratory disease by comparing agreement between three respiratory specialists, general practitioners (care coordinators), and decision support software.

METHODS

Care guidelines for two chronic obstructive pulmonary disease projects of the SA HealthPlus Coordinated Care Trial were formulated. Decision support software, Care Plan On-Line (CPOL), was created to represent the intent of these guidelines via automated attention flags to appear in patients' electronic medical records. For a random sample of 20 patients with care plans, decisions about the use of nine additional services (eg, smoking cessation, pneumococcal vaccination) were compared between the respiratory specialists, the patients' GPs and the CPOL attention flags.

RESULTS

Agreement among the specialists was at the lower end of moderate (intraclass correlation coefficient [ICC], 0.48; 95% CI, 0.39-0.56), with a 20% rate of contradictory decisions. Agreement with recommendations of specialists was moderate to poor for GPs (kappa, 0.49; 95% CI, 0.33-0.66) and moderate to good for CPOL (kappa, 0.72; 95% CI, 0.55-0.90). CPOL agreement with GPs was moderate to poor (kappa, 0.41; 95% CI, 0.24-0.58). GPs were less likely than specialists or CPOL to decide in favour of an additional service (P<0.001). CPOL was 87% accurate as an indicator of specialist decisions. It gave a 16% false-positive rate according to specialist decisions, and flagged 61% of decisions where GPs said No and specialists said Yes.

CONCLUSIONS

Automated decision support may provide GPs with improved access to the intent of guidelines; however, further investigation is required.

Outbreak of nosocomial infections due to extended-spectrum beta-lactamase-producing strains of enteric group 137, a new member of the family Enterobacteriaceae closely related to Citrobacter farmeri and Citrobacter amalonaticus

A member of the Enterobacteriaceae initially identified as Kluyvera cryocrescens by the MicroScan Gram-Negative Combo 13 panel caused an outbreak of nosocomial infections in four patients (pneumonia, n = 2; urinary tract infection, n = 1; wound infection, n = 1) and urinary tract colonization in one patient. When the strains were tested by the Enteric Reference Laboratory of the Centers for Disease Control and Prevention, biochemical results were most compatible with Yersinia intermedia, Kluyvera cryocrescens, and Citrobacter farmeri but identification scores were low and test results were discrepant. However, when the biochemical test profile was placed in the computer database as a new organism, all strains were identified as the organism with high identification scores (0. 999968 to 0.999997) and no discrepant test results. By 16S rRNA sequence analysis the organism clustered most closely with, but was distinct from, Citrobacter farmeri and Citrobacter amalonaticus. Based on its unique biochemical profile and rRNA sequence, this organism is designated Enteric Group 137. Restriction endonuclease analysis and taxonomic antibiograms of strains causing the outbreak demonstrated a single clone of Enteric Group 137, and antibiotic susceptibility testing revealed the presence of extended-spectrum beta-lactamase (ESBL) resistance. Enteric Group 137 appears to be a new opportunistic pathogen that can serve as a source of ESBL resistance in the hospital.

Gastric pathology associated with Helicobacter pylori

A bacterium is associated with a specific gastritis. Neutrophils infiltrate the necks of the glands, just deep to the infected foveolae. This infiltration rarely, if ever, occurs without H. pylori infection. Foveolar epithelial damage is common, with loss of cell structure. Electron microscopy suggests that the bacteria cause this damage as they attach to the superficial cell membrane. These features, defined by Whitehead et al as active changes, appear specific for H. pylori infection. The neutrophils and specific epithelial changes disappear within days of starting treatment for Helicobacter. They rapidly recur if the treatment is unsuccessful. Without treatment, the changes remain for decades and are severe in 10% to 20% of cases. Other changes occur in the mucosa. Reduced mucus secretion occurs in damaged or proliferating epithelium. This reduced secretion occurs near healing ulcers or with other types of inflammation but is often severe when Helicobacter is present. It returns to normal within weeks of treating the infection. The bacteria adhering to the cell membrane may cause this change directly. Lymphoid infiltration occurs with any type of chronic inflammation or immune reaction. The infiltration is not specific for Helicobacter, and it reduces slowly in months or years after eradication of H. pylori. Peptic ulceration, particularly duodenal ulceration, although not specific, is particularly common with H. pylori infection. The long-term inflammation probably causes other gastric pathology. Atrophy is common. Epithelial metaplasia occurs in about 20% of patients, usually mild. Other features, such as scarring, epithelial dysplasia, and in situ malignant change, are less common. They show little improvement after eradicating H. pylori. The part played by the bacteria in their cause remains uncertain. Pathologists see a long-standing chronic gastritis clearly related to a bacterium. The inflammation often is severe and commonly damages the mucosa, with ulceration, atrophy, metaplasia, and occasional premalignant changes. Physicians would treat inflammation of this degree in most other parts of the body. This disease is usually symptomless. There is some controversy, but eradicating Helicobacter often fails to improve nonulcer dyspepsia. This failure results in a continuing argument over whether or not to treat the infection. Meanwhile the pathology continues. A temporary solution to the problem is suggested: Patients infected with Helicobacter can give informed consent. Patients can be told about the infection, the pathology, the poor relationship to symptoms, and side effects of therapy, and they can decide.

Statistical modelling of general practice medicine for computer assisted data entry in electronic medical record systems

Electronic medical record (EMR) systems have much potential, however, there are still a number of issues that need to be resolved before EMRs are widely accepted. One of these issues is the data input task, a potentially serious practical barrier to on-line medical computer usage. This paper reports the empirical modelling of data input requirements for physicians who use a problem-orientated medical record system. Three statistical models (Bayesian conditional probability, multiple linear regression and discriminant analysis) to predict drug treatment given problem diagnoses are derived from EMRs of 2500 general Practice encounters. Two metrics are used to measure the predictive power of the models considering both the number of drugs correctly predicted and the strength with which the models predict them. The models are tested on 500 unseen records from the same patient-physician population and the data used to build the models. The Bayesian model produces the best predictions on unseen data and is also the easiest model to compute. A prototype interface that enables new patient cases to be entered is constructed to demonstrate how the predictive power of the model can translate into benefits in the data entry task.