Get Well
Socioeconomic Status and the Increased Prevalence of Autism in California
Marissa King & Peter Bearman
American Sociological Review, forthcoming
Abstract:
The prevalence of autism has increased precipitously - roughly 10-fold in the past 40 years - yet no one knows exactly what caused this dramatic rise. Using a large and representative dataset that spans the California birth cohorts from 1992 through 2000, we examine individual and community resources associated with the likelihood of an autism diagnosis over time. This allows us to identify key social factors that have contributed to increased autism prevalence. While individual-level factors, such as birth weight and parental education, have had a fairly constant effect on likelihood of diagnosis over time, we find that community-level resources drive increased prevalence. This study suggests that neighborhoods dynamically interact with the people living in them in different ways at different times to shape health outcomes. By treating neighborhoods as dynamic, we can better understand the changing socioeconomic gradient of autism and the increase in prevalence.
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Jay Pearson & Arline Geronimus
American Journal of Public Health, forthcoming
Objectives: We explored whether a White ethnic group with a history of structural disadvantage, Jewish Americans, shows evidence of continuing health impact independent of socioeconomic position (SEP), whether coethnic social ties appear health protective, and whether the strength of any protection varies by SEP.
Methods: In a series of ordered logistic regressions, we analyzed data from the National Jewish Population Survey, 2000-2001, regressing self-rated health on race/ethnicity, education, and income for US Blacks, Jews, and other Whites and, for Jews alone, indicators of coethnic social ties.
Results: Controlling for SEP indicators, the self-rated health of Jews converged with that of Blacks and was significantly worse than that of other Whites. Access to coethnic social ties was associated with better self-rated health among Jews, with the strongest estimated association among those of lower SEP.
Conclusions: The finding that a White ethnic group with a favorable socioeconomic profile reported significantly worse health than did other Whites, after controlling for SEP, calls for better understanding of the complex interplay of cultural, psychosocial, and socioeconomic resources in shaping population health.
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Michael Daly & Malcolm MacLachlan
Health Psychology, March 2011, Pages 228-235
Objective: This study aimed to investigate the role of the apolipoprotein ε4 allele in moderating the influence of an exogenous stressor, an earthquake, on health.
Design: A "natural experiment" design was used where the interaction between the presence of the apolipoprotein ε4 allele and the level of subjective and objective exposure to a devastating earthquake was examined in a population-based cohort of elderly Taiwanese (N = 718).
Main Outcome Measures: The cognitive-affective dimension of health was assessed by measures of perceived control and depression and functional limitations were assessed using measures of instrumental activities of daily living and mobility. Overall health status was gauged using a single-item measure of self-rated health.
Results: Those who experienced damage to their property or were forced to move from their homes (high objective exposure) demonstrated low levels of self-rated health and somewhat lower perceived control a year later, only if they were apolipoprotein ε4 carriers. Similarly, those who found the earthquake severely distressing (high subjective exposure) were shown to have low levels of functioning and low self-rated health a year later, only if they possessed the ε4 allele.
Conclusion: Our findings suggest that genetic variation in the apolipoprotein E gene may modify the health effects of the exogenous stress of natural disaster exposure.
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Health Shocks, Insurance Status and Net Worth: Intra- and Inter-Generational Effects
Dalton Conley & Jason Alan Thompson
NBER Working Paper, March 2011
Abstract:
An extensive literature has documented a robust correlation between socioeconomic status - measured in a variety of ways - and health outcomes; however, much uncertainty remains regarding what causal processes underlie this association. The present paper builds on a growing literature that seeks to better document how and why wealth and SES are related. Specifically, we ask the extent to which health shocks affect net worth - a less-studied dimension of socioeconomic status. Given a lack of instruments that meet the exclusion restriction, we use data from the Panel Study of Income Dynamics to pursue a first-differences identification strategy. We estimate a parameter for acute illnesses (which should have a causal effect on wave-to-wave wealth changes) and compare this coefficient to a counterfactual parameter for the presence of chronic illnesses (which we argue should be less causally related to wealth differences year-to-year). Additionally, we interact these health indicators with insurance status as a further test that the health-wealth relationship is likely causal net of covariates. Results show that the onset of an acute illness has a negative effect on family wealth levels and that the onset of chronic illnesses only makes an impact when it occurs for those uninsured. In intergenerational models, parental health insurance status also seems to matter. When parents suffer from chronic illness and have no health insurance, adult children's net worth declines. Adult children in white families also face a greater likelihood of falling into debt (excluding wealth from home equity) when parental medical expenses increase. Together, these findings suggest that health dynamics play an important role in intergenerational stratification processes-at least under the current health regime of the United States.
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Steven Yen, Donald Bruce & Lisa Jahns
Contemporary Economic Policy, forthcoming
Abstract:
We investigate the factors that contribute to participation in the Supplemental Nutrition Assistance Program (SNAP, formerly known as the Food Stamp Program) and the effects of such participation on self-assessed health (SAH). Our estimation approach consists of an endogenous switching ordered probability model, using the copula approach, for a sample of current and former Temporary Assistance for Needy Families (TANF) recipients in Tennessee. Results indicate that sociodemographic characteristics play a role in SNAP participation. Interestingly, we find that participation in SNAP is inversely related to SAH.
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Health Across the Life Span in the United States and England
Melissa Martinson, Julien Teitler & Nancy Reichman
American Journal of Epidemiology, forthcoming
Abstract:
This study systematically compared health indicators in the United States and England from childhood through old age (ages 0-80 years). Data were from the 1999-2006 National Health and Nutrition Examination Survey for the United States (n = 39,849) and the 2003-2006 Health Survey for England (n = 69,084). Individuals in the United States have higher rates of most chronic diseases and markers of disease than their same-age counterparts in England. Differences at young ages are as large as those at older ages for most conditions, including obesity, low high-density lipoprotein cholesterol, high cholesterol ratio, high C-reactive protein, hypertension (for females), diabetes, asthma, heart attack or angina (for females), and stroke (for females). For males, heart attack or angina is higher in the United States only at younger ages, and hypertension is higher in England than in the United States at young ages. The patterns were similar when the sample was restricted to whites, the insured, nonobese, nonsmoking nondrinkers, and specific income categories and when stratified by normal weight, overweight, and obese weight categories. The findings from this study indicate that US health disadvantages compared with England arise at early ages and that differences in the body weight distributions of the 2 countries do not play a clear role.
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Health-Related Quality of Life Among Central Appalachian Residents in Mountaintop Mining Counties
Keith Zullig & Michael Hendryx
American Journal of Public Health, forthcoming
Objectives: We examined the health-related quality of life of residents in mountaintop mining counties of Appalachia using the 2006 national Behavioral Risk Factor Surveillance System.
Methods: Dependent variables included self-rated health; the number of poor physical, poor mental, and activity limitation days (in the past 30 days); and the Healthy Days Index. Independent variables included metropolitan status, primary care physician supply, and Behavioral Risk Factor Surveillance System behavioral and demographic variables. We compared dependent variables across 3 categories: mountaintop mining (yes or no), other coal mining (yes or no), and a referent nonmining group. We used SUDAAN MULTILOG and multiple linear regression models with post hoc least squares means to test mountaintop mining effects after adjusting for covariates.
Results: Residents of mountaintop mining counties reported significantly more days of poor physical, mental, and activity limitation and poorer self-rated health (P<.01) compared with the other county groupings. Results were generally consistent in separate analyses by gender and age.
Conclusions: Mountaintop mining areas are associated with the greatest reductions in health-related quality of life even when compared with counties with other forms of coal mining.
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The continuation of the antebellum puzzle: Stature in the US, 1847-1894
Matthias Zehetmayer
European Review of Economic History, forthcoming
Abstract:
This article explores whether the antebellum decline in heights continued in the second half of the nineteenth century by using a data set of more than 58,000 US Army recruits born between 1847 and 1894. The main finding is that heights continued to decline during the Civil War by about 0.4 in. (1.0 cm) and stagnated for an extended period of time before they began to increase among the birth cohorts of the late 1880s. Recruits from the South remained the tallest despite the Civil War, while those from the Northeast were the shortest. Height was positively correlated with proximity to protein-rich nutrients during childhood and with geographic mobility, and was negatively correlated with urbanization and infant mortality rates.
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Dominic James Wilkinson
American Journal of Bioethics, February 2011, Pages 20-32
Abstract:
When is it permissible to allow a newborn infant to die on the basis of their future quality of life? The prevailing official view is that treatment may be withdrawn only if the burdens in an infant's future life outweigh the benefits. In this paper I outline and defend an alternative view. On the Threshold View, treatment may be withdrawn from infants if their future well-being is below a threshold that is close to, but above the zero-point of well-being. I present four arguments in favor of the Threshold View, and identify and respond to several counterarguments. I conclude that it is justifiable in some circumstances for parents and doctors to decide to allow an infant to die even though the infant's life would be worth living. The Threshold View provides a justification for treatment decisions that is more consistent, more robust, and potentially more practical than the standard view.
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Claudia Bambs et al.
Circulation, 1 March 2011, Pages 850-857
Background: Cardiovascular health is a new construct defined by the American Heart Association (AHA) as part of its 2020 Impact Goal definition. The applicability of this construct to community-based populations and the distributions of its components by race and sex have not been reported.
Methods and Results: The AHA construct of cardiovascular health and the AHA ideal health behaviors index and ideal health factors index were evaluated among 1933 participants (mean age 59 years; 44% blacks; 66% women) in the community-based Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study. One of 1933 participants (0.1%) met all 7 components of the AHA's definition of ideal cardiovascular health. Less than 10% of participants met 5 components of ideal cardiovascular health in all subgroups (by race, sex, age, and income level). Thirty-nine subjects (2.0%) had all 4 components of the ideal health behaviors index and 27 (1.4%) had all 3 components of the ideal health factors index. Blacks had significantly fewer ideal cardiovascular health components than whites (2.0±1.2 versus 2.6±1.4; P<0.001). After adjustment by sex, age, and income level, blacks had 82% lower odds of having 5 components of ideal cardiovascular health (odds ratio 0.18, 95% confidence interval, 0.10 to 0.34; P<0.001). No interaction was found between race and sex.
Conclusion: The prevalence of ideal cardiovascular health is extremely low in a middle-aged community-based study population. Comprehensive individual and population-based interventions must be developed to support the attainment of the AHA`s 2020 Impact Goal for cardiovascular health.
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Long-Term Employment Effects of Surviving Cancer
John Moran, Pamela Farley & Christopher Hollenbeak
Journal of Health Economics, forthcoming
Abstract:
We compare employment and usual hours of work for prime-age cancer survivors from the Penn State Cancer Survivor Survey to a comparison group drawn from the Panel Study of Income Dynamics using cross-sectional and difference-in-differences regression and matching estimators. Because earlier research has emphasized workers diagnosed at older ages, we focus on employment effects for younger workers. We find that as long as two to six years after diagnosis, cancer survivors have lower employment rates and work fewer hours than other similarly-aged adults.
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Superfund Cleanups and Infant Health
Janet Currie, Michael Greenstone & Enrico Moretti
NBER Working Paper, March 2011
Abstract:
We are the first to examine the effect of Superfund cleanups on infant health rather than focusing on proximity to a site. We study singleton births to mothers residing within 5km of a Superfund site between 1989-2003 in five large states. Our "difference in differences" approach compares birth outcomes before and after a site clean-up for mothers who live within 2,000 meters of the site and those who live between 2,000- 5,000 meters of a site. We find that proximity to a Superfund site before cleanup is associated with a 20 to 25% increase in the risk of congenital anomalies.
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Socio-Economic Status and Z-Score Standardized Height-for-Age of U.S.-Born Children (Ages 2-6)
Brian Karl Finch & Audrey Beck
Economics & Human Biology, forthcoming
Abstract:
This study explores socio-economic gradients in height (stature-for-age) among a nationally representative sample of 2-6 year old children in the United States. We use NHANES III (1988-1994) Youth data linked with a special Natality Data supplement which contains information from birth certificates among sampled NHANES III Youth who are less than 7 years of age. Our results indicate significant socio-economic gradients for both maternal education and family income, net of controls for confounders, including: birth weight, gestational age, family size, and parental heights. These results are in stark contrast to those from other developed countries that seem to indicate diminished or eliminated socio-economic disparities, net of known confounders. In the United States, it appears that socio-economic gradients have an effect on birth outcomes, and continue to have an additional direct and independent effect on height, even in early childhood.
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Jennifer Karas Montez et al.
Research on Aging, March 2011, Pages 145-171
Abstract:
The educational gradient of U.S. adult mortality became steeper between 1960 and the mid-1980s, but whether it continued to steepen is less clear given a dearth of attention to these trends since then. This study provides new evidence on trends in the education-mortality gradient from 1986 through 2006 by race, gender, and age among non-Hispanic Whites and Blacks using data from the 2010 release of the National Health Interview Survey Linked Mortality File. Results show that for White and Black men, the gradient steepened among older ages because declines in mortality risk across education levels were greater among the higher educated. The gradient steepened among White women, and to a lesser extent among Black women, because mortality risk decreased among the college-educated but increased among women with less than a high school diploma. Greater returns to higher education and compositional changes within educational strata likely contributed to the trends.
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Yongping Hao et al.
Health Psychology, March 2011, Pages 137-144
Objective: Studies of health-related quality of life (HRQOL) among Black and White cancer survivors have been based on small convenience samples and yielded inconsistent results. We examined Black-White disparities in survivors' HRQOL with a population-based sample, and tested the hypothesis that area-level segregation accounts for those disparities.
Design: A sample of survivors of 10 types of cancer was drawn from 11 U.S. state cancer registries and surveyed 12-15 months after diagnosis. The current sample consisted of 5195 survivors (415 Black, 4780 White) who resided in 584 counties.
Main Outcome Measures: SF-36 General Health subscale scores were used as the measure of HRQOL.
Results: Bivariate results revealed that Black survivors had significantly poorer HRQOL than did White survivors. Multilevel regression including individual-level (gender, age, marital status, education, cancer type, stage at diagnosis, cancer progression, comorbidities, race/ethnicity) and area-level (county segregation and poverty) variables found that HRQOL was poorer among survivors who resided in high-Black-segregated counties, whereas race/ethnicity was no longer significant.
Conclusion: These findings indicate that Black-White disparities in HRQOL among cancer survivors might be a function, not of race/ethnicity, but of area-level variables associated with race/ethnicity. The strong role of segregation highlights the need for interventions to target Black-segregated areas.
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Tanning: A Large-Scale Evaluation of Psychosocial, Environmental, and Policy-Level Correlates
Joni Mayer et al.
American Journal of Public Health, forthcoming
Objectives: We evaluated psychosocial, built-environmental, and policy-related correlates of adolescents' indoor tanning use.
Methods: We developed 5 discrete data sets in the 100 most populous US cities, based on interviews of 6125 adolescents (aged 14-17 years) and their parents, analysis of state indoor tanning laws, interviews with enforcement experts, computed density of tanning facilities, and evaluations of these 3399 facilities' practices regarding access by youths. After univariate analyses, we constructed multilevel models with generalized linear mixed models (GLMMs).
Results: In the past year, 17.1% of girls and 3.2% of boys had used indoor tanning. The GLMMs indicated that several psychosocial or demographic variables significantly predicted use, including being female, older, and White; having a larger allowance and a parent who used indoor tanning and allowed their adolescent to use it; and holding certain beliefs about indoor tanning's consequences. Living within 2 miles of a tanning facility also was a significant predictor. Residing in a state with youth-access legislation was not significantly associated with use.
Conclusions:. Current laws appear ineffective in reducing indoor tanning; bans likely are needed. Parents have an important role in prevention efforts.
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Effects on the U.S. of an H1N1 Epidemic: Analysis with a Quarterly CGE Model
Peter Dixon et al.
Journal of Homeland Security and Emergency Management, 2010
Abstract:
We simulate the effects of a hypothetical H1N1 epidemic in the U.S. using a quarterly CGE model. Quarterly periodicity allows us to capture the short-run nature of an epidemic. We find potentially severe economic effects in the peak quarter. Averaged over the epidemic year, the effects are considerably damped. Our results indicate that the macroeconomic consequences of an epidemic are more sensitive to demand-side effects, such as reductions in international tourism and leisure activities, than to supply-side effects, such as reductions in productivity. This suggests that demand stimulus policies might be an appropriate economic response to a serious epidemic.
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Day-Yu Chao et al.
PLoS ONE, January 2011, e14555
Background: Relying on surveillance of clinical cases limits the ability to understand the full impact and severity of an epidemic, especially when subclinical cases are more likely to be present in the early stages. Little is known of the infection and transmissibility of the 2009 H1N1 pandemic influenza (pH1N1) virus outside of Mexico prior to clinical cases being reported, and of the knowledge pertaining to immunity and incidence of infection during April-June, which is essential for understanding the nature of viral transmissibility as well as for planning surveillance and intervention of future pandemics.
Methodology/Principal Findings: Starting in the fall of 2008, 306 persons from households with schoolchildren in central Taiwan were followed sequentially and serum samples were taken in three sampling periods for haemagglutination inhibition (HI) assay. Age-specific incidence rates were calculated based on seroconversion of antibodies to the pH1N1 virus with an HI titre of 1:40 or more during two periods: April-June and September-October in 2009. The earliest time period with HI titer greater than 40, as well as a four-fold increase of the neutralization titer, was during April 26-May 3. The incidence rates during the pre-epidemic phase (April-June) and the first wave (July-October) of the pandemic were 14.1% and 29.7%, respectively. The transmissibility of the pH1N1 virus during the early phase of the epidemic, as measured by the effective reproductive number R0, was 1.16 (95% confidence interval (CI): 0.98-1.34).
Conclusions: Approximately one in every ten persons was infected with the 2009 pH1N1 virus during the pre-epidemic phase in April-June. The lack of age-pattern in seropositivity is unexpected, perhaps highlighting the importance of children as asymptomatic transmitters of influenza in households. Although without virological confirmation, our data raise the question of whether there was substantial pH1N1 transmission in Taiwan before June, when clinical cases were first detected by the surveillance network.
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Trends in life expectancy by income from 1988 to 2007: Decomposition by age and cause of death
Lasse Tarkiainen et al.
Journal of Epidemiology & Community Health, forthcoming
Background: Less attention has been paid to mortality trends across income groups than those measured by other socioeconomic indicators. This study assessed the change in life expectancy by income over 20 years in the Finnish general population.
Methods: Life expectancy among 35-year-olds by household income quintiles was studied. Change in life expectancy from 1988-92 to 2003-7 was decomposed by age and cause of death. The dataset contained 754 087 deaths by oversample of 80% of all deaths during the period.
Results: The gap in life expectancy between the highest and the lowest income quintiles widened during the study period by 5.1 years among men and 2.9 years among women, and in 2007 it stood at 12.5 years and 6.8 years, respectively. Stagnation in the lowest income group was the main reason for the increased disparity for both sexes. Increasing mortality attributable to alcohol-related diseases and increasing or stagnating mortality for many cancers, as well as a slower decline in mortality due to ischaemic heart disease among men in the lowest income quintile, were the most significant factors increasing the gap.
Conclusions: The increasing gap in life expectancy was mostly due to the stagnation of mortality in the lowest income quintile and especially because of the increasing mortality in alcohol-related diseases. The increase in disparity may be more extreme when using income instead of occupational class or education, possibly because income identifies a lower and economically more deprived segment on a social hierarchy more clearly. The results identify a clear need to tackle the specific health problems of the poorest.
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Is public transport a risk factor for acute respiratory infection?
Joy Troko et al.
BMC Infectious Diseases, January 2011
Background: The relationship between public transport use and acquisition of acute respiratory infection (ARI) is not well understood but potentially important during epidemics and pandemics.
Methods: A case-control study performed during the 2008/09 influenza season. Cases (n=72) consulted a General Practitioner with ARI, and controls with another non-respiratory acute condition (n=66). Data were obtained on bus or tram usage in the five days preceding illness onset (cases) or the five days before consultation (controls) alongside demographic details. Multiple logistic regression modelling was used to investigate the association between bus or tram use and ARI, adjusting for potential confounders.
Results: Recent bus or tram use within five days of symptom onset was associated with an almost six-fold increased risk of consulting for ARI (adjusted OR=5.94 95% CI 1.33-26.5). The risk of ARI appeared to be modified according to the degree of habitual bus and tram use, but this was not statistically significant (1-3 times/week: adjusted OR=0.54 (95% CI 0.15-1.95; >3 times/week: 0.37 (95% CI 0.13-1.06).
Conclusions: We found a statistically significant association between ARI and bus or tram use in the five days before symptom onset. The risk appeared greatest among occasional bus or tram users, but this trend was not statistically significant. However, these data are plausible in relation to the greater likelihood of developing protective antibodies to common respiratory viruses if repeatedly exposed. The findings have differing implications for the control of seasonal acute respiratory infections and for pandemic influenza.
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A Population-Based Assessment of the Health of Homeless Families in New York City, 2001-2003
Bonnie Kerker et al.
American Journal of Public Health, March 2011, Pages 546-553
Objectives: We compared estimated population-based health outcomes for New York City (NYC) homeless families with NYC residents overall and in low-income neighborhoods.
Methods: We matched a NYC family shelter user registry to mortality, tuberculosis, HIV/AIDS, and blood lead test registries maintained by the NYC Department of Health and Mental Hygiene (2001-2003).
Results: Overall adult age-adjusted death rates were similar among the 3 populations. HIV/AIDS and substance-use deaths were 3 and 5 times higher for homeless adults than for the general population; only substance-use deaths were higher than for low-income adults. Children who experienced homelessness appeared to be at an elevated risk of mortality (41.3 vs 22.5 per 100 000; P < .05). Seven in 10 adult and child deaths occurred outside shelter. Adult HIV/AIDS diagnosis rates were more than twice citywide rates but comparable with low-income rates, whereas tuberculosis rates were 3 times higher than in both populations. Homeless children had lower blood lead testing rates and a higher proportion of lead levels over 10 micrograms per deciliter than did both comparison populations.
Conclusions: Morbidity and mortality levels were comparable between homeless and low-income adults; homeless children's slightly higher risk on some measures possibly reflects the impact of poverty and poor-quality, unstable housing.
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Louise Hawkley, Leah Lavelle, Gary Berntson & John Cacioppo
Psychophysiology, forthcoming
Abstract:
Low socioeconomic status (SES) has been associated with higher levels of allostatic load (AL). Posited mechanisms for this association include stress, personality, psychosocial variables, coping, social networks, and health behaviors. This study examines whether these variables explain the SES-AL relationship in a population-based sample of 208 51- to 69-year-old White, Black, and Hispanic adults in the Chicago Health, Aging, and Social Relations Study. AL was based on nine markers of physiological dysregulation. SES was inversely associated with a composite measure of AL; hostility and poor sleep quality helped to explain the association between AL and SES. Factor analyses revealed four AL components corresponding to the bodily systems of interest. SES was significantly associated with two AL components, suggesting that the effects of SES on physiological dysregulation are specific to certain systems in a middle to early old-age population.
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Is there a health penalty of China's rapid urbanization?
E. Van de Poel, O. O'Donnell & E. Van Doorslaer
Health Economics, forthcoming
Abstract:
While highly pertinent to the human welfare consequences of development, the impact of rapid urbanization on population health is not obvious. This paper uses community and individual-level longitudinal data from the China Health and Nutrition Survey to estimate the net health impact of China's unprecedented urbanization. We construct an index of urbanicity from a broad set of community characteristics and define urbanization in terms of movements across the distribution of this index. We use difference-in-differences estimators to identify the treatment effect of urbanization on the self-assessed health of individuals. We find that urbanization raises the probability of reporting of poor health and that a greater degree of urbanization has a larger effect. The effect may, in part, be attributable to changed health expectations, but it also appears to operate through health behaviour. Populations experiencing urbanization tend to consume more fat and smoke more.