Health and Wealth
Peter Muennig, Kevin Fiscella, Daniel Tancredi & Peter Franks
American Journal of Public Health, forthcoming
Objectives: We sought to quantify the potential health impact of selected medical and nonmedical policy changes within the United States.
Methods: Using data from the 1997-2000 National Health Interview Surveys (linked to mortality data through 2002) and the 1996-2002 Medical Expenditure Panel Surveys, we calculated age-specific health-related quality-of-life scores and mortality probabilities for 8 social and behavioral risk factors. We then used Markov models to estimate the quality-adjusted life years lost.
Results: Ranked quality-adjusted life years lost were income less than 200% of the poverty line versus 200% or greater (464 million; 95% confidence interval [CI]=368, 564); current-smoker versus never-smoker (329 million; 95% CI=226, 382); body mass index 30 or higher versus 20 to less than 25 (205 million; 95% CI=159, 269); non-Hispanic Black versus non-Hispanic White (120 million; 95% CI=83, 163); and less than 12 years of school relative to 12 or more (74 million; 95% CI=52, 101). Binge drinking, overweight, and health insurance have relatively less influence on population health.
Conclusions: Poverty, smoking, and high-school dropouts impose the greatest burden of disease in the United States.
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Debbie Barrington
Journal of Family Issues, August 2010, Pages 1041-1064
Abstract:
This study used data from the Panel Study of Income Dynamics (PSID) on two generations of African American women who gave birth from 1967 to 2005 to describe changing relationships between marital status and low birth weight (LBW) across the generations. An increasing protection of marriage on infant LBW across the two generations was found after adjusting for socioeconomic and demographic confounding factors via (a) logistic regression using generalized estimating equations, (b) propensity score analyses taking into account the differential distribution of confounders across the generations, and (c) sensitivity analyses that adjusted for childhood health of the mother prior to marriage. Intergenerational findings also suggest that marriage across generations was most protective against infant LBW; the lowest risk for LBW was found among women who were both married when they gave birth to their infants and had mothers who were married at the time they themselves were born.
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Catherine Love, Richard David, Kristin Rankin & James Collins
American Journal of Epidemiology, 15 July 2010, Pages 127-134
Abstract:
White women experience their lowest rate of low birth weight (LBW) in their late 20s; the nadir LBW for African-American women is under 20 years with rates rising monotonically thereafter, hypothesized as due to "weathering" or deteriorating health with cumulative disadvantage. Current residential environment affects birth outcomes for all women, but little is known about the impact of early life environment. The authors linked neighborhood income to a transgenerational birth file containing infant and maternal birth data, allowing assessment of economic effects over a woman's life course. African-American women who were born in poorer neighborhoods and were still poor as mothers showed significant weathering with regard to LBW and small for gestational age (SGA) but not preterm birth (PTB). However, African-American women in upper-income areas at both time points had a steady fall in LBW and SGA rate with age, similar to the pattern seen in white women. No group of white women, even those always living in poorer neighborhoods, exhibited weathering with regard to LBW, SGA, or PTB. In contrast, the degree of weathering among African-American women is related to duration of exposure to low-income areas and disappears for those with a life residence in non-poor neighborhoods.
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Radha Jagannathan, Michael Camasso & Usha Sambamoorthi
Social Science & Medicine, July 2010, Pages 152-160
Abstract:
In this paper, we employ a classical experiment to determine if welfare reform causes poor women to experience increased levels of clinical anxiety and depression. We organize our analyses around the insights provided by lifestyle change and ecosocial theories of illness. Our data come from the New Jersey Family Development Program (FDP), one of the most highly publicized welfare experiments in the U.S. A sample of 8393 women was randomly assigned into two groups, one which stressed welfare-to-work and the other which offered traditional welfare benefits. These women were followed from 1992 through 1996 and information on clinical diagnoses was collected quarterly from physician treatment claims to the government Medicaid program. Our intention-to-treat estimates show that for short-term welfare recipients FDP decreased the prevalence of anxiety by 40% and increased depression by 8%. For black women both anxiety and depression diagnoses declined while Hispanic women experienced a 68% increase in depression. We discuss several public policy implications which arise from our work.
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Socioeconomic Status in One's Childhood Predicts Offspring Cardiovascular Risk
Hannah Schreier & Edith Chen
Brain, Behavior, and Immunity, forthcoming
Objective: To test whether effects of socioeconomic environments can persist across generations, we examined whether parents' childhood socioeconomic status (SES) could predict blood pressure (BP) trajectories in their youth across a 12-month study period and C-reactive protein (CRP) levels at one year follow-up.
Methods: BP was assessed in 88 healthy youth (M age = 13 2.4) at three study visits, each 6 months apart. CRP was also assessed in youth at baseline and one year follow-up. Parents reported on current and their own childhood SES (education and crowding).
Results: If parents' childhood SES was lower, their children displayed increasing SBP and CRP over the 12-month period, or conversely, the higher parents' childhood SES, the greater the decrease in SBP and CRP in their youth over time. These effects persisted even after controlling for current SES. A number of other factors, including child health behaviors, parent psychosocial characteristics, general family functioning, and parent physiology could not explain these effects.
Conclusion: Our study suggests that the SES environment parents grow up in may influence physical health across generations, here, SBP and CRP in their children, and hence that intergenerational histories are important to consider in predicting cardiovascular health in youth.
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Gabriella Conti, James Heckman & Sergio Urzua
American Economic Review, May 2010, Pages 234-238
"We determine the role played by early cognitive, noncognitive, and health endowments. We identify the causal effect of education on health and health-related behaviors. We develop an empirical model of schooling choice and post-schooling outcomes, where both schooling and the outcomes determined in part by schooling are influenced by measured early family environments and latent capabilities (cognitive, noncognitive and health). We show that family background characteristics, and cognitive, noncognitive, and health endowments developed by age 10, are important determinants of labor market and health disparities at age 30. Not properly accounting for personality traits overestimates the importance of cognitive ability in determining adult health. Selection on factors determined early in life explains more than half of the observed difference by education in poor health, depression, and obesity. Education has an important causal effect in explaining differences in many adult outcomes and healthy behaviors. We uncover significant gender differences. We go beyond the current literature which typically estimates mean effects to compute distributions of treatment effects. We show how the health returns to education can vary among individuals who are similar with respect to their observed characteristics, and how a mean effect can hide gains and losses for different individuals. Our research highlights the important role played by the early years in producing health."
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Inequality and Infant and Childhood Mortality in the United States in the Twentieth Century
Michael Haines
NBER Working Paper, June 2010
Abstract:
This paper deals with the issue of using infant and childhood mortality as an indicator of inequality. The case is that of the United States in the 20th century. Using microdata from the 1900 and 1910 Integrated Public Use Microsamples (IPUMS), published data from the Birth Registration Area in the 1920s, results from a number of surveys, and the Linked Birth & Infant Death Files from the National Center for Health Statistics for 1991, infant and child mortality can be related to such other variables as occupation of father or mother, education of father or mother, family income, race, ethnicity, and residence. The evidence shows that, although there have been large absolute reductions in the level of infant and child mortality rates and also a reduction in the absolute levels of differences across socioeconomic groups, relative inequality has not diminished over the 20th century.
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Health outcomes of Experience Corps®: A high-commitment volunteer program
S.I. Hong & Nancy Morrow-Howell
Social Science & Medicine, July 2010, Pages 414-420
Abstract:
Experience Corps® (EC) is a high-commitment US volunteer program that brings older adults into public elementary schools to improve academic achievement of students. It is viewed as a health promotion program for the older volunteers. We evaluated the effects of the EC program on older adults' health, using a quasi-experimental design. We included volunteers from 17 EC sites across the US. They were pre-tested before beginning their volunteer work and post-tested after two years of service. We compared changes over time between the EC participants (n = 167) and a matched comparison group of people from the US Health and Retirement Study (2004, 2006). We developed the comparison group by using the nearest available Mahalanobis metric matching within calipers combined with the boosted propensity scores of those participating in the EC. We corrected for clustering effects via survey regression analyses with robust standard errors and calculated adjusted post-test means of health outcomes, controlling for all covariates and the boosted propensity score of EC participants. We found that compared to the comparison group, the EC group reported fewer depressive symptoms and functional limitations after two years of participation in the program, and there was a statistical trend toward the EC group reporting less decline in self-rated health. Results of this study add to the evidence supporting high-intensity volunteering as a social model of health promotion for older adults.
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Underlying Causes of the Emerging Nonmetropolitan Mortality Penalty
Jeralynn Cossman, Wesley James, Arthur Cosby & Ronald Cossman
American Journal of Public Health, August 2010, Pages 1417-1419
Abstract:
The nonmetropolitan mortality penalty results in an estimated 40201 excessive deaths per year, deaths that would not occur if nonmetropolitan and metropolitan residents died at the same rate. We explored the underlying causes of the nonmetropolitan mortality penalty by examining variation in cause of death. Declines in heart disease and cancer death rates in metropolitan areas drive the nonmetropolitan mortality penalty. Future work should explore why the top causes of death are higher in nonmetropolitan areas than they are in metropolitan areas.
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Natalie Slopen, Tené Lewis, Tara Gruenewald, Mahasin Mujahid, Carol Ryff, Michelle Albert & David Williams
Psychosomatic Medicine, forthcoming
Objectives: To determine whether early life adversity (ELA) was predictive of inflammatory markers and to determine the consistency of these associations across racial groups.
Methods: We analyzed data from 177 African Americans and 822 whites aged 35 to 86 years from two preliminary subsamples of the Midlife in the United States biomarker study. ELA was measured via retrospective self-report. We used multivariate linear regression models to examine the associations between ELA and C-reactive protein, interleukin-6, fibrinogen, endothelial leukocyte adhesion molecule-1, and soluble intercellular adhesion molecule-1, independent of age, gender, and medications. We extended race-stratified models to test three potential mechanisms for the observed associations.
Results: Significant interactions between ELA and race were observed for all five biomarkers. Models stratified by race revealed that ELA predicted higher levels of log interleukin-6, fibrinogen, endothelial leukocyte adhesion molecule-1, and soluble intercellular adhesion molecule-1 among African Americans (p < .05), but not among whites. Some, but not all, of these associations were attenuated after adjustment for health behaviors and body mass index, adult stressors, and depressive symptoms.
Conclusions: ELA was predictive of high concentrations of inflammatory markers at midlife for African Americans, but not whites. This pattern may be explained by an accelerated course of age-related disease development for African Americans.
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Increasing marginal utility of small increases in life-expectancy?: Results from a population survey
Maria Knoph Kvamme, Dorte Gyrd-Hansen, Jan Abel Olsen & Ivar Sønbø Kristiansen
Journal of Health Economics, July 2010, Pages 541-548
Abstract:
The standard practice in cost-effectiveness analyses of health care is to assign a linear value to increasing lifetime gains. The aim of the current study was to examine the possible existence of non-linear utility for short life extensions. A representative sample of the Norwegian population, aged 40-59 years (n = 2402), was asked to imagine that they had a limited remaining lifetime (1 year or 10 years) and were offered a treatment that would increase lifetime by a specified amount of time from 1 week to 1 year. In all scenarios, the price per week of life extension was held constant. The proportion of respondents that accepted the treatment increased with increasing extensions, indicating a convex utility function. The result suggests increasing marginal utility for life extensions up to 1 year.
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Psychotherapeutic interventions for depressed, low-income women: A review of the literature
Lauren Levy & Michael O'Hara
Clinical Psychology Review, forthcoming
Abstract:
Low-income women have very high rates of depression and also face a number of unique barriers that can prevent them from seeking, accepting, engaging in, or benefiting from psychotherapy treatment. Untreated depression often leads to deleterious psychological consequences for these women and their children, and may also diminish a woman's ability to improve her economic circumstances. We reviewed the literature on psychotherapeutic interventions for depressed, low-income women, identifying a number of practical, psychological, and cultural barriers that often prevent them from engaging in psychotherapy. Next, we assessed the degree to which established intervention programs help women overcome these barriers. The data suggest that it is quite difficult to engage depressed, low-income women in psychotherapy, but that a number of standard psychotherapy approaches do show promise. However, we found that many of the currently available interventions fail to fully address the barriers that prevent this population from engaging in treatment. Moreover, the impact these interventions have on engagement and attrition rates or clinical improvements is often inadequately reported. We provide preliminary recommendations for clinicians who work with low-income women as well as suggestions for bolstering the literature base.
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Brian Biggs, Lawrence King, Sanjay Basu & David Stuckler
Social Science & Medicine, July 2010, Pages 266-273
Abstract:
Despite findings indicating that both national income level and income inequality are each determinants of public health, few have studied how national income level, poverty and inequality interact with each other to influence public health outcomes. We analyzed the relationship between gross domestic product (GDP) per capita in purchasing power parity, extreme poverty rates, the gini coefficient for personal income and three common measures of public health: life expectancy, infant mortality rates, and tuberculosis (TB) mortality rates. Introducing poverty and inequality as modifying factors, we then assessed whether the relationship between GDP and health differed during times of increasing, decreasing, and decreasing or constant poverty and inequality. Data were taken from twenty-two Latin American countries from 1960 to 2007 from the December 2008 World Bank World Development Indicators, World Health Organization Global Tuberculosis Database 2008, and the Socio-Economic Database for Latin America and the Caribbean. Consistent with previous studies, we found increases in GDP have a sizable positive impact on population health. However, the strength of the relationship is powerfully influenced by changing levels of poverty and inequality. When poverty was increasing, greater GDP had no significant effect on life expectancy or TB mortality, and only led to a small reduction in infant mortality rates. When inequality was rising, greater GDP had only a modest effect on life expectancy and infant mortality rates, and no effect on TB mortality rates. In sharp contrast, during times of decreasing or constant poverty and inequality, there was a very strong relationship between increasing GDP and higher life expectancy and lower TB and infant mortality rates. Finally, inequality and poverty were found to exert independent, substantial effects on the relationship between national income level and health. Wealthier is indeed healthier, but how much healthier depends on how increases in wealth are distributed.
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Effects of vacation from work on health and well-being: Lots of fun, quickly gone
Jessica de Bloom, Sabine Geurts, Toon Taris, Sabine Sonnentag, Carolina de Weerth & Michiel Kompier
Work & Stress, April 2010, Pages 196-216
Abstract:
Although vacation from work provides a valuable opportunity for recovery, few studies have met the requirements for assessing its effects. These include taking measurements well ahead of the vacation, during the vacation and at several points in time afterwards. Our study on vacation (after-) effects focused on two related questions: (1) Do health and well-being of working individuals improve during a vacation? and (2) How long does a vacation effect last after resumption of work? In a longitudinal study covering seven weeks, 96 Dutch workers reported their health and well-being levels two weeks before a winter sports vacation, during vacation and one week, two weeks and four weeks after vacation on seven indicators. Participants' health and well-being improved during vacation on five indicators: health status, mood, tension, energy level and satisfaction. However, during the first week of work resumption, health and well-being had generally returned to pre-vacation levels. In conclusion, a winter sports vacation is associated with improvements in self-reported health and well-being among working individuals. However, these effects fade out rapidly after work resumption. We propose a framework for future vacation research and suggest investigating the role of vacation type, duration and means to prolong vacation relief.
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Christina Mair, Ana Diez Roux, Theresa Osypuk, Stephen Rapp, Teresa Seeman & Karol Watson
Social Science & Medicine, August 2010, Pages 541-550
Abstract:
The racial/ethnic composition of a neighborhood may be related to residents' depressive symptoms through differential levels of neighborhood social support and/or stressors. We used the Multi-Ethnic Study of Atherosclerosis to investigate cross-sectional associations of neighborhood racial/ethnic composition with the Center for Epidemiologic Studies-Depression (CES-D) scale in adults aged 45-84. The key exposure was a census-derived measure of the percentage of residents of the same racial/ethnic background in each participant's census tract. Two-level multilevel models were used to estimate associations of neighborhood racial/ethnic composition with CES-D scores after controlling for age, income, marital status, education and nativity. We found that living in a neighborhood with a higher percentage of residents of the same race/ethnicity was associated with increased CES-D scores in African American men (p < 0.05), and decreased CES-D scores in Hispanic men and women and Chinese women, although these differences were not statistically significant. Models were further adjusted for neighborhood-level covariates (social cohesion, safety, problems, aesthetic quality and socioeconomic factors) derived from survey responses and census data. Adjusting for other neighborhood characteristics strengthened protective associations amongst Hispanics, but did not change the significant associations in African American men. These results demonstrate heterogeneity in the associations of race/ethnic composition with mental health and the need for further exploration of which aspects of neighborhood environments may contribute to these associations.
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The Effect of Education on Adult Health and Mortality: Evidence from Britain
Damon Clark & Heather Royer
NBER Working Paper, May 2010
Abstract:
There is a strong, positive and well-documented correlation between education and health outcomes. There is much less evidence on the extent to which this correlation reflects the causal effect of education on health - the parameter of interest for policy. In this paper we attempt to overcome the difficulties associated with estimating the causal effect of education on health. Our approach exploits two changes to British compulsory schooling laws that generated sharp differences in educational attainment among individuals born just months apart. Using regression discontinuity methods, we confirm that the cohorts just affected by these changes completed significantly more education than slightly older cohorts subject to the old laws. However, we find little evidence that this additional education improved health outcomes or changed health behaviors. We argue that it is hard to attribute these findings to the content of the additional education or the wider circumstances that the affected cohorts faced (e.g., universal health insurance). As such, our results suggest caution as to the likely health returns to educational interventions focused on increasing educational attainment among those at risk of dropping out of high school, a target of recent health policy efforts.
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David Rehkopf, Christopher Jencks & Maria Glymour
Social Science & Medicine, August 2010, Pages 431-439
Abstract:
Research on earnings and health frequently relies on self-reported earnings (SRE) for a single year, despite repeated criticism of this measure. We use 31 years (1961-1991) of earnings recorded by the United States Social Security Administration (SSA) to predict the 1992 prevalence of disability, diabetes, stroke, heart disease, cancer, depression and death by 2002 in a subset of Health and Retirement Study participants (n = 5951). We compare odds ratios (ORs) for each health outcome associated with self-reported or administratively recorded earnings. Individuals with no 1991 SSA earnings had worse health in multiple domains than those with positive earnings. However, this association diminished as the time lag between earnings and health increased, so that the absence of earnings before approximately 1975 did not predict health in 1992. Among those with positive earnings, lengthening the lag between SSA earnings and health did not significantly diminish the magnitude of the association with diabetes, heart disease, stroke, or death. Longer lags did reduce but did not eliminate the association between earnings and both disability and depression. Despite theoretical limitations of single year SRE, there were no statistically significant differences between the ORs estimated with single-year SRE and those estimated with a 31-year average of SSA earnings. For example, a one unit increase in logged SRE for 1991 predicted a 19% reduction in the odds of dying by 2002 (OR = 0.81; 95% confidence interval: 0.72,0.90), while a similar increase in average SSA earnings for 1961-1991 had an OR of 0.72 (0.63, 0.82). The point estimates for the OR associated with 31 year average SSA earnings were further from the null than the ORs associated with single year SRE for heart disease, depression, and death, and closer to the null for disability, diabetes, and stroke, but none of these differences was statistically significant.