Wellness
Eric Reither, Jay Olshansky & Yang Yang
Health Affairs, August 2011, Pages 1562-1568
Abstract:
Traditional methods of projecting population health statistics, such as estimating future death rates, can give inaccurate results and lead to inferior or even poor policy decisions. A new "three-dimensional" method of forecasting vital health statistics is more accurate because it takes into account the delayed effects of the health risks being accumulated by today's younger generations. Applying this forecasting technique to the US obesity epidemic suggests that future death rates and health care expenditures could be far worse than currently anticipated. We suggest that public policy makers adopt this more robust forecasting tool and redouble efforts to develop and implement effective obesity-related prevention programs and interventions.
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Joseph Ferrie & Karen Rolf
Explorations in Economic History, forthcoming
Abstract:
The link between circumstances faced by individuals early in life (including those encountered in utero) and later life outcomes has been of increasing interest since the work of Barker in the 1970s on birth weight and adult disease. We provide such a life course perspective for the U.S. by following 45,000 individuals from the household where they resided before age 5 until their death and analyzing the link between the characteristics of their childhood environment - particularly, its socioeconomic status - and their longevity and specific cause of death. White U.S.-born males living before age 5 in lower SES households (measured by father's occupation and family home ownership) who survive to age 70 die younger and are more likely to die from heart disease than those living before age 5 in higher SES households. The pathways potentially generating these effects are discussed.
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Till Stowasser et al.
NBER Working Paper, August 2011
Abstract:
Much has been said about the stylized fact that the economically successful are not only wealthier but also healthier than the less affluent. There is little doubt about the existence of this socio-economic gradient in health, but there remains a vivid debate about its source. In this paper, we review the methodological challenges involved in testing the causal relationships between socio-economic status and health. We describe the approach of testing for the absence of causal channels developed by Adams et al. (2003) that seeks identification without the need to isolate exogenous variation in economic variables, and we repeat their analysis using the full range of data that have become available in the Health and Retirement Study since, both in terms of observations years and age ranges covered. This analysis shows that causal inference critically depends on which time periods are used for estimation. Using the information of longer panels has the greatest effect on results. We find that SES causality cannot be ruled out for a larger number of health conditions than in the original study. An approach based on a reduced-form interpretation of causality thus is not very informative, at least as long as the confounding influence of hidden common factors is not fully controlled.
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Imprisonment and (Inequality in) Population Health
Christopher Wildeman
Social Science Research, forthcoming
Abstract:
This article extends research on the consequences of mass imprisonment and the factors shaping population health and health inequalities by considering the associations between imprisonment and population health - measured as life expectancy at birth and the infant mortality rate - and black-white differences in population health using state-level panel data from the United States (N = 669), 1980-2004. Results show that imprisonment is significantly associated with poorer population health, though associations between imprisonment and infant mortality and female life expectancy are somewhat more consistently statistically significant than are associations with male life expectancy, and associations are more pronounced and statistically significant for blacks than they are for whites. Results also show, however, that increases in imprisonment are associated with decreases in the mortality rates of young black men. Thus, though imprisonment tends to be associated with higher mortality risk and greater black-white differences in mortality, it may, in the short-run, have some paradoxical mortality benefits for young black men.
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Do vehicle recalls reduce the number of accidents? The case of the U.S. car market
Yong-Kyun Bae & Hugo Benítez-Silva
Journal of Policy Analysis and Management, forthcoming
Abstract:
The number of automobile recalls in the U.S. has increased sharply in the last two decades, and the numbers of units involved are often counted in the millions. In 2010 alone, over 20 million vehicles were recalled in the United States, and the massive recalls of full model lines by Toyota have brought this issue to the front pages around the country and the world. However, there is no quantitative evidence of the effect of recalls on safety. Without that evidence, the government and insurance companies have been reluctant to request and use more detailed recall information to increase correction rates, and regulators have not studied the possible link between the growing number of recalls and the risk of life for consumers. In this paper we empirically quantify the effect of vehicle recalls on safety using repeated cross-sections on accidents of individual drivers and aggregate vehicle recall data to construct synthetic panel data on individual drivers of a particular vehicle model. We estimate the effect of recalls on the number of accidents and find that a 10 percent increase in the recall rate of a particular model reduces the accidents of that model by between 0.78 percent and 1.6 percent when using the full sample of accidents in our data. We also find that recalls classified as "hazardous" are more effective in reducing accidents, and the recall effect is especially strong when we restrict attention to accidents that lead to personal injuries and only include vehicles more likely to be at fault for the accident, but much less so for accidents that only lead to property damage. We also find that vehicle models with recalls with higher correction rates have on average fewer accidents in the years following a recall, which indicates the importance of the role of drivers' behavior regarding recalls on safety. Our findings suggest that policymakers should consider, for example, policies to allow insurance companies to take into account recall correction behavior when pricing auto insurance, which could be made possible through regulatory changes by the U.S. government, and should revisit the complex trade-offs between pre- and post-market regulation in this important industry.
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Bo Li et al.
American Journal of Epidemiology, forthcoming
Abstract:
The authors assessed changes in the health status of US 1991 Gulf War-era veterans from a 1995 baseline survey to a 2005 follow-up survey, using repeated measurement data from 5,469 deployed Gulf War veterans and 3,353 nondeployed Gulf War-era veterans who participated in both surveys. Prevalence differences in health status between the 2 surveys were estimated for adverse health indices and chronic diseases for each veteran group. Persistence risk ratios and incidence risk ratios were calculated after adjustment for demographic and military service characteristics through Mantel-Haenszel stratified analysis. At 10-year follow-up, deployed veterans were more likely to report persistent poor health, as measured by the health indices (functional impairment, limitation of activities, repeated clinic visits, recurrent hospitalizations, perception of health as fair or poor, chronic fatigue syndrome-like illness, and posttraumatic stress disorder), than nondeployed veterans. Additionally, deployed veterans were more likely to experience new onset of adverse health (as measured by the indices) and certain chronic diseases than were nondeployed veterans. During the 10-year period from 1995 to 2005, the health of deployed veterans worsened in comparison with nondeployed veterans because of a higher rate of new onset of various health outcomes and greater persistence of previously reported adverse health on the indices.
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Gregory Miller Edith Chen & Karen Parker
Psychological Bulletin, forthcoming
Abstract:
Among people exposed to major psychological stressors in early life, there are elevated rates of morbidity and mortality from chronic diseases of aging. The most compelling data come from studies of children raised in poverty or maltreated by their parents, who show heightened vulnerability to vascular disease, autoimmune disorders, and premature mortality. These findings raise challenging theoretical questions. How does childhood stress get under the skin, at the molecular level, to affect risk for later diseases? And how does it incubate there, giving rise to diseases several decades later? Here we present a biological embedding model, which attempts to address these questions by synthesizing knowledge across several behavioral and biomedical literatures. This model maintains that childhood stress gets "programmed" into macrophages through epigenetic markings, posttranslational modifications, and tissue remodeling. As a consequence these cells are endowed with proinflammatory tendencies, manifest in exaggerated cytokine responses to challenge and decreased sensitivity to inhibitory hormonal signals. The model goes on to propose that over the life course, these proinflammatory tendencies are exacerbated by behavioral proclivities and hormonal dysregulation, themselves the products of exposure to early stress. Behaviorally, the model posits that childhood stress gives rise to excessive threat vigilance, mistrust of others, poor social relationships, impaired self-regulation, and unhealthy lifestyle choices. Hormonally, early stress confers altered patterns of endocrine and autonomic discharge. This milieu amplifies the proinflammatory environment already instantiated by macrophages. Acting in concert with other exposures and genetic liabilities, the resulting inflammation drives forward pathogenic mechanisms that ultimately foster chronic disease.
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Poor and Sick: Estimating the Relationship between Household Income and Health
Athina Economou & Ioannis Theodossiou
Review of Income and Wealth, September 2011, Pages 395-411
Abstract:
This study evaluates the effect of the individual's household income on their health at the later stages of working life. A structural equation model is utilized in order to derive a composite and continuous index of the latent health status from qualitative health status indicators. The endogenous relationship between health status and household income status is taken into account by using IV estimators. The findings reveal a significant effect of individual household income on health before and after endogeneity is taken into account as well as a host of other factors known to influence health, including hereditary factors and the individual's locus of control. Importantly, it is also shown that the childhood socioeconomic position of the individual has long lasting effects on health as it appears to play a significant role in determining health during the later stages of working life.
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State Quality-Adjusted Life Expectancy for U.S. adults from 1993 to 2008
Haomiao Jia, Matthew Zack & William Thompson
Quality of Life Research, August 2011, Pages 853-863
Purpose: Quality-Adjusted Life Expectancy (QALE) is a summary measure of mortality and health-related quality of life (HRQOL) across different stages of life. This study developed a method to calculate state-level QALE for U.S. adults.
Methods: Population HRQOL data came from the Behavioral Risk Factor Surveillance System (BRFSS). Using age-specific deaths from the Mortality Summary File, this study constructed life tables to estimate life expectancy and QALE for all 50 States and the District of Columbia by sex and race from
1993 through 2008.
Results: From 1993 to 2008, the QALE of an U.S. adult at 18 years old had increased from 51.2 to 52.3 years. In 2006, states with the highest QALE were Hawaii (56.2), Minnesota (55.2), North Dakota (54.9), Iowa (54.7), and Nebraska (54.4), while the states with the lowest QALE were West Virginia (47.1), Mississippi (48.2), Alabama (48.5), Kentucky (48.5), and Oklahoma (49.0).
Conclusions: Because population HRQOL values and mortality statistics are available from existing and publicly accessible data and because formulas for the calculation of QALE and its standard error are easy to incorporate in a spreadsheet, State and local Health Departments can calculate QALE as a routine surveillance measurement for tracking their population's health over time.
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Marko Elovainio et al.
American Journal of Epidemiology, forthcoming
Abstract:
In this study, the health-related selection hypothesis (that health predicts social mobility) and the social causation hypothesis (that socioeconomic status influences health) were tested in relation to cardiometabolic factors. The authors screened 8,312 United Kingdom men and women 3 times over 10 years between 1991 and 2004 for waist circumference, body mass index, systolic and diastolic blood pressure, fasting glucose, fasting insulin, serum lipids, C-reactive protein, and interleukin-6; identified participants with the metabolic syndrome; and measured childhood health retrospectively. Health-related selection was examined in 2 ways: 1) childhood health problems as predictors of adult occupational position and 2) adult cardiometabolic factors as predictors of subsequent promotion at work. Social causation was assessed using adult occupational position as a predictor of subsequent change in cardiometabolic factors. Hospitalization during childhood and lower birth weight were associated with lower occupational position (both P's ≤ 0.002). Cardiometabolic factors in adulthood did not consistently predict promotion. In contrast, lower adult occupational position predicted adverse changes in several cardiometabolic factors (waist circumference, body mass index, fasting glucose, and fasting insulin) and an increased risk of new-onset metabolic syndrome (all P's ≤ 0.008). These findings suggest that health-related selection operates at younger ages and that social causation contributes to socioeconomic differences in cardiometabolic health in midlife.
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David Jones
Journal of Urban Economics, forthcoming
Abstract:
In order to gain a better understanding of the effects of an investment in primary prevention on health, I investigate the impact of treatment of lead-based paint hazards in housing units (the preventive action) on childhood lead poisoning (the health outcome) at the census tract level in Chicago, IL. I use the findings from the analysis to simulate and then weigh the costs of lead interventions against the potential benefits of reducing blood lead levels in children. Childhood lead poisoning presents an interesting case study of the potential of preventive care in reducing the prevalence of a disease. There is a clear, well-defined pathway of exposure (deteriorating lead paint in older homes) and no method of secondary care that effectively mitigates the negative health effects. I find that a one-tenth percentage point increase in the proportion of older housing units that have been remediated is associated with a four-tenths percentage point reduction in the prevalence of childhood lead poisoning, an elasticity of roughly 0.5. Citywide, this is roughly 2.5 cases of lead poisoning averted for every housing unit remediated. Furthermore, I find evidence that the effect of remediations in preventing the disease has improved over time. The lower bound estimates of the benefits associated with the reduction in lead poisoning - increased expected lifetime earnings and reduced medical expenditures - are two to twenty times the estimated costs of the remediations.
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Kimberly Yousey-Hindes & James Hadler
American Journal of Public Health, forthcoming
Objectives: We examined surveillance data for disparities in pediatric influenza associated hospitalizations according to neighborhood socioeconomic status (SES) measures in New Haven County, Connecticut.
Methods: We geocoded influenza-associated hospitalization case data from the past 7 years for children from birth to age 17 years and linked these to US Census 2000 tract-level SES data. Following the methods of Harvard's Public Health Disparities Geocoding Project, we examined neighborhood SES variables, including measures of poverty and crowding. We calculated influenza associated hospitalization incidence by influenza season and individual case characteristics, stratified by SES measures.
Results: Overall, the mean annual incidence of pediatric influenza-associated hospitalization in high-poverty and high-crowding census tracts was at least 3 times greater than that in low-poverty and low-crowding tracts. This disparity could not be fully explained by prevalence of underlying conditions or receipt of influenza vaccination.
Conclusions: Linkage of geocoded surveillance data and census information allows for ongoing monitoring of SES correlates of health and may help target interventions. Our analysis indicates a correlation between residence in impoverished or crowded neighborhoods and incidence of influenza-associated hospitalization among children in Connecticut.
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Estimated HIV Incidence in the United States, 2006-2009
Joseph Prejean et al.
PLoS ONE, August 2011, e17502
Background: The estimated number of new HIV infections in the United States reflects the leading edge of the epidemic. Previously, CDC estimated HIV incidence in the United States in 2006 as 56,300 (95% CI: 48,200-64,500). We updated the 2006 estimate and calculated incidence for 2007-2009 using improved methodology.
Methodology: We estimated incidence using incidence surveillance data from 16 states and 2 cities and a modification of our previously described stratified extrapolation method based on a sample survey approach with multiple imputation, stratification, and extrapolation to account for missing data and heterogeneity of HIV testing behavior among population groups.
Principal Findings: Estimated HIV incidence among persons aged 13 years and older was 48,600 (95% CI: 42,400-54,700) in 2006, 56,000 (95% CI: 49,100-62,900) in 2007, 47,800 (95% CI: 41,800-53,800) in 2008 and 48,100 (95% CI: 42,200-54,000) in 2009. From 2006 to 2009 incidence did not change significantly overall or among specific race/ethnicity or risk groups. However, there was a 21% (95% CI:1.9%-39.8%; p = 0.017) increase in incidence for people aged 13-29 years, driven by a 34% (95% CI: 8.4%-60.4%) increase in young men who have sex with men (MSM). There was a 48% increase among young black/African American MSM (12.3%-83.0%; p<0.001). Among people aged 13-29, only MSM experienced significant increases in incidence, and among 13-29 year-old MSM, incidence increased significantly among young, black/African American MSM. In 2009, MSM accounted for 61% of new infections, heterosexual contact 27%, injection drug use (IDU) 9%, and MSM/IDU 3%.
Conclusions/Significance: Overall, HIV incidence in the United States was relatively stable 2006-2009; however, among young MSM, particularly black/African American MSM, incidence increased. HIV continues to be a major public health burden, disproportionately affecting several populations in the United States, especially MSM and racial and ethnic minorities. Expanded, improved, and targeted prevention is necessary to reduce HIV incidence.
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Trends in Sunscreen Use Among U.S. High School Students: 1999-2009
Sherry Everett Jones et al.
Journal of Adolescent Health, forthcoming
Purpose: To examine trends in sunscreen use during 1999-2009 among U.S. high school students.
Methods: Data from the 1999-2009 national Youth Risk Behavior Surveys were analyzed. The surveys used a three-stage cluster sample design to produce nationally representative samples of students in grades 9-12 attending public and private schools. Student participation in the survey was anonymous and voluntary. Participants completed a self-administered questionnaire during a regular class period. The overall response rates ranged from 63% to 72%.
Results: During 1999-2009, the percentage of white students who never or rarely wore sunscreen when outside on a sunny day for >1 hour increased (from 57.5% to 69.4%), as did the percentage among Hispanic students (from 71.6% to 77.9%). This increase was most pronounced among white female students. The percentage of white and Hispanic students who most of the time or always wore sunscreen decreased during this same period. Rates of sunscreen use did not change among black students.
Conclusions: Because of declines in sunscreen use, professionals in clinical, school, and community settings should emphasize the important role sunscreen may play in preventing skin cancer.