Associations of Sociodemographic and Neighborhood Vulnerability With Cardiovascular Health in Midlife Women in the United States

Why Do Americans Have Shorter Life Expectancy and Worse Health Than Do People in Other High-Income Countries?

Americans lead shorter and less healthy lives than do people in other high-income countries. We review the evidence and explanations for these variations in longevity and health. Our overview suggests that the US health disadvantage applies to multiple mortality and morbidity outcomes. The American health disadvantage begins at birth and extends across the life course, and it is particularly marked for American women and for regions in the US South and Midwest. Proposed explanations include differences in health care, individual behaviors, socioeconomic inequalities, and the built physical environment. Although these factors may contribute to poorer health in America, a focus on proximal causes fails to adequately account for the ubiquity of the US health disadvantage across the life course. We discuss the role of specific public policies and conclude that while multiple causes are implicated, crucial differences in social policy might underlie an important part of the US health disadvantage.

Credit Access in the United States

We measure differences in US households’ access to credit and explore the mechanisms driving such differences using newly constructed population-level linked credit bureau and Census data. We find large differences in credit scores by race, class, and hometown that emerge in one’s 20s and persist throughout the life cycle. These gaps are primarily driven by differences in delinquencies that emerge in young adulthood. By age 30, 73% of Black individuals, 62% of those from low-income families, and 51% of those from Appalachia and the South have a 90+ day delinquency on their credit report, in contrast to 36% for White individuals, 20% for high-income families, and 31% for those from the upper Midwest. These delinquencies are correlated with income and wealth, but observed income profiles and wealth account for at most 10–35% of the gaps in delinquencies across groups. In contrast, movers-based estimates of hometown effects imply that childhood exposure accounts for around 50% of the differences in delinquencies across hometowns. Counties that promote repayment also promote upward income mobility, but adult income mediates only a small fraction of this relationship: growing up in a place where others are likely to repay improves credit outcomes even for those who do not have higher income in adulthood. We provide suggestive evidence on the mechanisms driving these patterns. JEL Codes: G5, H0.

How Health Disparities Develop over the Lifecycle

In the Netherlands, there are striking socioeconomic differences in mortality among older adults, with a 4.4 percentage point (67 percent) higher five-year mortality rate for 70-year-old individuals with below-median income than for those with above-median income. To better understand the role of chronic disease in these health disparities, Kaveh Danesh, Jonathan T. Kolstad, William D. Parker, and Johannes Spinnewijn develop an index of chronic disease burden in The Chronic Disease Index: Analyzing Health Inequalities over the Lifecycle (NBER Working Paper 32577). This index is a measure of health status that can be measured earlier in life and shows how chronic health evolves with age and differs across income groups.

Homebound: The Long-Term Rise in Time Spent at Home Among U.S. Adults

The changes in daily life induced by the COVID-19 pandemic brought renewed attention to longstanding concerns about social isolation in the United States. Despite the links between the physical setting for individuals' daily lives and their connections with family, friends, and the various institutions of collective life, trends in where American adults spend their time have been largely overlooked as researchers have focused on how and with whom they spend their time. This article analyzes data from the American Time Use Survey over a timeframe spanning nineteen years and argues that the changes in Americans' daily routines induced by the COVID era should be seen as an acceleration of a longer-term trend: the rise of time spent at home. Results show that from 2003 to 2022, average time spent at home among American adults has risen by one hour and 39 minutes in a typical day. Time at home has risen for every subset of the population and for virtually all activities. Preliminary analysis indicates that time at home is associated with lower levels of happiness and less meaning, suggesting the need for enhanced empirical attention to this major shift in the setting of American life.

Homebound: The Long-Term Rise in Time Spent at Home Among U.S. Adults

The changes in daily life induced by the COVID-19 pandemic brought renewed attention to longstanding concerns about social isolation in the United States. Despite the links between the physical setting for individuals' daily lives and their connections with family, friends, and the various institutions of collective life, trends in where American adults spend their time have been largely overlooked as researchers have focused on how and with whom they spend their time. This article analyzes data from the American Time Use Survey over a timeframe spanning nineteen years and argues that the changes in Americans' daily routines induced by the COVID era should be seen as an acceleration of a longer-term trend: the rise of time spent at home. Results show that from 2003 to 2022, average time spent at home among American adults has risen by one hour and 39 minutes in a typical day. Time at home has risen for every subset of the population and for virtually all activities. Preliminary analysis indicates that time at home is associated with lower levels of happiness and less meaning, suggesting the need for enhanced empirical attention to this major shift in the setting of American life.

Menopausal hormone therapy and coronary heart disease: the roller-coaster history

In the USA it is estimated that more than one million women become menopausal each year. Coronary heart disease (CHD) is the leading cause of mortality in menopausal woman globally. The majority of...

The Global Decline in the Mental Health of the Young

One of the major findings in wellbeing research until recently was that happiness was U-shaped by age and unhappiness hump-shaped by age. There was a midlife crisis — a finding reported in well over 600 published papers using data on 145 countries. It was present in both developing and developed countries. And it was persistent over time. The finding of a peak in ill-being in midlife was consistent with Anne Case and Angus Deaton’s work on mortality and the so-called “deaths of despair.”1 In the US in particular and to a lesser extent in other countries, White prime-aged individuals without a college degree had high death rates from suicide, drug overdoses, and cirrhosis of the liver. Drug overdose deaths in the US, for example, peaked at midlife ages. In 2023, the Centers for Disease Control and Prevention (CDC) reported that overdose death rates per 100,000 by age rose from 13.5 for 15-to-24-year-olds to 45.6 for 25-to-34-year-olds and 60.8 for 35-to-44-year-olds, and then declined to 53.3 for 45-to-54-year-olds, 49.2 for 55-to-64-year-olds, and 14.7 for those over the age of 65.2 The morbidity data matched the mortality data.

LF11 - Cohort Futures

On belonging, becoming, and communities with a clock.

Reducing Bias in Observational Studies Using Subclassification on the Propensity Score

The propensity score is the conditional probability of assignment to a particular treatment given a vector of observed covariates. Previous theoretical arguments have shown that subclassification on the propensity score will balance all observed covariates. Subclassification on an estimated propensity score is illustrated, using observational data on treatments for coronary artery disease. Five subclasses defined by the estimated propensity score are constructed that balance 74 covariates, and thereby provide estimates of treatment effects using direct adjustment. These subclasses are applied within subpopulations, and model-based adjustments are then used to provide estimates of treatment effects within these subpopulations. Two appendixes address theoretical issues related to the application: the effectiveness of subclassification on the propensity score in removing bias, and balancing properties of propensity scores with incomplete data.

Improving and Expanding Estimates of the Global Burden of Disease Due to Environmental Health Risk Factors

Abstract Background: The Global Burden of Disease (GBD) study, coordinated by the Institute for Health Metrics and Evaluation (IHME), produces influential, data-driven estimates of the burden of disease and premature death due to major risk factors. Expanded quantification of disease due to environmental health (EH) risk factors, including climate change, will enhance accuracy of GBD estimates, which will contribute to developing cost-effective policies that promote prevention and achieving Sustainable Development Goals. Objectives: We review key aspects of the GBD for the EH community and introduce the Global Burden of Disease–Pollution and Health Initiative (GBD-PHI), which aims to work with IHME and the GBD study to improve estimates of disease burden attributable to EH risk factors and to develop an innovative approach to estimating climate-related disease burden—both current and projected. Methods: We discuss strategies for improving GBD quantification of specific EH risk factors, including air pollution, lead, and climate change. We highlight key methodological challenges, including new EH risk factors, notably evidence rating and global exposure assessment. Discussion: A number of issues present challenges to the scope and accuracy of current GBD estimates for EH risk factors. For air pollution, minimal data exist on the exposure–risk relationships associated with high levels of pollution; epidemiological studies in high pollution regions should be a research priority. For lead, the GBD’s current methods do not fully account for lead’s impact on neurodevelopment; innovative methods to account for subclinical effects are needed. Decisions on inclusion of additional EH risk–outcome pairs need to be guided by findings of systematic reviews, the size of exposed populations, feasibility of global exposure estimates, and predicted trends in exposures and diseases. Neurotoxicants, endocrine-disrupting chemicals, and climate-related factors should be high priorities for incorporation into upcoming iterations of the GBD study. Enhancing the scope and methods will improve the GBD’s estimates and better guide prevention policy. https://doi.org/10.1289/EHP5496

Most Community Health Centers Provide Prenatal Care, But One-Third Still Lack Services | HPHCI: Department of Population Medicine

Boston, MA—A new national study provides the first comprehensive look at prenatal care services offered by federally qualified health centers (FQHCs), revealing that while these safety-net providers play a critical role in caring for low-income and racially diverse pregnant populations, significant gaps in access remain.

Does Using Social Media Jeopardize Well-Being? The Importance of Separating Within- From Between-Person Effects

Social networking sites (SNS) are frequently criticized as a driving force behind rising depression rates. Yet empirical studies exploring the associations between SNS use and well-being have been predominantly cross-sectional, while the few existing longitudinal studies provided mixed results. We examined prospective associations between SNS use and multiple indicators of well-being in a nationally representative sample of Dutch adults ( N ∼ 10,000), comprising six waves of annual measures of SNS use and well-being. We used an analytic method that estimated prospective effects of SNS use and well-being while also estimating time-invariant between-person associations between these variables. Between individuals, SNS use was associated with lower well-being. However, within individuals, year-to-year changes in SNS use were not prospectively associated with changes in well-being (or vice versa). Overall, our analyses suggest that the conclusions about the causal impact of social media on rising mental health problems in the population might be premature.

9/11 Health

For over two decades the Registry researchers have been tracking health trends, investigating emerging health conditions, and identifying gaps in care among people affected by 9/11.

Arsenic exposure at birth, socioeconomic status, and epigenetic aging among adults in northern Chile

Background Arsenic exposure remains a major global health concern, and early-life exposure has been linked to cancer, cardiovascular disease, and diabetes. Epigenetic biomarkers of aging may capture long-term effects of arsenic, yet whether exposure during sensitive developmental windows leaves detectable epigenetic signatures decades later remains unclear. Socioeconomic status (SES) may modify these relationships, yet its role as a modifier has not been examined. Methods We leveraged a natural experiment in northern Chile, where municipal drinking-water arsenic concentrations were extremely high from 1958 to 1972. Decades later, leukocyte DNA methylation was measured among 358 adults (mean age = 65.7 years) using the Illumina EPIC v2 array. Arsenic concentration at birth (0-860 μg/L) was assigned from historical water records. Current exposure was measured in urine (2-646 μg/g creatinine). We evaluated associations of birth and current arsenic exposure with epigenome-wide methylation and epigenetic aging, incorporating multiplicative interaction and stratification by SES. Results No CpGs were linked to birth arsenic exposure, whereas nine CpGs passed the Bonferroni threshold for current urinary arsenic (pBonferroni

Arsenic exposure at birth, socioeconomic status, and epigenetic aging among adults in northern Chile

Background Arsenic exposure remains a major global health concern, and early-life exposure has been linked to cancer, cardiovascular disease, and diabetes. Epigenetic biomarkers of aging may capture long-term effects of arsenic, yet whether exposure during sensitive developmental windows leaves detectable epigenetic signatures decades later remains unclear. Socioeconomic status (SES) may modify these relationships, yet its role as a modifier has not been examined. Methods We leveraged a natural experiment in northern Chile, where municipal drinking-water arsenic concentrations were extremely high from 1958 to 1972. Decades later, leukocyte DNA methylation was measured among 358 adults (mean age = 65.7 years) using the Illumina EPIC v2 array. Arsenic concentration at birth (0-860 μg/L) was assigned from historical water records. Current exposure was measured in urine (2-646 μg/g creatinine). We evaluated associations of birth and current arsenic exposure with epigenome-wide methylation and epigenetic aging, incorporating multiplicative interaction and stratification by SES. Results No CpGs were linked to birth arsenic exposure, whereas nine CpGs passed the Bonferroni threshold for current urinary arsenic (pBonferroni

Per- and polyfluoroalkyl substances, apolipoproteins and the risk of coronary heart disease in US men and women

Existing evidence for associations of per- and polyfluoroalkyl substances (PFASs) with blood lipids, lipoproteins and apolipoproteins (apo), and coronary heart disease (CHD) risk is limited and inconsistent. This study aims to explore associations between plasma PFASs, blood lipoprotein subspecies defined by apolipoproteins, and CHD risk.