How Health Disparities Develop over the Lifecycle

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.

Avoidable mortality, risk factors and policies for tackling noncommunicable diseases – leveraging data for impact: monitoring commitments in the WHO European Region ahead of the Fourth United Nations High-Level Meeting

The report notes that, in order to tackle NCDs and address the commercial, social, environmental and digital determinants of health, there is a need for accelerated multisectoral whole-of-government and whole-of-society action, integrated policies, enhanced preventive measures and strengthened health systems.

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.

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

BACKGROUND: Many women have suboptimal cardiovascular health (CVH), which declines during midlife. Few studies have characterized CVH across the menopausal transition or identified its sociodemographic and neighborhood determinants. METHODS: We analyzed a prospective cohort of women in eastern Massachusetts enrolled during pregnancy (1999–2002) and followed to midlife (2019–2024). Exposures included household income, education, race and ethnicity, and neighborhood Social Vulnerability Index (categorized from very low [<20th percentile] to very high [≥80th percentile]; higher categories=greater neighborhood vulnerability). Women self-reported their menopause status using questionnaires. Using Life’s Essential 8, we derived CVH scores (0–100 points; higher score=better CVH) at 3-, 8-, 13-, 18-, and 23-year follow-up visits. Linear spline mixed-effect models examined associations of sociodemographics and neighborhood Social Vulnerability Index with differences in CVH across different menopause stages (premenopause, perimenopause, and postmenopause). RESULTS: Among 1200 women (mean enrollment age, 32.1 years; 67.5% Non-Hispanic White), 15.4% had household incomes ≤$40 000/y, 8.8% had ≤high school education, and 17.4% resided in very high Social Vulnerability Index neighborhoods. After covariate adjustment, women with lower income, lower education, or identifying as Non-Hispanic Black exhibited lower CVH across follow-up. Independent of individual sociodemographics, continued residence in vulnerable neighborhoods over time was associated with lower CVH and unfavorable CVH trajectories across follow-up. For example, residence in very high (versus very low) Social Vulnerability Index neighborhoods from enrollment to 3-year follow-up corresponded to mean CVH differences of −6.7 (95% CI, −12.3 to −1.2) at 3-year, −9.8 (95% CI, −15.6 to −4.0) at 8-year, −8.9 (95% CI, −13.9 to −3.9) at 13-year, −6.7 (95% CI, −12.9 to −0.5) at 18-year, and −7.2 (95% CI, −12.5 to −1.9) at 23-year follow-up, and with faster CVH score decline during premenopause (−0.62 points/y; 95% CI, −1.22 to −0.02). CONCLUSIONS: Women from disadvantaged sociodemographic backgrounds or residing in vulnerable neighborhoods exhibit poorer CVH across the menopausal transition, highlighting opportunities to optimize long-term CVH and mitigate cardiovascular disease risk.

STAT

Reporting from the frontiers of health and medicine

Use it or lose it: How cognitive skills change with age

Cognitive skills are commonly assumed to begin deteriorating from the age of 30, which could pose a significant challenge for rapidly ageing populations. But this assumption relies largely on cross-sectional data that cannot distinguish between ageing patterns and cohort differences. Using German longitudinal data, this column finds that skills, on average, increase markedly into one’s 40s before decreasing slightly in literacy and more severely in numeracy. In addition, skills decline at older ages only for those with below-average skill usage, outlining a clear policy pathway for avoiding skill declines.

Estimating Discount Functions with Consumption Choices over the Lifecycle

We estimate β-δ time preferences and relative risk aversion (RRA) using a lifecycle model including stochastic income, liquid and illiquid assets, credit cards, dependents, Social Security, mortality, and bequests. Preference parameters are identified by cross-tabulating four lifecycle age intervals and four balance sheet moments: the proportion of households carrying (i.e., revolving) credit card debt, average carried credit card debt, average net wealth among households carrying credit card debt, and average net wealth among households not carrying credit card debt. The sixteen moments are approximately matched by (MSM) parameter estimates β = 0:50, δ = 0:99, and RRA = 1:3.

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.

Researchers Confront an Epidemic of Loneliness (Published 2016)

Social isolation is linked to physical illness and to functional and cognitive decline. Programs to reach out to the elderly are growing, particularly in Britain.

Wage Compression Drives Nordic Income Equality

Income inequality in the Nordic countries — Denmark, Finland, Norway, and Sweden — is substantially lower than in the United States or the United Kingdom despite similar levels of per capita income. The Gini coefficient for disposable income in Nordic countries averages 0.27, compared to 0.39 in the US and 0.36 in the UK. In Income Equality in the Nordic Countries: Myths, Facts, and Lessons (NBER Working Paper 33444), Magne Mogstad, Kjell G. Salvanes, and Gaute Torsvik analyze the underlying source of these disparities. They employ detailed microeconomic data and statistical decomposition techniques and consider distributional statistics on income, wages, working hours, education, and skills across these countries.

Why older people are happier and what we can learn from them | Psyche Ideas

Around the world, happiness tends to peak later in life. It has more to do with balancing priorities than elderly wisdom

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

Digital inequality in communication during a time of physical distancing: The case of COVID-19

In times of physical distancing, such as during the COVID-19 pandemic, people are likely to turn to digital communication to replace in-person interactions. Yet, persisting digital inequality suggests that not everyone will be equally able or disposed to increasing digital communication during a public health crisis. Using survey data from a national sample of U.S. participants (N = 2,925) that we collected during the early months of the pandemic, we analyzed how sociodemographics, living arrangements, and Internet experiences and skills relate to increases and decreases in various digital communication methods. We find that people privileged in their socioeconomic status, their Internet skills and online experiences are more likely to increase and less likely to decrease digital communication during the pandemic. The findings illustrate how digital inequalities can put already disadvantaged groups at greater risk of diminished social contact during a public health crisis. We discuss the theoretical implications of our findings for digital inequality research, the practical implications for inclusive crisis responses, and directions for future research.

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.

The social model of disability: thirty years on

This year marks exactly 30 years since I published a book introducing the social model of disability onto an unsuspecting world and yet, despite the impact this model has had, all we now seem to do...

The social model of disability: thirty years on

This year marks exactly 30 years since I published a book introducing the social model of disability onto an unsuspecting world and yet, despite the impact this model has had, all we now seem to do...