Dataset Information

Not just smoking and high-tech medicine: socioeconomic inequities in U.S. mortality rates, overall and by race/ethnicity, 1960-2006.

ABSTRACT: Recent research on the post-1980 widening of U.S. socioeconomic inequalities in mortality has emphasized the contribution of smoking and high-tech medicine, with some studies treating the growing inequalities as effectively inevitable. No studies, however, have analyzed long-term trends in U.S. mortality rates and inequities unrelated to smoking or due to lack of basic medical care, even as a handful have shown that U.S. socioeconomic inequalities in overall mortality shrank between the mid-1960s and 1980. The authors accordingly analyzed U.S. mortality data for 1960-2006, stratified by county income quintile and race/ethnicity, for mortality unrelated to smoking and preventable by 1960s' standards of medical care. Key findings are that relative and absolute socioeconomic inequalities in U.S. mortality unrelated to smoking and preventable by 1960s' medical care standards shrank between the 1960s and 1980 and then increased and stagnated, with absolute rates on a par with several leading causes of death, and with the burden greatest for U.S. populations of color. None of these findings can be attributed to trends in smoking-related deaths and access to high-tech medicine, and they also demonstrate that socioeconomic inequities in mortality can shrink and need not inevitably rise.

SUBMITTER: Krieger N

PROVIDER: S-EPMC3359870 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

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Not just smoking and high-tech medicine: socioeconomic inequities in U.S. mortality rates, overall and by race/ethnicity, 1960-2006.

Krieger Nancy N Chen Jarvis T JT Kosheleva Anna A Waterman Pamela D PD

International journal of health services : planning, administration, evaluation 20120101 2

Recent research on the post-1980 widening of U.S. socioeconomic inequalities in mortality has emphasized the contribution of smoking and high-tech medicine, with some studies treating the growing inequalities as effectively inevitable. No studies, however, have analyzed long-term trends in U.S. mortality rates and inequities unrelated to smoking or due to lack of basic medical care, even as a handful have shown that U.S. socioeconomic inequalities in overall mortality shrank between the mid-1960 ...[more]

PMID: 22611656

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Project description:Background:Higher socioeconomic status (SES) indicators such as educational attainment and income reduce the risk of chronic lung diseases (CLDs) such as Chronic Obstructive Pulmonary Disease (COPD), emphysema, chronic bronchitis, and asthma. Marginalization-related Diminished Returns (MDRs) refer to smaller health benefits of high SES for marginalized populations such as racial and ethnic minorities compared to the socially privileged groups such as non-Hispanic Whites. It is still unknown, however, if MDRs also apply to the effects of education and income on CLDs. Purpose:Using a nationally representative sample, the current study explored racial and ethnic variation in the associations between educational attainment and income and CLDs among American adults. Methods:In this study, we analyzed data (n = 25,659) from a nationally representative survey of American adults in 2013 and 2014. Wave one of the Population Assessment of Tobacco and Health (PATH)-Adult study was used. The independent variables were educational attainment (less than high school = 1, high school graduate = 2, and college graduate =3) and income (living out of poverty =1, living in poverty = 0). The dependent variable was any CLDs (i.e., COPD, emphysema, chronic bronchitis, and asthma). Age, gender, employment, and region were the covariates. Race and ethnicity were the moderators. Logistic regressions were fitted to analyze the data. Results:Individuals with higher educational attainment and those with higher income (who lived out of poverty) had lower odds of CLDs. Race and ethnicity showed statistically significant interactions with educational attainment and income, suggesting that the protective effects of high education and income on reducing odds of CLDs were smaller for Blacks and Hispanics than for non-Hispanic Whites. Conclusions:Education and income better reduce the risk of CLDs among Whites than Hispanics and Blacks. That means we should expect disproportionately higher than expected risk of CLDs in Hispanics and Blacks with high SES. Future research should test if high levels of environmental risk factors contribute to the high risk of CLDs in high income and highly educated Black and Hispanic Americans. Policy makers should not reduce health inequalities to SES gaps because disparities sustain across SES levels, with high SES Blacks and Hispanics remaining at risk of health problems.

Project description:BACKGROUND:Very few studies with nationally representative samples have investigated the combined effects of race/ethnicity and socioeconomic position (SEP) on polypharmacy (PP) among older Americans. For instance, we do not know if prevalence of PP differs between African Americans (AA) and white older adults, whether this difference is due to a racial gap in SEP, or whether racial and ethnic differences exist in the effects of SEP indicators on PP. Aims: We investigated joint effects of race/ethnicity and SEP on PP in a national household sample of American older adults. Methods: The first wave of the University of Michigan National Poll on Healthy Aging included a total of 906 older adults who were 65 years or older (80 AA and 826 white). Race/ethnicity, SEP (income, education attainment, marital status, and employment), age, gender, and PP (using 5+ medications) were measured. Logistic regression was applied for data analysis. Results: Race/ethnicity, age, marital status, and employment did not correlate with PP; however, female gender, low education attainment, and low income were associated with higher odds of PP among participants. Race/ethnicity interacted with low income on odds of PP, suggesting that low income might be more strongly associated with PP in AA than white older adults. Conclusions: While SEP indicators influence the risk of PP, such effects may not be identical across diverse racial and ethnic groups. That is, race/ethnicity and SEP have combined/interdependent rather than separate/independent effects on PP. Low-income AA older adults particularly need to be evaluated for PP. Given that race and SEP have intertwined effects on PP, racially and ethnically tailored interventions that address PP among low-income AA older adults may be superior to universal interventions and programs that ignore the specific needs of diverse populations. The results are preliminary and require replication in larger sample sizes, with PP measured directly without relying on individuals' self-reports, and with joint data collected on chronic disease.

Project description:ImportanceAddiction treatment rapidly transitioned to a primarily telehealth modality (telephone and video) during the COVID-19 pandemic, raising concerns about disparities in utilization.ObjectiveTo examine whether there were differences in overall and telehealth addiction treatment utilization after telehealth policy changes during the COVID-19 pandemic by age, race, ethnicity, and socioeconomic status.Design, setting, and participantsThis cohort study examined electronic health record and claims data from Kaiser Permanente Northern California for adults (age ≥18 years) with drug use problems before the COVID-19 pandemic (from March 1, 2019, to December 31, 2019) and during the early phase of the COVID-19 pandemic (March 1, 2020, to December 31, 2020; hereafter referred to as COVID-19 onset). Analyses were conducted between March 2021 and March 2023.ExposureThe expansion of telehealth services during COVID-19 onset.Main outcomes and measuresGeneralized estimating equation models were fit to compare addiction treatment utilization during COVID-19 onset with that before the COVID-19 pandemic. Utilization measures included the Healthcare Effectiveness Data and Information Set of treatment initiation and engagement (including inpatient, outpatient, and telehealth encounters or receipt of medication for opioid use disorder [OUD]), 12-week retention (days in treatment), and OUD pharmacotherapy retention. Telehealth treatment initiation and engagement were also examined. Differences in changes in utilization by age group, race, ethnicity, and socioeconomic status (SES) were examined.ResultsAmong the 19 648 participants in the pre-COVID-19 cohort (58.5% male; mean [SD] age, 41.0 [17.5] years), 1.6% were American Indian or Alaska Native; 7.5%, Asian or Pacific Islander; 14.3%, Black; 20.8%, Latino or Hispanic; 53.4%, White; and 2.5%, unknown race. Among the 16 959 participants in the COVID-19 onset cohort (56.5% male; mean [SD] age, 38.9 [16.3] years), 1.6% were American Indian or Alaska Native; 7.4%, Asian or Pacific Islander; 14.6%, Black; 22.2%, Latino or Hispanic; 51.0%, White; and 3.2%, unknown race. Odds of overall treatment initiation increased from before the COVID-19 pandemic to COVID-19 onset for all age, race, ethnicity, and SES subgroups except for patients aged 50 years or older; patients aged 18 to 34 years had the greatest increases (adjusted odds ratio [aOR], 1.31; 95% CI, 1.22-1.40). Odds of telehealth treatment initiation increased for all patient subgroups without variation by race, ethnicity, or SES, although increases were greater for patients aged 18 to 34 years (aOR, 7.17; 95% CI, 6.24-8.24). Odds of overall treatment engagement increased (aOR, 1.13; 95% CI, 1.03-1.24) without variation by patient subgroups. Retention increased by 1.4 days (95% CI, 0.6-2.2 days), and OUD pharmacotherapy retention did not change (adjusted mean difference, -5.2 days; 95% CI, -12.7 to 2.4 days).ConclusionsIn this cohort study of insured adults with drug use problems, there were increases in overall and telehealth addiction treatment utilization after telehealth policies changed during the COVID-19 pandemic. There was no evidence that disparities were exacerbated, and younger adults may have particularly benefited from the transition to telehealth.

Dataset Information

Not just smoking and high-tech medicine: socioeconomic inequities in U.S. mortality rates, overall and by race/ethnicity, 1960-2006.

Publications

Not just smoking and high-tech medicine: socioeconomic inequities in U.S. mortality rates, overall and by race/ethnicity, 1960-2006.

Similar Datasets

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