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Projections of white and black older adults without living kin in the United States, 2015 to 2060.

ABSTRACT: Close kin provide many important functions as adults age, affecting health, financial well-being, and happiness. Those without kin report higher rates of loneliness and experience elevated risks of chronic illness and nursing facility placement. Historical racial differences and recent shifts in core demographic rates suggest that white and black older adults in the United States may have unequal availability of close kin and that this gap in availability will widen in the coming decades. Whereas prior work explores the changing composition and size of the childless population or those without spouses, here we consider the kinless population of older adults with no living close family members and how this burden is changing for different race and sex groups. Using demographic microsimulation and the United States Census Bureau's recent national projections of core demographic rates by race, we examine two definitions of kinlessness: those without a partner or living children, and those without a partner, children, siblings, or parents. Our results suggest dramatic growth in the size of the kinless population as well as increasing racial disparities in percentages kinless. These conclusions are driven by declines in marriage and are robust to different assumptions about the future trajectory of divorce rates or growth in nonmarital partnerships. Our findings draw attention to the potential expansion of older adult loneliness, which is increasingly considered a threat to population health, and the unequal burden kinlessness may place on black Americans.

SUBMITTER: Verdery AM

PROVIDER: S-EPMC5651770 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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Projections of white and black older adults without living kin in the United States, 2015 to 2060.

Verdery Ashton M AM Margolis Rachel R

Proceedings of the National Academy of Sciences of the United States of America 20171002 42

Close kin provide many important functions as adults age, affecting health, financial well-being, and happiness. Those without kin report higher rates of loneliness and experience elevated risks of chronic illness and nursing facility placement. Historical racial differences and recent shifts in core demographic rates suggest that white and black older adults in the United States may have unequal availability of close kin and that this gap in availability will widen in the coming decades. Wherea ...[more]

PMID: 28973934

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Project description:BackgroundThe American Society of Clinical Oncology (ASCO) has strived to address racial/ethnic disparities in cancer care since 2009. Surgery plays a pivotal role in cancer care; however, it is unclear whether and how racial/ethnic disparities in cancer surgery have changed over time.MethodsThis cohort study included 1,113,256 White and Black cancer patients across 9 years (2007-2015) using patient data extracted from the Surveillance, Epidemiology, and End Results (SEER)-18 registries. Patient data were included from 2007 to adjust insurance status and by 2015 to obtain at least a 3-year survival follow-up (until 2018). The primary outcome was a surgical intervention. The secondary outcomes were the use of (neo)adjuvant chemotherapy and cancer-specific survival (CSS). Adjusted associations of the race (Black/White) with the outcomes were measured in each cancer type and year.ResultsThe gap between surgery rates for Black and White patients narrowed overall, from an adjusted odds ratio (aOR) of 0.621 (0.592-0.652) in 2007 to 0.734 (0.702-0.768) in 2015. However, the racial gap persisted in the surgery rates for lung, breast, prostate, esophageal, and ovarian cancers. In surgically treated patients with lymph node metastasis, Black patients with colorectal cancer (CRC) were less likely to receive (neo)adjuvant chemotherapy than White patients. Black patients undergoing surgery were more likely to have a worse CSS rate than White patients undergoing surgery. In breast cancer patients, the overall trend was narrow, but continuously present, with an adjusted hazard ratio (aHR) of 1.224 (1.278-1.173) in 2007 and 1.042 (1.132-0.96) in 2015.ConclusionsOverall, progress has been made toward narrowing the Black-White gap in cancer surgical opportunity and survival. Future efforts should be directed toward those specific cancers for which the Black-White gap continues. Additionally, it is worth addressing the Black-White gap regarding the use of (neo)adjuvant chemotherapy for CRC treatment.

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Dataset Information

Projections of white and black older adults without living kin in the United States, 2015 to 2060.

Publications

Projections of white and black older adults without living kin in the United States, 2015 to 2060.

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