Wartime health shocks and the postwar socioeconomic status and mortality of union army veterans and their children.
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ABSTRACT:
SUBMITTER: Costa DL
PROVIDER: S-EPMC7096284 | biostudies-literature | 2020 Mar
REPOSITORIES: biostudies-literature
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Wartime health shocks and the postwar socioeconomic status and mortality of union army veterans and their children.
Costa Dora L DL Yetter Noelle N DeSomer Heather H
Journal of health economics 20191228
We investigate when and how health shocks reverberate across the life cycle and down to descendants in a manual labor economy by examining the association of war wounds with the socioeconomic status and older age mortality of US Civil War (1861-5) veterans and of their adult children. Younger veterans who had been severely wounded in the war left the farm sector, becoming laborers. Consistent with human capital and job matching models, older severely wounded men were unlikely to switch sectors a ...[more]
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Project description:This paper overviews the research opportunities made possible by a NIA-funded program project, Early Indicators, Intergenerational Processes, and Aging. Data collection began almost three decades ago on 40,000 soldiers from the Union Army in the US Civil War. The sample contains extensive demographic, economic, and medical data from childhood to death. In recent years, a large sample of African-American soldiers and an oversampling of soldiers from major US cities have been added. Hundreds of historical maps containing public health data have been geocoded to place soldiers and their family members in a geospatial context. With newly granted funding, thousands of veterans will be linked to the demographic information available from the census and vital records of their children.
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Project description:BackgroundThe VHA is the largest integrated US health system and is increasingly moving care into the communities where veterans reside. Veterans who utilize the VA for their care have worse health status than the general population. However, there is limited evidence about the association of neighborhood environment and health outcomes among veterans.ObjectivesThe primary aim of this study is to assess the relative contribution of neighborhood environment, health system, and individual characteristics to health status and mortality of veterans.MethodsInformation on personal socio-economic indicators, existing medical conditions and health status were obtained from baseline data from a multi-site, randomized trial of primary care patients (n = 15,889). The physical component scale (PCS) and mental component scale (MCS) summarized health status. Census tracts were used as proxies for neighborhoods. A summary score based on census tract data characterized the neighborhood socio-economic environment and walkability. Data were analyzed with multilevel hierarchical models. Analyses of health status were cross-sectional. Mortality analyses were longitudinal as participants were followed for an average of 722.5 days to ascertain vital status.ResultsNeighborhood SES was associated with PCS and MCS scores, controlling for individual socio-economic status, self-reported co-morbid disease, smoking status, and health care access. In the lowest versus highest quartiles of neighborhood SES, adjusted PCS scores were 34.4 vs. 35.4 (p < 0.05) and adjusted MCS scores were 46.2 versus 47.0 (p < 0.05). PCS score was also significantly associated with neighborhood walkability (p < 0.05). Mortality was lower for veterans living in neighborhoods with the highest decile neighborhood SES (HR 0.78, highest vs. lowest decile 95% CI 0.63, 0.97).ConclusionsVeterans living in lower SES neighborhoods have poorer health status and a higher risk of mortality, independent of individual characteristics and health care access. Neighborhood walkability was associated with higher PCS scores.
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Project description:ImportanceSocioeconomic factors are associated with worse outcomes after hospitalization, but neither the Centers for Medicare & Medicaid Services (CMS) nor the Veterans Affairs (VA) health care system adjust for socioeconomic factors in profiling hospital mortality.ObjectiveTo evaluate changes in Veterans Affairs medical centers' (VAMCs') risk-standardized mortality rates among veterans hospitalized for heart failure and pneumonia after adjusting for socioeconomic factors.Design, setting, and participantsIn this cross-sectional study, retrospective data were used to assess 131 VAMCs' risk-standardized 30-day mortality rates with or without adjustment for socioeconomic covariates. The study population included 42 892 veterans hospitalized with heart failure and 39 062 veterans hospitalized with pneumonia from January 1, 2012, to December 31, 2014. Data were analyzed from March 1, 2019, to April 1, 2020.Main outcomes and measuresThe primary outcome was 30-day mortality after admission. Socioeconomic covariates included neighborhood disadvantage, race/ethnicity, homelessness, rurality, nursing home residence, reason for Medicare eligibility, Medicaid and Medicare dual eligibility, and VA priority.ResultsThe study population included 42 892 veterans hospitalized with heart failure (98.2% male; mean [SD] age, 71.9 [11.4] years) and 39 062 veterans hospitalized with pneumonia (96.8% male; mean [SD] age, 71.0 [12.4] years). The addition of socioeconomic factors to the CMS models modestly increased the C statistic from 0.77 (95% CI, 0.77-0.78) to 0.78 (95% CI, 0.78-0.78) for 30-day mortality after heart failure and from 0.73 (95% CI, 0.72-0.73) to 0.74 (95% CI, 0.73-0.74) for 30-day mortality after pneumonia. Mortality rates were highly correlated (Spearman correlations of ≥0.98) in models that included or did not include socioeconomic factors. With the use of the CMS model for heart failure, VAMCs in the lowest quintile had a mean (SD) mortality rate of 6.0% (0.4%), those in the middle 3 quintiles had a mean (SD) mortality rate of 7.2% (0.4%), and those in the highest quintile had a mean (SD) mortality rate of 8.8% (0.6%). After the inclusion of socioeconomic covariates, the adjusted mean (SD) mortality was 6.1% (0.4%) for hospitals in the lowest quintile, 7.2% (0.4%) for those in the middle 3 quintiles, and 8.6% (0.5%) for those in the highest quintile. The mean absolute change in rank after socioeconomic adjustment was 3.0 ranking positions (interquartile range, 1.0-4.0) among hospitals in the highest quintile of mortality after heart failure and 4.4 ranking positions (interquartile range, 1.0-6.0) among VAMCs in the lowest quintile. Similar findings were observed for mortality rankings in pneumonia and after inclusion of clinical covariates.Conclusions and relevanceThis study suggests that adjustments for socioeconomic factors did not meaningfully change VAMCs' risk-adjusted 30-day mortality rates for veterans hospitalized for heart failure and pneumonia. The implications of such adjustments should be examined for other quality measures and health systems.
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Project description:Previous research finds that marriage is associated with better health and lower mortality, and one of the mechanisms underlying this association is health-related selection out of marriage. Using longitudinal survey data from 2,348 couples from the Fragile Families and Child Wellbeing Study, we examine whether certain health behaviors-smoking and binge drinking-are associated with risk of union dissolution among couples with young children. We use discrete time hazard models to test whether associations between health behaviors and union dissolution differ between married and cohabiting parents. We find no statistically significant association between binge drinking and union dissolution for either cohabiting or married couples. Parental smoking, however, is associated with union dissolution. On average, married and cohabiting couples in which both parents smoke have a higher risk of union dissolution than couples in which neither parent smokes. Additionally, father's smoking (in couples in which the mother does not smoke) is associated with union dissolution, but only for married couples. These findings illustrate the importance of considering the health behaviors of both partners and provide further evidence of differences in union dissolution dynamics between married and cohabiting couples.
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Project description:ObjectiveApproximately three to six months after returning from deployment, military service members complete the Post-Deployment Health Reassessment (PDHRA), which includes screens for alcohol misuse, depression, and posttraumatic stress disorder (PTSD). To determine whether Army Reserve Component (RC) members (Army National Guard and Army Reserve) with positive screening scores on the PDHRA receive needed care, the investigators examined the association between positive scores and enrollment and utilization of care ("linkage") in the Veterans Health Administration (VHA), as well as rescreening scores, diagnosis, and behavioral treatment in VHA.MethodsMixed-effects regression models were used to predict linkage to VHA within six months after RC members (N=73,164) completed the PDHRA, with alcohol misuse, depression, and PTSD screen scores as key independent variables. Regression models were stratified by gender and National Guard versus Reserve status. Among those who linked to VHA (N=25,168), screening scores and subsequent diagnosis and treatment in VHA were also examined.ResultsArmy RC members with positive PTSD and depression screening scores were more likely than those with negative screens to link to VHA, and most (54%-84%) received VHA treatment once diagnosed. Positive screens for alcohol misuse were associated with linkage to VHA for men but not for women, and treatment rates for alcohol use disorders were relatively low (0%-25%) for both men and women diagnosed as having an alcohol use disorder.ConclusionsThe finding that Army RC members with greater indications of behavioral health problems linked to VHA is encouraging. However, more outreach and treatment engagement strategies could be directed to those with alcohol use disorder, particularly women.
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Project description:BackgroundThe dimensions along which mortality is patterned in India remains unclear. We examined the specific contribution of social castes, household income, assets, and monthly per capita consumption to mortality differentials in India.Methods and findingsCross-sectional data on 217,363 individuals from 41,554 households from the 2004-2005 India Human Development Survey was analyzed using multiple logistic regressions. Mortality differentials across social castes were attenuated after adjusting for household economic factors such as income and assets. Individuals living in the lowest income and assets quintiles had an increased risk of mortality with odds ratio (OR) of 1.66 (95% CI ?=? 1.23-2.24) in the bottom income quintile and OR of 2.94 (95% CI ?=? 1.66-5.22) in the bottom asset quintile. Counter-intuitively, individuals living in households with lowest monthly consumption per capita had significantly lower probability of death (OR ?= ?0.27, 95% CI ?= ?0.20-0.38).ConclusionsMortality burden in India is largely patterned on economic dimensions as opposed to caste dimensions, though caste may play an important role in predicting economic opportunities.
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Project description:Our study aims to investigate the association between SRH and all-cause mortality, and to investigate whether the SRH-mortality association varies across different socioeconomic status (SES) groups among middle-aged and older Chinese adults. We used data from China Health and Retirement Longitudinal Study (CHARLS), including 11,762 participants for the final analysis. Cox proportional hazards regression was conducted to investigate the association between SRH status and subsequent mortality. There were 724 death events occurred. The results were shown that fair/poor SRH participants tend to die than better SRH peers (HR 1.46, 95% CI 1.12-1.91). The association only occurred in those with rural residency (HR 1.46, 95% CI 1.05-2.04), those who were literate (HR 1.65, 95% CI 1.17-2.33), those with above-average household income (HR 1.95, 95% CI 1.15-3.29) and those working in agriculture and below (HR 1.38, 95% CI 1.02-1.88). In conclusion, worse SRH may be a predictor of all-cause mortality among middle-aged and elderly Chinese, especially in people with rural residency, literacy, above-average household income and working in agriculture and below.
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Project description:Subjective status, an individual's perception of her socioeconomic standing, is a robust predictor of physical health in many societies. To date, competing interpretations of this correlation remain unresolved. Using longitudinal data on 8430 older adults from the 2000 and 2007 waves of the Indonesia Family Life Survey, we test these oft-cited links. As in other settings, perceived status is a robust predictor of self-rated health, and also of physical functioning and nurse-assessed general health. These relationships persist in the presence of controls for unobserved traits, such as difficult-to-measure aspects of family background and persistent aspects of personality. However, we find evidence that these links likely represent bi-directional effects. Declines in health that accompany aging are robust predictors of declines in perceived socioeconomic status, net of observed changes to the economic profile of respondents. The results thus underscore the social value afforded good health status.
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