Associations of Depressive Symptoms With All-Cause and Cause-Specific Mortality by Race in a Population of Low Socioeconomic Status: A Report From the Southern Community Cohort Study.
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SUBMITTER: Cui Y
PROVIDER: S-EPMC8024049 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionDepression is common but underrecognized in patients with chronic kidney disease (CKD), especially among racial/ethnic minorities. We examined the association between depressive symptoms and all-cause mortality (including deaths before and after end-stage renal disease [ESRD]) and whether antidepressant use impacts this association, overall, and by race/ethnicity.MethodsWe ascertained whether the presence of depressive symptoms, defined by a Beck Depression Inventory II (BDI) score of >14 at cohort enrollment, was associated with all-cause mortality (before or after ESRD) among study participants of the Chronic Renal Insufficient Cohort (CRIC) overall and by race/ethnicity. Models were adjusted for socioeconomic factors, baseline CKD severity, time-updated comorbid conditions, and time-updated antidepressant use. Confirmatory analyses were performed among African American Study of Kidney Disease and Hypertension (AASK) participants.ResultsAmong 3739 CRIC participants, 16.3% had a baseline BDI of >14; 18.2% reported antidepressant use. Crude mortality rate was 3.16 per 100 person-years during 6.8 years of median follow-up. Baseline BDI >14 was independently associated with higher risk of all-cause mortality (adjusted hazard ratio [aHR]: 1.27; 95% confidence interval: 1.07-1.52) without attenuation by antidepressant use. Differences among white and black individuals were noted (Pinteraction= 0.02) but not among white versus Hispanic individuals (Pinteraction = 0.43) or black versus Hispanic individuals (Pinteraction = 0.22). Depressive symptoms were associated with higher mortality among white individuals (aHR: 1.66; 1.21-2.28), but not Hispanic individuals (aHR: 1.47; 0.95-2.28) or black individuals (aHR: 1.06; 0.82-1.37). Similar results were noted among 611 AASK participants (aHR: 0.99; 0.69-1.42).ConclusionsThe presence of depressive symptoms is a risk factor for all-cause mortality among patients with mild-moderate CKD, particularly among white individuals. Further studies are needed to understand the heterogeneity in the response to the presence of depressive symptoms by race.
| S-EPMC6365404 | biostudies-literature
Project description:ImportanceSocioeconomic status may help delineate racial and ethnic inequities in mortality.ObjectiveTo investigate the joint associations of race, ethnicity, and neighborhood and individual socioeconomic status with mortality.Design, setting, and participantsThis prospective analysis used data from the Multiethnic Cohort Study. A population-based sample of participants recruited from California (mainly Los Angeles County) and Hawaii from 1993 to 1996 was followed up until 2013. African American, European American, Japanese American, Latino American, and Native Hawaiian men and women were included. Participants with baseline residential addresses that could not be geocoded or who were missing information on education or adjustment variables were excluded. Data analyses were conducted from January 2018 to December 2020.ExposuresNeighborhood socioeconomic status (nSES) was derived using US Census block group data on education, occupation, unemployment, household income, poverty, rent, and house values. Participants self-reported their highest education attainment. Five racial and ethnic groups, 2 states of residence, 2 nSES, and 2 education categories were combined to create a joint exposure variable. Low and high nSES were defined as quintiles 1 to 3 and 4 to 5, respectively. Low and high education levels were defined as high school or less and greater than high school graduate, respectively.Main outcomes and measuresAll-cause, cardiovascular disease (CVD), cancer, and non-CVD and noncancer deaths were ascertained through 2013 via linkage to death certificates and the US National Death Index. Multivariable Cox proportional hazards regression analyses were conducted.ResultsAmong 182 912 participants (100 785 [55.1%] women and 82 127 [44.9%] men; mean [SD] age, 60.0 [8.9] years; 31 138 African American, 45 796 European American, 52 993 Japanese American, 39 844 Latino American, and 13 141 Native Hawaiian participants) with a mean (SD) follow-up of 17 (5) years, there were 63 799 total deaths, including 23 191 CVD deaths, 19 008 cancer deaths, and 21 235 non-CVD and noncancer deaths. The lowest all-cause mortality was found among 15 104 Japanese American participants in Hawaii with high nSES and high education (eg, 2870 all-cause deaths [19.0%]), and this population served as the reference group for all regression analyses. Native Hawaiian participants in Hawaii with low nSES and low education had the highest all-cause mortality HR (2.38; 95% CI, 2.21-2.57). African American and European American participants in California with low nSES and low education had the next highest all-cause mortality HRs (2.01; 95% CI, 1.91-2.11 and 1.98; 95% CI, 1.85-2.12, respectively). Latino American participants in California with low nSES had equivalent all-cause mortality HRs regardless of education level (high education: 1.57; 95% CI, 1.48-1.66; low education: 1.57; 95% CI, 1.50-1.65). Patterns for cause-specific mortality were similar to those for all-cause mortality. For example, Native Hawaiian participants in Hawaii with low nSES and low education had highest CVD mortality HR (2.92; 95% CI, 2.60-3.27) and cancer mortality HR (2.01; 95% CI, 1.77-2.29).Conclusions and relevanceThese results suggest that joint associations of nSES and education may further delineate racial and ethnic inequities in mortality and that future investigations of racial and ethnic inequities in mortality should consider differences by measures of socioeconomic status, especially for underserved populations.
| S-EPMC9002338 | biostudies-literature
Project description:Importance:Colorectal cancer (CRC) screening is rarely studied in populations who may face additional barriers to participate in cancer screening, such as African American individuals and individuals with low socioeconomic status (SES). Objective:To examine the associations of CRC screening and modalities with CRC incidence and mortality by race and SES. Design, Setting, and Participants:This cohort study used data from the Southern Community Cohort Study, which enrolled more than 85 000 participants from community health centers or stratified random sampling of the general population in 12 states in the southeastern United States. The present study included data from cohort members who were eligible for CRC screening as recommended by expert organizations based on age and family history. Participants completed questionnaires from 2002 to 2009 and were contacted again from 2008 to 2012. Linkages to state cancer registries and the National Death Index as of December 31, 2016, identified incident CRC and vital status. Data analysis was performed from January 1, 2018, to October 30, 2019. Main Outcomes and Measures:Incident CRC (n?=?632) and mortality (n?=?10?003). Cox proportional hazards regression models evaluated associations between screening modalities and CRC risk and mortality. Information on fecal occult blood test use was only obtained on the follow-up questionnaire. Self-identified race was measured as African American/black, white, or other, and SES was defined by household income. Results:This study included 47?596 participants (median baseline age, 54 years [interquartile range, 10 years]; 32 185 [67.6%] African American; 28 884 [60.7%] female; and 26 075 [54.8%] with household income <$15?000). A total of 24 432 participants (63.9%) had never undergone CRC testing at baseline. The CRC testing assessed at baseline and follow-up interviews was associated with significant CRC risk reduction (hazard ratio [HR], 0.55; 95% CI, 0.44-0.70 for ever colonoscopy at baseline). Results were similar in analyses stratified by race (African American: HR, 0.65; 95% CI, 0.50-0.85; white: HR, 0.44; 95% CI, 0.27-0.70) and household income (<$15?000: HR, 0.63; 95% CI, 0.46-0.86, ?$15?000: HR, 0.49; 95% CI, 0.35-0.69). Ever sigmoidoscopy at baseline was associated with CRC risk reduction (HR, 0.66; 95% CI, 0.51-0.87), and undergoing fecal occult blood test in the interval between baseline and follow-up interview was associated with CRC risk reduction (HR, 0.75; 95% CI, 0.57-0.98). Inverse associations were also observed between CRC mortality and receipt of colonoscopy (HR for women, 0.39; 95% CI, 0.21-0.73; HR for men, 0.69; 95% CI, 0.40-1.18) and sigmoidoscopy (HR for women, 0.37; 95% CI, 0.16-0.85; HR for men, 0.82; 95% CI, 0.46-1.47); however, the association did not extend to fecal occult blood test (HR for women, 1.02; 95% CI, 0.62-1.70; HR for men, 1.03; 95% CI, 0.55-1.93). Conclusions and Relevance:In this study, CRC test rates were low among African American individuals and those with low SES. The findings suggest that screening, particularly with colonoscopy, is significantly associated with reduced risk of CRC and mortality. The CRC disparities experienced by individuals with low SES and African American individuals may be lessened by improving access to and uptake of CRC screening.
| S-EPMC6991213 | biostudies-literature
Project description:Bangladesh has achieved remarkable gains in health indicators during the last four decades despite low levels of economic development. However, the persistence of inequities remains disturbing. This success was also accompanied by health and demographic transitions, which in turn brings new challenges for a nation that has yet to come to terms with pre-transition health challenges. It is therefore important to understand the causes of death and their relationship with socioeconomic status (SES).The paper aims to assess the causes of death by SES based on surveillance data from a rural area of Bangladesh, in order to understand the situation and inform policy makers and programme leaders.We analysed population-based mortality data collected from the Chakaria Health and Demographic Surveillance System in Bangladesh. The causes of death were determined by using a Bayesian-based programme for interpreting verbal autopsy findings (InterVA-4). The data included 1,391 deaths in 217,167 person-years of observation between 2010 and 2012. The wealth index constructed using household assets was used to assess the SES, and disease burdens were compared among the wealth quintiles.Analysing cause of death (CoD) revealed that non-communicable diseases (NCDs) were the leading causes of deaths (37%), followed by communicable diseases (CDs) (22%), perinatal and neonatal conditions (11%), and injury and accidents (6%); the cause of remaining 24% of deaths could not be determined. Age-specific mortality showed premature birth, respiratory infections, and drowning were the dominant causes of death for childhood mortality (0-14 years), which was inversely associated with SES (p<0.04). For adult and the elderly (15 years and older), NCDs were the leading cause of death (51%), followed by CDs (23%). For adult and the elderly, NCDs concentrated among the population from higher SES groups (p<0.005), and CDs among the lower SES groups (p<0.001).Epidemiologic transition is taking place with a shift from the dominance of CDs to NCDs. SES inequity in mortality still persists--the poor suffer from CDs in all age groups, whereas those better off suffer more from NCDs than CDs. Policy makers thus need to consider the social distribution of diseases before developing any public health action targeted towards reducing mortality and the extent of disease burden in an equitable manner.
| S-EPMC4220129 | biostudies-literature
Project description:Young blacks receiving dialysis have an increased risk of death compared with whites in the United States. Factors influencing this disparity among the young adult dialysis population have not been well explored. Our study examined the relation of neighborhood socioeconomic status (SES) and racial differences in mortality in United States young adults receiving dialysis. We merged US Renal Data System patient-level data from 11,027 black and white patients ages 18-30 years old initiating dialysis between 2006 and 2009 with US Census data to obtain neighborhood poverty information for each patient. We defined low SES neighborhoods as those neighborhoods in U.S. Census zip codes with ≥20% of residents living below the federal poverty level and quantified race differences in mortality risk by level of neighborhood SES. Among patients residing in low SES neighborhoods, blacks had greater mortality than whites after adjusting for baseline demographics, clinical characteristics, rurality, and access to care factors. This difference in mortality between blacks and whites was significantly attenuated in higher SES neighborhoods. In the United States, survival between young adult blacks and whites receiving dialysis differs by neighborhood SES. Additional studies are needed to identify modifiable factors contributing to the greater mortality among young adult black dialysis patients residing in low SES neighborhoods.
| S-EPMC4214533 | biostudies-literature
Project description:ObjectiveInvestigate the relationship between socioeconomic status (SES) and race with self-reported fatigue, depression, and anxiety levels in multiple sclerosis (MS).MethodsCross-sectional review of the MS Partners Advancing Technology and Health Solutions (MS PATHS) database for adults with MS in the United States. We evaluated race and socioeconomic status (available markers: insurance, employment status, or level of education) as predictors of fatigue, depression, and anxiety sub-scores of the Neuro-QoL (Quality of life in neurological disorders), with particular interest between Caucasians/whites (CA) and African Americans/blacks (AA). Multivariate linear regression models included as covariates age, sex, disability status, smoking status, body mass index, and disease-modifying therapy.Results7,430 individuals were included; compared to CA, AA tended to be younger, more female-predominant, and had a higher level of disability. AA had completed slightly less education, had a higher level of Medicaid coverage or uninsured status, and had higher rates of unemployed or disabled status. In the univariate model, markers of lower SES, by whichever definition we used, correlated with worse affective symptoms. In the multivariate model stratified by race, CA showed similar trends. In contrast, in AA, only lower SES by employment status was correlated with worse affective symptoms. In both CA and AA, moderate and severe level of disability correlated with worse affective symptoms.ConclusionSES and race may influence affective symptoms reported by individuals with MS. The reasons for the correlation are likely multifactorial. Longitudinal studies should strive to identify factors associated with risk of affective symptoms in MS that may be modifiable.
| S-EPMC7311313 | biostudies-literature
Project description:OBJECTIVES:The objective of this study was to investigate the association between physical growth in preadult life with five outcomes at ages 64 to 76: weight, body mass index (BMI), estimated body fat percentage, hand grip strength, and mortality. METHODS:Super-imposition by translation and rotation (SITAR) growth curves of 40?484 Guatemalan individuals aged 3 to 19?years were modeled for the parameters of size, timing and intensity (peak growth velocity, eg, cm/year) of height, weight, BMI, and grip strength. Associations between the SITAR parameters and old age outcomes were tested using linear and binary logistic regression for a follow-up sample of high socioeconomic status (SES) Guatemalans, of whom 50 were aged 64 to 76?years at re-measurement and 45 died prior to the year 2017. RESULTS:SITAR models explained 69% to 98% of the variance in each outcome, with height the most precise. Individuals in the follow-up sample who had a higher BMI before the age of 20?years had higher estimated body fat (B = 1.4 CI -0.02-2.8) and BMI (B = 1.2, CI 0.2-2.2) at the ages of 64 to 76?years. Those who grew slower in height but faster in weight and BMI before the age of 20?years had higher BMI and body fat later in life. CONCLUSIONS:These findings highlight the importance of a life course perspective on health and mortality risk. Childhood exposures leading to variation in preadult growth may be key to better understanding health and mortality risks in old age.
| S-EPMC6767560 | biostudies-literature
Project description:BackgroundIn the United States, due to residential segregation, racial minorities and families with low socioeconomic status (SES) tend to live in less safe neighborhoods than their White and high SES counterparts. As such, in the US, race and SES closely correlate with neighborhood safety. Due to the high chronicity of stress in unsafe neighborhoods, perceived neighborhood safety may be a mechanism through which race and SES are linked to children's mental health. Simultaneously, race and SES may alter the effects of perceived neighborhood safety on children's mental health.AimTo explore racial and SES differences in the effects of neighborhood safety on children's internalizing symptoms, we compared racially and SES diverse groups of American children for the effects of parents' perceived neighborhood safety on children's internalizing symptoms.MethodsThis cross-sectional study included 10484 children from the Adolescent Brain Cognitive Development (ABCD) study. Mixed-effects regression was used for data analysis. The predictor variable was parents' perceived neighborhood safety which was treated as a continuous measure. The primary outcome was children's internalizing symptoms reported by children. Race, parental education, household income, and family structure were moderators.ResultsOverall, the parents' high neighborhood safety was associated with lower levels of internalizing symptoms in children. Race and household income showed statistically significant interactions with subjective neighborhood safety on children's internalizing symptoms. Parents' perceived neighborhood safety showed a stronger inverse association with children's internalizing symptoms for Black than White families. Parents' perceived neighborhood safety showed a stronger inverse association with children's internalizing symptoms for high income than low-income families. Parental education or family structure did not show any significant interaction with parents' perceived neighborhood safety on children's internalizing symptoms.ConclusionThe degree to which neighborhood safety may be associated with children's internalizing symptoms may depend on race and household income. Some of the effects of race and SES on children's mental health outcomes may be due to interactions with contextual factors such as neighborhood safety. More research is needed on why and how diverse racial and SES groups differ in the association between perceived neighborhood safety and children's well-being.
| S-EPMC8478356 | biostudies-literature
Project description:The authors assessed the extent to which socioeconomic status (SES) and the personality factors termed the "big 5" (neuroticism, extraversion, openness to experience, agreeableness, conscientiousness) represented confounded or independent risks for all-cause mortality over a 10-year follow-up in the Midlife Development in the United States (MIDUS) cohort between 1995 and 2004. Adjusted for demographics, the 25th versus 75th percentile of SES was associated with an odds ratio of 1.43 (95% confidence interval (CI): 1.11, 1.83). Demographic-adjusted odds ratios for the 75th versus 25th percentile of neuroticism were 1.38 (95% CI: 1.10, 1.73) and 0.63 (95% CI: 0.47, 0.84) for conscientiousness, the latter evaluated at high levels of agreeableness. Modest associations were observed between SES and the big 5. Adjusting each for the other revealed that personality explained roughly 20% of the SES gradient in mortality, while SES explained 8% of personality risk. Portions of SES and personality risk were explained by health behaviors, although some residual risk remained unexplained. Personality appears to explain some between-SES strata differences in mortality risk, as well as some individual risk heterogeneity within SES strata. Findings suggest that both sociostructural inequalities and individual disposition hold public health implications. Future research and prevention aimed at ameliorating SES health disparities may benefit from considering the risk clustering of social disadvantage and dispositional factors.
| S-EPMC2800299 | biostudies-literature
Project description:We aimed to examine whether associations between socioeconomic status (SES) and longitudinal sleep quality patterns are mediated by depressive symptoms. We utilized data on 3347 participants in the Korean Genome and Epidemiology Study aged 40-69 years at baseline from 2001 to 2002 who were followed up for 16 years. A group-based modeling approach was used to identify sleep quality trajectories using the Pittsburgh Sleep Quality Index (years 2, 6, 8, 10, and 12). Educational attainment (college graduated or less), monthly household income (≥$2500 or less), and occupation (unemployed, manual labor, and professional labor) at baseline (year 0) were used for analyses. Depressive symptoms were assessed using Beck's Depression Inventory at year 4. Associations between SES and sleep quality patterns were examined using a multinomial logistic regression model. The mediation effect of depressive symptoms was further examined using PROC CAUSALMED. We identified five distinct sleep quality trajectories: "normal-stable" (n = 1697), "moderate-stable" (n = 1157), "poor-stable" (n = 320), "developing to poor" (n = 84), and "severely poor-stable" (n = 89). Overall, associations between SES levels and longitudinal sleep patterns were not apparent after full adjustment for sociodemographic and lifestyle factors measured at baseline. Depressive symptoms, however, tended to fully mediate associations between SES levels and sleep quality patterns (odds ratio range for indirect effects of depressive symptoms: for education, 1.05-1.17; for income, 1.05-1.15). A significant mediating role for depressive symptoms between SES levels and longitudinal sleep quality warrants consideration among mental healthcare professionals.
| S-EPMC8361348 | biostudies-literature