Adjustment For Socioeconomic Factors Research Articles

Long-term trends in mortality by living arrangements and the role of socioeconomic factors, Finland 1991-2020.

Recent decades have witnessed major changes in living arrangements, potentially impacting their well-established associations with mortality. However, research considering long-term trends in these differentials is scarce. We used individual-level register data on the total Finnish population aged 30 years and over from 1991 to 2020 to examine trends in the association between living arrangements and all-cause, as well as external and alcohol-related mortality. We calculated age-standardized mortality rates, quantified group differentials in absolute and relative terms, and assessed the contribution of socioeconomic factors with Poisson-models. Analyses were conducted separately for men and women in age groups 30-49, 50-69, and 70+. All-cause mortality was consistently lowest among men and women living with a partner. Highest rates were observed in the growing group of individuals living alone or with persons other than a partner or child, who experienced up to a five-fold excess mortality compared to those living with a partner and children. Mortality declined across all living arrangement groups over time. While absolute rate differences mostly narrowed, relative differences widened across all ages. Adjustments for socioeconomic factors somewhat attenuated mortality differentials, with their contribution increasing modestly by the end of the study period. In conclusion, over the past 30 years, relative mortality differences by living arrangement have increased at all ages for both men and women. These widening differentials pose a growing public health burden, particularly for the growing group of individuals living alone. Our results suggest that factors beyond socioeconomic differentiation are contributing to these trends.

Socioeconomic factors and COVID-19 mortality in immune-mediated rheumatic diseases patients: regional analysis from Argentina, Mexico and Brazil

BackgroundSARS-CoV-2 infection has become a major international issue, not only from a medical point of view, but also social, economic and political. Most of the available information comes from the United States, Europe, and China, where the population and the socioeconomic status are very different from Latin American countries. This study evaluates the effect of regional socioeconomic characteristics on mortality due SARS-CoV-2 infection in patients with immune-mediated rheumatic diseases (IMRD) from Argentina, Mexico and Brazil.MethodsData from three national registries, SAR-COVID (Argentina), CMR-COVID (Mexico) and ReumaCoV-Brasil (Brazil), were combined. Adult IMRD patients with SARS-CoV-2 infection were recruited. National data for each province/state, including population density, number of physicians per inhabitant, income, unemployment, GINI index, Municipal Human Development Index (MHDI), stringency index, vaccination rate and most frequent viral strains per period were assessed as risk factors for mortality due to COVID-19.ResultsA total of 4744 patients were included, 2534 (53.4%) from SAR-COVID, 1166 (24.6%) from CMRCOVID and 1044 (22.0%) from ReumaCoV-Brasil. Mortality due to COVID-19 was 5.4%. In the multivariable analysis, higher number of physicians per 1000 inhabitants and being infected during the vaccination period of each country were associated with lower mortality. After adjustment for socioeconomic factors, there was no association with country of residence and mortality.ConclusionThese findings corroborate the complex interplay between socioeconomic factors, rheumatic disease activity, and regional disparities as determinants of death due to COVID-19 in Argentina, Brazil and Mexico. Thus, this research provides valuable insights for guiding public health policies and clinical practice in the ongoing fight against the COVID-19 pandemic.

Activity limitations, use of assistive devices, and mortality and clinical events in 25 high-income, middle-income, and low-income countries: an analysis of the PURE study

Activity limitations, use of assistive devices, and mortality and clinical events in 25 high-income, middle-income, and low-income countries: an analysis of the PURE study

Lifecourse correlates of self-rated health and associations with subsequent mortality: findings from the Hertfordshire Cohort Study

Lifecourse correlates of self-rated health and associations with subsequent mortality: findings from the Hertfordshire Cohort Study

Parental Mental Illness and the Likelihood of Child Out-of-Home Care: A Cohort Study.

To detail the relationship between parental mental illness and the likelihood of out-of-home care (OHC) among their children, and to identify factors which modify this relationship. Using Swedish national registers, children born in 2000 to 2011 (n = 1 249 463) were linked to their parents. Time-dependent parental mental illness (nonaffective and affective psychosis, substance misuse, depression, anxiety and stress, eating disorders, personality disorders, attention deficit hyperactivity disorder, autism, and intellectual disability), was identified through International Classification of Diseases codes. After adjustment for socioeconomic factors, children living with mentally ill parents were 4 times as likely to be placed in OHC than children without (95% confidence interval [CI] 4.24-4.61). The highest hazard ratio (HR) was in the youngest children aged 0 to 1 year (5.77, 95% CI 5.42-6.14), exposed to maternal illness (HR 4.56, 95% CI 4.37-4.76), and parental intellectual disability (HR 4.73, 95% CI 4.09-5.46). Children with parental mental illness with multiple risk factors were at particularly high risk. Compared with children without parental mental illness, and those with university-educated parents, children whose parents had mental illness and only had education to age 16 had a 15 times higher risk of OHC (95% CI 13.75-16.54). Children with parental mental illness are considerably more likely to be removed from home into care during childhood, particularly during the first year of life and if they are from socially disadvantaged families. Greater knowledge of these risks should lead to increased support for vulnerable new families.

The technological reserve hypothesis: A meta‐analysis

Abstract BackgroundOlder adults are increasingly crossing the digital divide, regularly engaging with technologies such as the internet, smartphones, and personal computers. Two distinct theories of the cognitive impact of this digital engagement have been raised. According to the digital distraction hypothesis, regular engagement with technology acutely negatively effects cognition by increasing distractions and decreases cognitive skills over the long‐term by regularly offloading tasks such as recall of facts, directions, and other daily memory tasks into digital technologies. By contrast, according to the technological reserve hypothesis, regular engagement with technology acutely benefits functioning via use of assistive technologies and can reduce long‐term risk for cognitive disorders with age by promoting complex cognitive engagement, sustained connection, and acquisition of digital based compensatory skills.MethodRandom effects meta‐analysis was used to pool effect sizes, with primary effect sizes reported as odds ratios (odds of developing a cognitive diagnosis or odds of having lower cognitive scores as appropriate to each study). We conducted systematic evaluations of study quality and to determine the influence of socioeconomic, education, age, and type of technology.ResultOf 6,183 records identified, 26 studies met inclusion criteria and were included in the final analysis. Engagement with smartphones, computers, and/or the internet was associated with decreased risk of cognitive decline, mild cognitive impairment, and dementia (pooled OR = 0.45, 95% CI 0.318‐0.637, p<.0001; I2 = 99.2%; Figure 1). Potential confounding variables, such as adjustment for socioeconomic factors and education or type of technology measured did not moderate this relationship (Figure 2). Study quality was generally good (Figure 3), though all studies assessed technology use by self‐report and few measured intraindividual changes in technology use over time.ConclusionEngagement with everyday digital technologies is associated with decreased risk of cognitive decline and dementia, consistent with the technological reserve hypothesis. While these studies do not prove causality of this relationship, they do highlight the potential for digital health approaches to promote cognitive health and well being with age. Limitations, particularly with regard to understanding digital disparities and incorporating objective digital use metrics in future studies are discussed in detail.

Maternal high body mass index, but not gestational diabetes, is associated with poorer educational attainment in mid-childhood

Previous studies suggest that gestational diabetes mellitus is associated with poorer cognitive outcomes in children. However, confounding factors, especially maternal body mass index, have been poorly accounted for. This study aimed to examine the independent associations between maternal body mass index, gestational diabetes mellitus status, and educational outcomes. Antenatal data from a prospective birth cohort (Pregnancy Outcome Prediction Study, 2008-2012, Cambridge, United Kingdom) were linked to mid-childhood educational outcomes (Department for Education, United Kingdom). A total of 3249 children born at term were stratified by maternal gestational diabetes mellitus status and body mass index at booking (<25 vs ≥25 kg/m2). Regression models adjusted for relevant maternal, child, and socioeconomic factors were used to determine associations with academic outcomes at ages of 5 to 7 years. No differences in educational attainment were found between children exposed to gestational diabetes mellitus and nonexposed children. Neither maternal glucose levels measured at 11 to 14 or 24 to 28 weeks, nor acceleration of the fetal abdominal circumference growth velocity were related to educational attainment at ages of 5 to 7 years. Children of mothers with booking body mass index ≥25 kg/m2 (vs <25 kg/m2) were ∼50% more likely to not meet expected educational standards regardless of gestational diabetes mellitus status (age 5: adjusted odds ratio, 1.44; 95% confidence interval, 1.19-1.74; P<.001; age 6: adjusted odds ratio, 1.61; 95% confidence interval, 1.28-2.02; P<.001). The association between maternal body mass index and offspring educational attainment is dose-dependent and robust to stratification by gestational diabetes mellitus status and adjustment for socioeconomic factors. Mid-childhood educational attainment is not associated with maternal glucose status. This may provide important reassurance for pregnant women and clinicians. However, maternal body mass index is associated with lower childhood educational attainment and may be modifiable with intervention before or during pregnancy.

Increased risk of hospitalization, intensive care and death due to COVID-19 in patients with adrenal insufficiency: A Swedish nationwide study.

Patients with adrenal insufficiency (AI) have excess morbidity and mortality related to infectious disorders. Whether patients with AI have increased morbidity and mortality from COVID-19 is unknown. In this linked Swedish national register-based cohort study, patients with primary and secondary AI diagnosis were identified and followed from 1 January 2020 to 28 February 2021. They were compared with a control cohort from the general population matched 10:1 for age and sex. The following COVID-19 outcomes were studied: incidence of COVID-19 infection, rates of hospitalization, intensive care admission and death. Hazard ratios (HR) with 95% confidence intervals (95% CI) adjusted for socioeconomic factors and comorbidities were estimated using Cox regression analysis. We identified 5430 patients with AI and 54,300 matched controls: There were 47.6% women, mean age was 57.1 (standard deviation 18.1) years, and the frequency of COVID-19 infection was similar, but the frequency of hospitalization (2.1% vs. 0.8%), intensive care (0.3% vs. 0.1%) and death (0.8% vs. 0.2%) for COVID-19 was higher in AI patients than matched controls. After adjustment for socioeconomic factors and comorbidities, the HR (95% CI) was increased for hospitalization (1.96, 1.59-2.43), intensive care admission (2.76, 1.49-5.09) and death (2.29, 1.60-3.28). Patients with AI have a similar incidence of COVID-19 infection to a matched control population, but a more than twofold increased risk of developing a severe infection or a fatal outcome. They should therefore be prioritized for vaccination, antiviral therapy and other appropriate treatment to mitigate hospitalization and death.

OR30-06 Hospitalisation, Intensive Care And Death Due To COVID-19 In Swedish Patients With Adrenal Insufficiency

Abstract Disclosure: R. Bergthorsdottir: None. D. Esposito: None. G. Johannsson: None. O. Ragnarsson: None. P. Dahlqvist: None. S. Bensing: None. J. Nåtman: None. F. Nyberg: None. Background: Patients with adrenal insufficiency (AI) have increased risk for morbidity and mortality related to infectious disorders. Whether patients with AI have an increased risk for infection with Coronavirus disease 2019 (COVID-19), need of hospitalisation, intensive care or death in COVID-19 disease is still unknown. Methods: Swedish national register-based cohort study. Patients with primary and secondary AI were identified in linked Swedish national healthcare registers and followed from 2020-01-01 until 2021-02-28, and were compared to controls from the general population, matched 10:1 for age and sex. The following COVID-19 outcomes were studied: hospitalisation, intensive care and death. Findings: We identified 5430 patients with AI, and 54300 controls; 47.6% females, with a mean (±SD) age of 57.1 (±18.1) years. The prevalence of positive COVID-19 testing and diagnosis were similar in patients with AI and controls. The rate of hospitalisation (2.1% vs 0.8%), intensive care (0.3% vs 0.1%) and death (0.8% vs 0.2%) for COVID-19 were higher in AI patients than controls, respectively. After adjustment for socioeconomic factors and comorbidities, the hazard ratio (95% confidence interval) for hospitalisation was 1.96 (1.59-2.43), for intensive care admission it was 2.76 (1.49-5.09) and for death 2.29 (1.60-3.28). Interpretation: Patients with AI have an increased risk for severe and fatal COVID-19 infection and should therefore be prioritised for vaccination, early antiviral and supportive treatment to prevent hospitalisation and death. Presentation: Sunday, June 18, 2023

Socioeconomic status may affect association of vegetable intake with risk of ischemic cardio-cerebral vascular disease: a Mendelian randomization study

BackgroundPrevious studies found that increasing vegetable intake benefits are reduced after adjustment for socioeconomic factors. Using genetic variation as an instrumental variable for vegetable intake and socioeconomic status, we investigated the relationship between vegetable intake and ischemic cardio-cerebral vascular diseases and focused on whether socioeconomic status was a possible confounder.MethodsFrom three independent genome-wide association studies, we extracted instrumental variables reflecting raw and cooked vegetable intake, which were used to perform Mendelian randomization analysis. To evaluate the effects of socioeconomic factors on vegetable intake, univariate and multivariate Mendelian randomization analyses were performed using single nucleotide polymorphisms representing education attainment and household income reported in the literature. We also performed outlier assessment and a series of sensitivity analyses to confirm the results.ResultsGenetically predicted raw and cooked vegetable intake were not associated with any ischemic cardio-cerebral vascular diseases and lipid components after Bonferroni correction. Univariate Mendelian randomized analysis revealed that raw vegetable intake was positively correlated with education attainment (β = 0.04, p = 0.029) and household income (β = 0.07, p < 0.001). Multivariate Mendelian randomized model showed a positive correlation between household income and raw vegetable intake (β = 0.06, p = 0.004). Socioeconomic status was closely associated with eating habits and lifestyle related to the risk of cardiovascular diseases.ConclusionGenetically determined raw and cooked vegetable intake was not associated with significant benefits in terms of ischemic cardio-cerebral vascular diseases while genetically determined socioeconomic status may have an impact on vegetable intake. Socioeconomic status, which was closely associated with other eating habits and lifestyle, may affect the association between vegetable intake and ischemic cardio-cerebral vascular diseases.

Life's simple 7 and its association with trajectories in depressive symptoms among urban middle-aged adults

Life's simple 7 and its association with trajectories in depressive symptoms among urban middle-aged adults

Age at first exposure to antibiotics and neurodevelopmental outcomes in childhood

RationaleViral illnesses in children are common and are frequently treated with antibiotic medication. Antibiotics reduce the diversity and composition of the gut microbiota, leading to poor developmental outcomes.ObjectivesTo investigate the relationship between age at first exposure to antibiotics and cognitive and behavioural development at 4.5 years while controlling for multiple confounders, including otitis media.MethodsStudy participants were 5589 children enrolled in the broadly generalisable Growing Up in New Zealand cohort study, with antibiotic exposure data, maternal antenatal information, and age 4.5-year behaviour and cognitive outcome data. Children were categorised as first exposed to antibiotics according to the following mutually exclusive ages: 0–2 months; 3–5 months; 6–8 months; 9–11 months; 12–54 months or not exposed by 54 months. Developmental outcome measures included the Strengths and Difficulties Questionnaire, Luria hand clap task, and the Peabody Picture Vocabulary Test-III.ResultsIn univariate analysis, there was an evident dose–response relationship where earlier exposure to antibiotics in the first year of life was associated with behavioural difficulties, lower executive function scores, and lower receptive language ability. After adjusting for confounders, pairwise comparisons showed that first antibiotic exposure between birth and 3 months or between 6 and 9 months was associated with lower receptive vocabulary. Antibiotic exposure at any age prior to 12 months was associated with increases in behavioural difficulties scores at 4.5 years.ConclusionsFollowing adjustment for socioeconomic factors and otitis media, there is evidence that antibiotic exposure during potentially sensitive windows of development is associated with receptive language and behaviour later in childhood.

Art Engagement and Risk of Type 2 Diabetes: Evidence From the English Longitudinal Study of Ageing.

Objectives: To examine the prospective association between art engagement and the risk of type 2 diabetes. Methods: Adults aged ≥50 from the English Longitudinal Study of Ageing were asked about the frequency of art engagement, including going to the cinema, the art gallery or museum, and the theatre, a concert, or the opera. Cox proportional hazards regression models were used to examine the risk of type 2 diabetes associated with art engagement. Results: During a median follow-up of 12.2years, we identified 350 cases of type 2 diabetes from 4,064 participants through interviews. After multivariable adjustment, compared with people who never went to the cinema, those going to the cinema frequently had a significantly lower risk of developing type 2 diabetes (HR = 0.61, 95% CI: 0.44-0.86). After further adjustment for socioeconomic factors, the association was slightly attenuated but remained statistically significant (HR = 0.65, 95% CI: 0.46-0.92). Similar results were found for going to the theatre, a concert, or the opera. Conclusion: Frequent art engagement may be associated with a lower risk of type 2 diabetes, which was independent of individuals' socioeconomic factors.

Abstract WP72: Psychological Distress Is Prevalent Among Family Surrogate Decision Makers In The Year After Stroke And Differs By Ethnicity

Introduction: We investigated long-term psychological distress among stroke family surrogate decision makers in Mexican Americans (MAs) and non-Hispanic Whites (NHWs). Methods: Ischemic and hemorrhagic stroke patients from the Brain Attack Surveillance in Corpus Christi (BASIC) project and their family surrogate decision makers from the Outcomes Among Surrogate Decision Makers in Stroke (OASIS) were enrolled. Family surrogates completed validated measures of post-traumatic stress (NSESSS), anxiety (GAD-7), and depression (PHQ-8) at discharge, 3, 6, and 12 months. Ethnic differences were assessed with multilevel linear mixed models, sequentially adjusted for pre-specified covariates as shown in the table. Results: There were 301 family surrogates for 241 stroke patients. MA patients were younger and less likely than NHWs to have died before the initial outcome interview (43% vs 56%, p=0.05), with no difference in baseline severity. MA family surrogates had lower educational attainment, income, and less use of advance care plans than NHWs. High scores on measures of psychological distress were common at all time points (Table). All psychological outcomes were worse among MAs on unadjusted analyses (Table). Symptoms of post-traumatic stress remained worse among MAs in the fully-adjusted model. Ethnic differences in anxiety were attenuated after adjustment for family demographics. Ethnic differences in depression were attenuated after adjustment for socioeconomic factors. Advance care plans were not associated with outcomes after accounting for other covariates and did not seem to confound any ethnic differences. Conclusions: Psychological distress is prevalent among family surrogate decision makers in the year after stroke and may be worse among MAs. Efforts are needed to support family members of all ethnic groups after severe strokes.

Abstract C043: Aberrant mRNA splice variants as novel prognostic biomarkers for tumor aggressiveness and treatment resistance in African American prostate cancer

Abstract African Americans (AAs) have among the highest incidence of prostate cancer (PCa) and mortality attributable to this disease, and AA PCa disparities remains a clinical challenge. Specifically, AAs are 1.6 times more likely to develop PCa, and 2.4 times more likely to die from this disease compared to European Americans (EAs). A number of studies have shown that higher mortality and recurrence rates of PCa in AA men were observed even after adjustment for socioeconomic factors, suggesting that intrinsic biological difference may account for part of the PCa disparities. Our recent genomic study has identified global splicing events as critical drivers for promoting AA and EA PCa disparities. In this study, we utilized population-specific cell lines as in-vitro AA and EA PCa models to evaluate the molecular functions of the aberrant splice variants involved in cancer aggressiveness and drug resistance. Comprehensive functional assays (such as MTT, apoptosis, invasion, kinase activity assays, and western blotting analysis in PCa cells treated with vehicle or small molecule drugs, etc.) were employed to elucidate the functional roles of an oncogenic splice variant, PIK3CD-S, in AA and EA PCa cells in response to drug treatments. Immunohistochemistry and RNAScope assays were performed to examine the expression profile of PIK3CD-L (full length) and PIK3CD-S variants in an independent PCa cohort derived from AA and EA patients. Higher PIK3CD-S/PIK3CD-L expression ratios were detected in AA PCa cell lines and patient specimens. In addition, the functional validations have indicated that the higher PIK3CD-S/PIK3CD-L expression ratio in AA PCa cells potentially contributes to the higher cell proliferative and invasive capacities. By targeting splicing mechanism and/or PI3K isoforms using specific small molecule inhibitors in AA and EA cell models, we further explored the functional mechanisms of these oncogenic splice variants underlying the drug resistance. In conclusion, our molecular mapping/validation and functional analysis suggest that high PIK3CD-S/PIK3CD-L expression profile may contribute to the PCa aggressiveness and treatment resistance in AA PCa, potentially serving as a precision prognostic biomarker and novel drug target in advanced PCa Citation Format: Siyoung Ha, Himali Gujrati, Bi-Dar Wang. Aberrant mRNA splice variants as novel prognostic biomarkers for tumor aggressiveness and treatment resistance in African American prostate cancer [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C043.

Complications and Healthcare Consumption of Pregnant Women with a Migrant Background: Could There be an Association with Psychological Distress?

ObjectivePrevious studies reported less prenatal healthcare consumption and more perinatal complications in women with a migrant background. Hence, we investigated in a country with free healthcare access whether women with a migrant background differed with respect to pregnancy complications, healthcare consumption and in terms of associations with psychological distress in comparison to native Dutch.MethodsWe included 324 native Dutch and 303 women with a migrant background, who visited two hospitals in Amsterdam for antenatal care between 2014 and 2015. Participants completed the Edinburgh Postnatal Depression Scale, the Hospital Depression and Anxiety Scale, and sociodemographic questions. Complications and healthcare consumption during pregnancy were extracted from medical records. Regression analyses were used with adjustment for covariates.ResultsExcept for gestational diabetes [adjusted OR = 3.09; 95% CI = (1.51, 6.32)], no differences were found between groups in perinatal complications [OR = 1.15; 95% CI = (0.80, 1.64)], nor in healthcare consumption [OR = 0.87; 95% CI = (0.63, 1.19)].Women with a migrant background reported more depressive symptoms [Cohen’s d = 0.25; 95% CI = (0.10, 0.41)], even after adjustment for socio-economic factors. Psychological distress was associated with more hospital admissions during pregnancy. When experiencing depressive symptoms, women with a migrant background had an increased risk to be admitted [OR = 1.11; 95% CI = (1.01, 1.21)].Conclusions for PracticeThis cohort study found no differences in pregnancy-related complications, except for diabetes, nor different healthcare consumption, in women with a migrant background versus native Dutch, in a country with free health care access. However, women with a migrant background experienced more depressive symptoms, and when depressed their risk for hospital admission increased. Additional research is warranted to improve healthcare for this population.

Patient-reported reasons for no-shows to screening mammogram appointments among African American women.

e18534 Background: Mammography screening significantly reduces breast-cancer related mortality; however, many women fail to undergo screening as recommended by national guidelines. No-shows are responsible for a significant proportion of delayed or missed cancer screening exams. Further, no-shows disproportionately affect underserved and minority populations. We previously identified a high no-show rate for screening mammograms among patients seeking care our institution. African American (AA) women were almost three times more likely to no-show than non-Hispanic white women. The racial disparity in no-shows persisted after adjustment for socioeconomic factors. The objective of this survey study was to identify reasons for missed mammogram screening appointments among AA women. Methods: We conducted a survey (via mail or telephone) of AA women who missed their screening mammogram appointment in summer 2021. Using a structured survey instrument, we collected information on patient-specific and health service barriers. Patient-specific barriers included procedure-related concerns (e.g., concern about discomfort), cognitive-emotional factors (e.g., fear of finding cancer), and changes in health status. Health service barriers included logistical factors (e.g., transportation), cost (e.g., lack of insurance) and scheduling problems (e.g., forgot about appointment or scheduled at an inconvenient time). Here we describe the most common reasons for missed appointments and compared women who reported patient-specific versus health service barriers. Results: 255 women who no-showed for their appointment were contacted and 91 participated in the study survey (35.6% response rate). Most respondents (90%) attributed their no-show to at least one of the listed barriers. Nineteen (7.5%) attributed their no-show to COVID-19, but only 1 person reported this as their only barrier. Scheduling issues were the most commonly reported barriers (57.8%), followed by transportation (38.9%). Three-quarters of respondents reported health service barriers, while only 40.7% reported patient-related barriers. The most common patient-related barriers were cognitive-emotional (25%), changes in health status (20.9%) and procedure-related concerns (15.6%). The majority of respondents (82.6%) were interested in rescheduling their mammogram. Conclusions: Most appointment no-shows among surveyed AA women resulted from potentially preventable scheduling and transportation issues. Relatively few respondents reported cognitive-emotional or procedure-related concerns. Further, the majority of respondents were interested in rescheduling their mammogram; which suggests that these women remain motivated to undergo breast cancer screening. Programs which address preventable health-service related issues may help these women keep their appointments.

Alcohol consumption as a predictor of mortality and life expectancy: Evidence from older Chinese males

Alcohol consumption as a predictor of mortality and life expectancy: Evidence from older Chinese males

Does early life phthalate exposure mediate racial disparities in children's cognitive abilities?

Background:Early life exposure to phthalates may be associated with reduced cognition. However, it is unknown if disproportionate exposure to phthalates contributes to racial disparities in children’s intellectual abilities.Methods:We used data from 253 mother-child pairs in Cincinnati, OH (the Health Outcomes and Measures of the Environment study, 2003–2006). We measured urinary concentrations of 11 phthalate metabolites twice during pregnancy and up to six times in childhood. We evaluated children’s cognitive abilities at ages 5 and 8 years. Using mediation models, we quantified covariate-adjusted direct and indirect effects of race on children’s Full-Scale Intelligence Quotient (IQ) scores for individual phthalate metabolite concentrations during gestation and childhood.Results:Average IQ scores among Black children (n = 90) were 7.0 points lower (95% confidence interval [CI] = −12, −1.8) than among White children (n = 145) after adjustment for socioeconomic factors. Urinary monobenzyl phthalate and monoethyl phthalate (MEP) concentrations during gestation and childhood were higher among Black than White children. We did not observe evidence that phthalate concentrations mediated the race-IQ association, with the exception of MEP. Childhood MEP concentrations partially mediated the race-IQ association. For instance, each 10-fold increase in MEP concentrations at age 2 years contributed to a 1.9-point disparity in IQ scores between Black and White children (95% CI = −4.7, 0.7). Other phthalate metabolite concentrations during pregnancy or childhood did not mediate the race-IQ association.Conclusions:Despite observing racial disparities in exposure to some phthalates and IQ, we found little evidence that phthalates contribute to IQ disparities.

Sex differences in functional limitations and the role of socioeconomic factors: a multi-cohort analysis

SummaryBackgroundWomen are more likely to have functional limitations than are men, partly because of greater socioeconomic disadvantage. However, how sex differences vary by severity of functional limitations remains unclear. We examined sex differences in functional limitations, with attention to socioeconomic factors and severity of limitations.MethodsLongitudinal data on limitations in basic activities of daily living (ADL) and instrumental activities of daily living (IADL) and mobility activities were drawn from 62 375 participants from 14 countries. For ADL, IADL, and mobility, participants were categorised based on number of limited activities (0, 1, 2, or ≥3). Sex differences in limitations in four birth cohorts (1895–1929, 1930–38, 1939–45, and 1946–60) were analysed before and after adjustment for socioeconomic factors (education and labour force status).FindingsThe prevalence of IADL and ADL limitations was higher in women than in men. After adjustment for socioeconomic factors, this sex difference was attenuated. The sex difference in IADL limitations at age 75 years (in the 1895–1929 cohort) was 3·7% before adjustment for socioeconomic factors (95% CI 2·6–4·7) and 1·7% (1·1–2·2) after adjustment. For ADL, the sex difference in limitations at age 75 years (in the 1895–1929 cohort) was 3·2% (2·3–4·1) before adjustment for socioeconomic factors and 1·4% (0·9–1·8) after adjustment. Sex differences in mobility limitations (16·1%, 95% CI 14·4–17·7) remained after adjustment for socioeconomic factors (14·3%, 12·7–15·9). After age 85 years, women were more likely to have three or more IADL or mobility limitations and men were more likely to have one or two limitations.InterpretationSocioeconomic factors largely explain sex differences in IADL and ADL limitations but not mobility. Sex differences in mobility limitations in midlife are important targets for future research and interventions.FundingNational Institute on Aging, UK National Institute for Health Research, European Commission, and US Social Security Administration.