General Social Survey-National Death Index Research Articles

County-level political group density, partisan polarization, and individual-level mortality among adults in the United States: A lagged multilevel study

ObjectiveTo investigate the associations between county-level political group density, partisan polarization, and individual-level mortality from all causes and from coronary heart disease (CHD) in the United States. MethodsUsing data from five survey waves (1998–2006) of the General Social Survey-National Death Index dataset and the County Presidential Election Return 2000 dataset, we fit weighted Cox proportional hazards models to estimate the associations between (1) political group density and (2) partisan polarization measured at the county level in 2000 (n = 313 counties) categorized into quartiles with individual-level mortality (n = 14,983 participants) from all causes and CHD, controlling for individual- and county-level factors. Maximum follow-up was from one year after the survey up until 2014. We conducted these analyses using two separate measures based on county-level vote share differences and party affiliation ideological extremes. ResultsIn the overall sample, we found no evidence of associations between county-level political group density and individual-level mortality from all causes. There was evidence of a 13% higher risk of dying from heart disease in the highest quartile of county-level polarization (hazards ratio, HR = 1.13; 95% CI = 0.74–1.71). We observed heterogeneity of effects based on individual-level political affiliation. Among those identifying as Democrats, residing in counties with high (vs. low) levels of polarization appeared to be protective against mortality, with an associated 18% lower risk of dying from all causes (HR = 0.82, 95% CI = 0.71–0.94). This association was strongest in areas with the highest concentrations of Democrats. ConclusionsAmong all study participants, political group density and polarization at the county level in 2000 were not linked to individual-level mortality. At the same time, we found that Democratic party affiliation may be protective against the adverse effects of high polarization, particularly in counties with high concentrations of Democrats. Future research should further explore these associations to potentially identify new structural interventions to address political determinants of population health.

Structural stigma and all-cause mortality among sexual minorities: Differences by sexual behavior?

Using updated data from the General Social Survey/National Death Index (GSS/NDI) study, we examined whether the relationship between structural stigma—measured by aggregating 4 items assessing prejudice towards homosexuality to the community level—and all-cause mortality is present among gay men/lesbian women. Our hypothesis is based on emerging evidence that indicators of structural stigma specific to homosexuality, such as those used in the GSS/NDI, uniquely predict health outcomes among this group. Because the GSS/NDI lacked an identity-based measure of sexual orientation, we tested our hypothesis by employing a strategy that has a relatively high degree of sensitivity and specificity for ascertaining individuals most likely to identify as gay or lesbian: restricting analyses to individuals who reported same-sex sexual partners in the past year. We compared this approach against an alternative strategy, which has weaker specificity for identifying gay men/lesbian women: restricting analyses to individuals who reported any lifetime same-sex sexual behaviors. After controlling for 6 individual-level factors and fixed effects of survey year, structural stigma was associated with mortality among individuals who reported past-year same-sex sexual partners (HR = 1.95, 95% CI: 1.14, 3.31). Further, there was a dose-response relationship with mortality in this group, such that those residing in communities in the highest quartile of structural stigma had the greatest mortality risk, controlling for these same factors (HR = 2.12, 95% CI: 1.03, 4.38). In sensitivity analyses, the effect size for structural stigma ranged from 1.54 to 2.30, indicating a consistent, but small-to-moderate, effect. In contrast, no association between structural stigma and mortality was observed among respondents who reported lifetime same-sex sexual partners, nor among those reporting only opposite-sex sexual partners. This analysis therefore delimits potential boundary conditions of the association between structural stigma related to same-sex sexuality and all-cause mortality, highlighting the conditions under which this association is (and is not) observed.

Comparability of Mortality Estimates from Social Surveys and Vital Statistics Data in the United States

Social surveys prospectively linked with death records provide invaluable opportunities for the study of the relationship between social and economic circumstances and mortality. Although survey-linked mortality files play a prominent role in U.S. health disparities research, it is unclear how well mortality estimates from these datasets align with one another and whether they are comparable with U.S. vital statistics data. We conduct the first study that systematically compares mortality estimates from several widely-used survey-linked mortality files and U.S. vital statistics data. Our results show that mortality rates and life expectancies from the National Health Interview Survey Linked Mortality Files, Health and Retirement Study, Americans' Changing Lives study, and U.S. vital statistics data are similar. Mortality rates are slightly lower and life expectancies are slightly higher in these linked datasets relative to vital statistics data. Compared with vital statistics and other survey-linked datasets, General Social Survey-National Death Index life expectancy estimates are much lower at younger adult ages and much higher at older adult ages. Cox proportional hazard models regressing all-cause mortality risk on age, gender, race, educational attainment, and marital status conceal the issues with the General Social Survey-National Death Index that are observed in our comparison of absolute measures of mortality risk. We provide recommendations for researchers who use survey-linked mortality files.

Marital Happiness, Marital Status, Health, and Longevity

Married individuals are healthier and live longer than those who are never married, divorced, or widowed. But not all marriages are equal: unhappy marriages provide fewer benefits than happy ones. This study examined health and longevity across a nationally representative sample of U.S. adults, combining measures of marital status and marital happiness to compare those who were “very happy” in marriage to those who were “pretty happy” in marriage, “not too happy” in marriage, never married, divorced or separated, or widowed. We employed the General Social Survey–National Death Index to illuminate the associations among marital status, marital happiness, general happiness, and self-rated health and mortality risk. Compared to individuals who were “very happily” married, those who were “not too happy” in marriage were over twice as likely to report worse health and almost 40% more likely to die over the follow-up period, net of socioeconomic, geographic, and religiosity factors. Those not too happy in marriage also had equal or worse health and mortality risk compared to those who were never married, divorced or separated, or widowed. Results further indicate that general happiness underlies much of the relationship between marital happiness and better health and longevity. The literature on the health and longevity benefits of marriage is well established, but our results suggest that individuals in unhappy marriages may be a vulnerable population. We conclude that subjective well-being and relationship quality contribute to the health benefits of marriage.

Living with parents or grandparents increases social capital and survival: 2014 General Social Survey-National Death Index

IntroductionAfter nearly a century-long trend toward single-family living arrangements, people in wealthy nations are increasingly living in multi-generational households. Multi-generational living arrangements can, in theory, increase psychological, social, and financial capital—factors associated with improvements in health and longevity. MethodsWe conducted a survival analysis using the 2014 General Social Survey-National Death Index, a prospective multi-year survey. We explored whether single generational living arrangements were associated with a higher risk of mortality than multi-generational living arrangements. ResultsWe explored this association for different groups (e.g., the foreign-born and those with high self-reported stress in family relationships). Healthy subjects who live in two-generation households were found to have lower premature mortality (hazard ratio 0.9, 95% confidence interval = 0.82, 0.99). Otherwise, we found little evidence that living arrangements matter for the respondents’ risk of premature mortality. ConclusionsHealthy people living in two-generation households have longer survival than healthy people living on their own.

Subjective assessments of income and social class on health and survival: An enigma

We examined the association between various measures of subjective social class identification (SSCI) and self-rated health as well as survival using the 2014 General Social Survey-National Death Index dataset (n = 21,108). We used multinomial logistic regression models to assess the association between SSCI and self-rated health and used Cox proportional hazards to assess the association between SSCI and survival. All analyses were adjusted for age, year at interview, race, gender, family income, and educational attainment level. The measures of SSCI that we had available were strongly correlated with self-rated health after controlling for objective measures of social status. For example, those who saw themselves as lower class were nine times as likely to self-report poor rather than excellent health status (odds ratio = 8.69; 95% confidence interval = 5.04–14.98) compared with those saw themselves as upper class. However, no such associations were observed for survival. While our alternative measures of SSCI were important predictors of self-rated health, they were not predictive of survival. This suggests that there may be potential confounding between two perceptions: SSCI and self-rated health.

Sociodemographic Correlates of Sexlessness Among American Adults and Associations with Self-Reported Happiness Levels: Evidence from the U.S. General Social Survey.

Although sexual activity is commonly believed to be a key component of emotional well-being, little is known about the factors associated with the absence of sexual activity or its associations with self-reported happiness. Using the U.S. General Social Survey-National Death Index 2008 dataset, a series of nationally representative surveys (1988-2002), this study analyzed the sociodemographic and lifestyle factors associated with past-year sexlessness and self-reported happiness among American adults (n=17,744). After adjustment for marital status, there were no significant time trends evident in the proportion of American adults reporting past-year sexlessness. Among participants (age=18-89years), 15.2% of males and 26.7% of females reported past-year sexlessness while 8.7% of males and 17.5% of females reported no sex for 5years or more. For both genders, past-year sexlessness was most strongly associated with older age and being currently non-married in the multivariable models. Among males, the multivariable analysis also showed that sexlessness was associated with providing less than 20% of the household income (OR 2.27). In female participants, sexlessness was associated with very low income, poor health, lower financial satisfaction, absence of children, and having conservative sexual attitudes (OR 1.46-3.60). For both genders, Black race was associated with a much lower likelihood of sexlessness among currently non-married adults. The purported detrimental impact of sexlessness on self-reported happiness levels was not evident in this large, nationally representative study after adjusting for sociodemographic factors. Sexless Americans reported very similar happiness levels as their sexually active counterparts.

The Intergenerational Transfer of Education Credentials and Health: Evidence from the 2008 General Social Survey-National Death Index.

The educational attainment of a parent is a powerful predictor of children's wellbeing, but little is known about why this is the case. We used the 2008 General Social Survey to explore factors that may explain the relationship between one's father's education and one's own mortality. These include (1) intellectual traits, (2) material wellbeing, (3) psychological characteristics, (4) personality characteristics, and (5) social capital. The education credentials of one's father are significantly associated with one's risk of death. The strongest mediators are own educational attainment, family income, home ownership, and subjective socioeconomic status. To a lesser extent, respondents' happiness with friends and family and social bonding were also pathways. A father's educational attainment appears to influence his children's health, and may do so not only by improving the child's material circumstances but also through his or her educational attainment and other psychological and social characteristics.

Happiness and longevity in the United States

This is the first study to our knowledge to examine the relationship between happiness and longevity among a nationally representative sample of adults. We use the recently-released General Social Survey-National Death Index dataset and Cox proportional hazards models to reveal that overall happiness is related to longer lives among U.S. adults. Indeed, compared to very happy people, the risk of death over the follow-up period is 6% (95% CI 1.01–1.11) higher among individuals who are pretty happy and 14% (95% CI 1.06–1.22) higher among those who are not happy, net of marital status, socioeconomic status, census division, and religious attendance. This study provides support for happiness as a stand-alone indicator of well-being that should be used more widely in social science and health research.

Mortality risks among persons reporting same-sex sexual partners: evidence from the 2008 General Social Survey-National Death Index data set.

We investigated the possibility that men who have sex with men (MSM) and women who have sex with women (WSW) may be at higher risk for early mortality associated with suicide and other sexual orientation-associated health risks. We used data from the 1988-2002 General Social Surveys, with respondents followed up for mortality status as of December 31, 2008. The surveys included 17 886 persons aged 18 years or older, who reported at least 1 lifetime sexual partner. Of these, 853 reported any same-sex partners; 17 033 reported only different-sex partners. Using gender-stratified analyses, we compared these 2 groups for all-cause mortality and HIV-, suicide-, and breast cancer-related mortality. The WSW evidenced greater risk for suicide mortality than presumptively heterosexual women, but there was no evidence of similar sexual orientation-associated risk among men. All-cause mortality did not appear to differ by sexual orientation among either women or men. HIV-related deaths were not elevated among MSM or breast cancer deaths among WSW. The elevated suicide mortality risk observed among WSW partially confirms public health concerns that sexual minorities experience greater burden from suicide-related mortality.

Political party affiliation, political ideology and mortality

BackgroundEcological and cross-sectional studies have indicated that conservative political ideology is associated with better health. Longitudinal analyses of mortality are needed because subjective assessments of ideology may confound subjective assessments...

Cochran and Mays Respond.

Including sexual orientation questions in general population surveys has relatively recent origin.1 But in a short time, their presence has profoundly altered what is known about health disparities affecting lesbians, gay men, bisexuals, and homosexually experienced heterosexuals. Because sexual orientation is a new survey construct, both methodological and conceptual issues related to its assessment bear close scrutiny. Hottes et al. caution us that antigay stigma may reduce disclosure rates and, thus, undercount men who have sex with men (MSM). Indeed, we noted this in our original article underscoring that this effect was especially likely in early waves of the General Social Survey-National Death Index (GSS-NDI).2 We agree that the estimated difference in HIV-related deaths between MSM and heterosexual men is at odds with well-founded expectations and may be attributable to underreporting. Prevalence of HIV-attributable deaths (2.6%; 95% confidence interval [CI] = 2.0%; 3.1% of all deaths), but not suicide-attributable deaths (1.9%; 95% CI = 1.4%, 2.3%), was higher in the GSS-NDI than that observed in the United States in 2006.3 Still, such deaths were rare, and our estimate could be unstable. Hottes et al. also suggest, without explanation, that MSM were undersampled (selection bias); we know of no mechanism by which this could have occurred. The higher suicide attempt rates among MSM, documented in numerous surveys of similar design to the GSS-NDI, do not inevitably lead, as Hottes et al. imply, to higher suicide mortality rates among MSM. Predictors of attempts and deaths differ.4 And the existing evidence, while sparse, contradicts the hypothesis of Hottes et al.: a similar, small study5 also failed to detect sexual orientation differences in suicide mortality in a sample where MSM, as compared with heterosexual men, had evidenced higher suicide attempt rates. Still, we heartily agree that the robustness of our results must be tested. Like many early surveys linking sexual orientation to health outcomes, alternate explanations should be entertained6 until a preponderance of evidence supports unambiguous conclusions. In this regard, the recent decision by the National Health Interview Survey (NHIS)7 to measure only sexual orientation identity (e.g., gay or bisexual) has important implications for our ability to track the health and mortality risks for MSM. Estimates suggest that more than half of MSM identify as heterosexual,8 and scientific evidence9,10 shows that their health issues differ substantially both from gay- or bisexual-identifying men and from exclusively heterosexual men. With this decision, health concerns for MSM will remain hidden in the NHIS, a major health surveillance system used to achieve our nation’s health goals.

Misclassification and Undersampling of Sexual Minorities in Population Surveys.

A letter to the editor is presented in response to the article The General Social Survey-National Death Index: An Innovative New Dataset for Social Scientists by P. Muennig, G. Johnson. J. Kim et al., which appeared in a 2014 issue of Biomed Research Notes.

Religious Affiliation, Religious Service Attendance, and Mortality.

Very few studies have examined the effects of both religious affiliation and religiosity on mortality at the same time, and studies employing multiple dimensions of religiosity other than religious attendance are rare. Using the newly created General Social Survey-National Death Index data, our report contributes to the religion and mortality literature by examining religious affiliation and religiosity at the same time. Compared to Mainline Protestants, Catholics, Jews, and other religious groups have lower risk of death, but Black Protestants, Evangelical Protestants, and even those with no religious affiliation are not different from Mainline Protestants. While our study is consistent with previous findings that religious attendance leads to a reduction in mortality, we did not find other religious measures, such as strength of religious affiliation, frequency of praying, belief in an afterlife, and belief in God to be associated with mortality. We also find interaction effects between religious affiliation and attendance. The lowest mortality of Jews and other religious groups is more apparent for those with lower religious attendance. Thus, our result may emphasize the need for other research to focus on the effects of religious group and religious attendance on mortality at the same time.

Measurement confounding affects the extent to which verbal IQ explains social gradients in mortality

BackgroundIQ is thought to explain social gradients in mortality. IQ scores are based roughly equally on Verbal IQ (VIQ) and Performance IQ tests. VIQ tests, however, are suspected to confound...

Emotion suppression and mortality risk over a 12-year follow-up

ObjectiveSuppression of emotion has long been suspected to have a role in health, but empirical work has yielded mixed findings. We examined the association between emotion suppression and all-cause, cardiovascular, and cancer mortality over 12years of follow-up in a nationally representative US sample. MethodsWe used the 2008 General Social Survey–National Death Index (GSS–NDI) cohort, which included an emotion suppression scale administered to 729 people in 1996. Prospective mortality follow up between 1996 and 2008 of 111 deaths (37 by cardiovascular disease, 34 by cancer) was evaluated using Cox proportional hazards models adjusted for age, gender, education, and minority race/ethnicity. ResultsThe 75th vs. 25th percentile on the emotional suppression score was associated with hazard ratio (HR) of 1.35 (95% Confidence Interval [95% CI]=1.00, 1.82; P=.049) for all-cause mortality. For cancer and cardiovascular disease mortality, the HRs were 1.70 (95% CI=1.01, 2.88, P=.049) and 1.47 (95% CI=.87, 2.47, P=.148) respectively. ConclusionsEmotion suppression may convey risk for earlier death, including death from cancer. Further work is needed to better understand the biopsychosocial mechanisms for this risk, as well as the nature of associations between suppression and different forms of mortality.

Do the psychosocial risks associated with television viewing increase mortality? Evidence from the 2008 General Social Survey–National Death Index dataset

BackgroundTelevision viewing is associated with an increased risk of mortality, which could be caused by a sedentary lifestyle, the content of television programming (e.g., cigarette product placement or stress-inducing content), or both. MethodsWe examined the relationship between self-reported hours of television viewing and mortality risk over 30 years in a representative sample of the American adult population using the 2008 General Social Survey–National Death Index dataset. We also explored the intervening variable effect of various emotional states (e.g., happiness) and beliefs (e.g., trust in government) of the relationship between television viewing and mortality. ResultsWe find that, for each additional hour of viewing, mortality risks increased 4%. Given the mean duration of television viewing in our sample, this amounted to about 1.2 years of life expectancy in the United States. This association was tempered by a number of potential psychosocial mediators, including self-reported measures of happiness, social capital, or confidence in institutions. Although none of these were clinically significant, the combined mediation power was statistically significant (P < .001). ConclusionsTelevision viewing among healthy adults is correlated with premature mortality in a nationally representative sample of U.S. adults, and this association may be partially mediated by programming content related to beliefs or affective states. However, this mediation effect is the result of many small changes in psychosocial states rather than large effects from a few factors.

Gender differences in material, psychological, and social domains of the income gradient in mortality: implications for policy.

We set out to examine the material, psychological, and sociological pathways mediating the income gradient in health and mortality. We used the 2008 General Social Survey-National Death Index dataset (N = 26,870), which contains three decades of social survey data in the US linked to thirty years of mortality follow-up. We grouped a large number of variables into 3 domains: material, psychological, and sociological using factor analysis. We then employed discrete-time hazard models to examine the extent to which these three domains mediated the income-mortality association among men and women. Overall, the gradient was weaker for females than for males. While psychological and material factors explained mortality hazards among females, hazards among males were explained only by social capital. Poor health significantly predicted both income and mortality, particularly among females, suggesting a strong role for reverse causation. We also find that many traditional associations between income and mortality are absent in this dataset, such as perceived social status.

The general social survey-national death index: an innovative new dataset for the social sciences

BackgroundSocial epidemiology seeks in part to understand how social factors--ideas, beliefs, attitudes, actions, and social connections--influence health. However, national health datasets have not kept up with the evolving needs of this cutting-edge area in public health. Sociological datasets that do contain such information, in turn, provide limited health information.FindingsOur team has prospectively linked three decades of General Social Survey data to mortality information through 2008 via the National Death Index. In this paper, we describe the sample, the core elements of the dataset, and analytical considerations.ConclusionsThe General Social Survey-National Death Index (GSS-NDI), to be released publicly in October 2011, will help shape the future of social epidemiology and other frontier areas of public health research.

Henry Brougham and the Scottish methodological tradition

We examined the association between various measures of subjective social class identification (SSCI) and self-rated health as well as survival using the 2014 General Social Survey-National Death Index dataset (n = 21,108). We used multinomial logistic regression models to assess the association between SSCI and self-rated health and used Cox proportional hazards to assess the association between SSCI and survival. All analyses were adjusted for age, year at interview, race, gender, family income, and educational attainment level. The measures of SSCI that we had available were strongly correlated with self-rated health after controlling for objective measures of social status. For example, those who saw themselves as lower class were nine times as likely to self-report poor rather than excellent health status (odds ratio = 8.69; 95% confidence interval = 5.04–14.98) compared with those saw themselves as upper class. However, no such associations were observed for survival. While our alternative measures of SSCI were important predictors of self-rated health, they were not predictive of survival. This suggests that there may be potential confounding between two perceptions: SSCI and self-rated health.