Inequalities In Mortality Research Articles

A collaborator-engaged approach to tailoring strategies for implementing systematic health-related social needs assessment: Results from a cross-center study.

166 Background: Health-related social needs (HRSNs) exacerbate inequities in cancer incidence, morbidity and mortality. To improve health equity, policymakers recommend systematic HRSN screening in oncology clinics. In preliminary studies, we found low rates (<10%) of HRSN screening in oncology. Building upon these findings and transdisciplinary expertise across four Implementation Science Centers in Cancer Control (ISC3), in the current study, we engaged oncology care teams in tailoring site-specific strategies to implement HRSN screening. Methods: Centers varied in collaborator engagement methods, including Context-Driven Co-Design (CD2), which aims to harmonize the intervention (i.e., HRSN screening), context (e.g., oncology clinic), and implementation strategies. First, site leads conducted semi-structured interviews with 8-10 care team members and clinic observations to identify current HRSN assessment processes and opportunities and barriers to systematic HRSN screening. Second, site leads engaged collaborators in one-on-one interviews or, when using CD2, in 3-4 iterative co-design workshops in which they used context assessment data and user-centered design activities (e.g., storyboarding) to prioritize contextual factors, identify necessary adaptations to HRSN screening, and co-design implementation strategies to address salient barriers. Centers met monthly to share knowledge and troubleshoot. Results: Most Centers’ oncology clinics had established informal HRSN screening approaches. Across Centers, collaborators (e.g., providers, nurses, medical assistants, patients) identified similar opportunities (e.g., desire for a standardized approach to HRSN screening; well-functioning clinical teams and physical space). Common challenges included limited familiarity with HRSN screening and documentation tools; lack of standardized screening protocol; and limited awareness of HRSN screening’s purpose. Implementation strategies included pencil-and-paper screening tools; clinic signage regarding HRSN screening’s purpose; training and creation of standardized screening protocol; and a centralized resource for responding to HRSN with adjustment, assistance, alignment, and/or advocacy. Conclusions: Four ISC3 Centers developed multicomponent implementation plans tailored to their oncology clinic. Centers’ varied approaches and timelines presented challenges and opportunities for cross-Center learning. Oncology clinics exhibited substantial overlap in opportunities and challenges in HRSN screening. Much of CD2’s benefits were related to its collaborator-driven approach to implementation strategy development. Next steps include deploying implementation plans and assessing their impact on equitable reach and adoption of HRSN screening and response to identified needs.

Associations Between Infant Formula Exposure, Housing Instability and Postneonatal Mortality Among Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

To quantify infant mortality rates (IMR) using expanded racial categories, and to examine associations between infant formula exposure, housing instability and postneonatal mortality among Minnesota WIC Participants. Births in Minnesota from 2014 through 2019 (n = 404,102) and associated infant death records (n = 2034) were used to calculate neonatal and postneonatal rates using expanded racial categories. Those births that participated in the WIC program (n = 170,011) and their linked death records (n = 853) were analyzed using logistic regression to examine associations between formula exposure, housing instability, and postneonatal death. Postneonatal IMR was more than twice as prevalent among Black (African American) as East African immigrant infants (IMR = 3.9 vs 1.5). After adjustment for confounding (term status and nativity of mother (U.S. vs foreign born), infants exposed to formula by 28days were four times as likely to die in the postneonatal period as those without formula exposure (aOR = 4.0; 95% CI 3.2-4.9). WIC participants who experienced housing instability at birth were 1.7 times as likely to lose an infant in the postneonatal period (28 to 364days of age) as those in stable housing (aOR = 1.7; 95% CI 1.2, 2.4). Disaggregating Black mortality rates revealed inequities in infant mortality among Black families of varied backgrounds. Formula exposure and housing instability are modifiable risk factors associated with postneonatal mortality. Appropriate interventions to reduce barriers to breastfeeding and provide housing stability for vulnerable families could reduce disparities in postneonatal mortality.

Insights on Poverty-based Inequality in Old-age Mortality in India

BackgroundAs the global population ages, understanding the effect of poverty on old-age mortality becomes increasingly important, especially in India, which is undergoing significant demographic and socio-economic changes. Although previous research has established a link between poverty and mortality, there is a critical need for panel studies to investigate this relationship specifically among older adults. This study addresses this gap by using panel data to examine the association between initial poverty status and subsequent mortality among older adults in India. Additionally, it explores the factors contributing to mortality disparities between poor and non-poor older adults.MethodsWe analyzed panel data from two rounds of the India Human Development Survey. The age-sex standardized old-age mortality rates for poor and non-poor older adults were calculated using direct standardization. Mortality disparities were evaluated through bivariate and proportion tests, as well as multivariable logistic regression analyses. The Fairlie decomposition technique was employed to identify factors contributing to these disparities, with sensitivity analyses performed to ensure the robustness of the findings.ResultsThe age-sex standardized old-age mortality rate for the poor was 31.9 per 100 people, with a 1.15 times higher likelihood of mortality [95% CI: (1.04,1.27)] between round-I to round-II compared to non-poor counterparts. Factors such as household wealth (33.6%), social class (17.1%), education (12%), and occupation (4.3%) were significant indicators of the poverty gap in old-age mortality. Surprisingly, chronic diseases, age, and gender negatively affect mortality disparity, while higher mortality in extended families suggests a weakening traditional support system.ConclusionThe findings underscore the importance of addressing ageist attitudes and enhancing social safety nets and affordable healthcare for older adults, who face higher risks of poverty and premature death. The elevated mortality among those in prolonged poverty cycles highlights the need for policymakers to reconsider universal support policies for older individuals. Specifically, if non-poor older adults have longer lifespans, policies centred solely on poor may not effectively address the needs of all older individuals.

Inequality in Mortality and Cardiovascular Risk Among Young, Low-Income, Self-Employed Workers: Nationwide Retrospective Cohort Study.

Self-employment is a significant component of South Korea's labor force; yet, it remains relatively understudied in the context of occupational safety and health. Owing to different guidelines for health checkup participation among economically active individuals, disparities in health maintenance may occur across varying employment statuses. This study aims to address such disparities by comparing the risk of all-cause mortality and comorbidities between the self-employed and employee populations in South Korea, using nationwide data. We sought to provide insights relevant to other countries with similar cultural, social, and economic contexts. This nationwide retrospective study used data from the Korean National Health Insurance Service database. Participants (aged 20-59 y) who maintained the same insurance type (self-employed or employee insurance) for ≥3 years (at least 2008-2010) were recruited for this study and monitored until death or December 2021-whichever occurred first. The primary outcome was all-cause mortality. The secondary outcomes were ischemic heart disease, ischemic stroke, cancer, and hospitalization with a mental illness. Age-standardized cumulative incidence rates were estimated through an indirect method involving 5-unit age standardization. A multivariable Cox proportional hazards model was used to estimate the adjusted hazard ratio (HR) and 95% CI for each sex stratum. Subgroup analyses and an analysis of the effect modification of health checkup participation were also performed. A total of 11,652,716 participants were analyzed (follow-up: median 10.92, IQR 10.92-10.92 y; age: median 42, IQR 35-50 y; male: n=7,975,116, 68.44%); all-cause mortality occurred in 1.27% (99,542/7,851,282) of employees and 3.29% (124,963/3,801,434) of self-employed individuals (P<.001). The 10-year cumulative incidence rates of all-cause mortality differed significantly by employment status (1.1% for employees and 2.8% for self-employed individuals; P<.001). The risk of all-cause mortality was significantly higher among the self-employed individuals when compared with that among employees, especially among female individuals, according to the final model (male: adjusted HR 1.44, 95% CI 1.42-1.45; female: adjusted HR 1.89, 95% CI 1.84-1.94; P<.001). The risk of the secondary outcomes, except all types of malignancies, was significantly higher among the self-employed individuals (all P values were <.001). According to subgroup analyses, this association was prominent in younger individuals with lower incomes who formed a part of the nonparticipation groups. Furthermore, health checkup participation acted as an effect modifier for the association between employment status and all-cause mortality in both sexes (male: relative excess risk due to interaction [RERI] 0.76, 95% CI 0.74-0.79; female: RERI 1.13, 95% CI 1.05-1.21). This study revealed that self-employed individuals face higher risks of all-cause mortality, cardio-cerebrovascular diseases, and mental illnesses when compared to employees. The mortality risk is particularly elevated in younger, lower-income individuals who do not engage in health checkups, with health checkup nonparticipation acting as an effect modifier for this association.

Behavioral risk factors and socioeconomic inequalities in ischemic heart disease mortality in the United States: A causal mediation analysis using record linkage data.

Ischemic heart disease (IHD) is a major cause of death in the United States (US), with marked mortality inequalities. Previous studies have reported inconsistent findings regarding the contributions of behavioral risk factors (BRFs) to socioeconomic inequalities in IHD mortality. To our knowledge, no nationwide study has been conducted on this topic in the US. In this cohort study, we obtained data from the 1997 to 2018 National Health Interview Survey with mortality follow-up until December 31, 2019 from the National Death Index. A total of 524,035 people aged 25 years and older were followed up for 10.3 years on average (SD: 6.1 years), during which 13,256 IHD deaths occurred. Counterfactual-based causal mediation analyses with Cox proportional hazards models were performed to quantify the contributions of 4 BRFs (smoking, alcohol use, physical inactivity, and BMI) to socioeconomic inequalities in IHD mortality. Education was used as the primary indicator for socioeconomic status (SES). Analyses were performed stratified by sex and adjusted for marital status, race and ethnicity, and survey year. In both males and females, clear socioeconomic gradients in IHD mortality were observed, with low- and middle-education people bearing statistically significantly higher risks compared to high-education people. We found statistically significant natural direct effects of SES (HR = 1.16, 95% CI: 1.06, 1.27 in males; HR = 1.28, 95% CI: 1.10, 1.49 in females) on IHD mortality and natural indirect effects through the causal pathways of smoking (HR = 1.18, 95% CI: 1.15, 1.20 in males; HR = 1.11, 95% CI: 1.08, 1.13 in females), physical inactivity (HR = 1.16, 95% CI: 1.14, 1.19 in males; HR = 1.18, 95% CI: 1.15, 1.20 in females), alcohol use (HR = 1.07, 95% CI: 1.06, 1.09 in males; HR = 1.09, 95% CI: 1.08, 1.11 in females), and BMI (HR = 1.03, 95% CI: 1.02, 1.04 in males; HR = 1.03, 95% CI: 1.02, 1.04 in females). Smoking, physical inactivity, alcohol use, and BMI mediated 29% (95% CI, 24%, 35%), 27% (95% CI, 22%, 33%), 12% (95% CI, 10%, 16%), and 5% (95% CI, 4%, 7%) of the inequalities in IHD mortality between low- and high-education males, respectively; the corresponding proportions mediated were 16% (95% CI, 11%, 23%), 26% (95% CI, 20%, 34%), 14% (95% CI, 11%, 19%), and 5% (95% CI, 3%, 7%) in females. Proportions mediated were slightly lower with family income used as the secondary indicator for SES. The main limitation of the methodology is that we could not rule out residual exposure-mediator, exposure-outcome, and mediator-outcome confounding. In this study, BRFs explained more than half of the educational differences in IHD mortality, with some variations by sex. Public health interventions to reduce intermediate risk factors are crucial to reduce the socioeconomic disparities and burden of IHD mortality in the general US population.

Maternal characteristics and infant and child mortality: A cohort study in England linking Census and health data

Child mortality is a common measure of the overall health of society. Maternal characteristics, such as ethnicity and socioeconomic status are known to contribute to inequalities in health and mortality in babies and children. Overall, in the UK babies born to non-white mothers have a higher risk of mortality, and there is also a strong association between deprivation and risk of death. However, population data is currently lacking for England and Wales disentangling the various socioeconomic risk factors which are known to contribute to increased risk. We utilise population level data to assess the association between socioeconomic status, ethnicity, and child mortality. Our cohort consisted of all live singleton births in England and Wales between 2011 and 2016. We linked birth notifications to mothers’ 2011 Census records using NHS number, which provides person-level sociodemographic information. Death registration data was linked to identify all-cause and cause-specific deaths in babies. Babies were followed from date-of-birth for up to 10-years, or date-of-death. We report cumulative incidence of all-cause mortality for a 10-year follow-up for neonatal, infant and child deaths based on maternal socioeconomic and ethnic groups. Cox proportional hazard models are used to estimate hazard ratios for neonatal, infant and child deaths, with both minimally adjusted (maternal age and baby sex) and fully-adjusted models (accounting for other maternal, household and birth characteristics). This presentation will give an overview of our unique linked data sources, the statistical techniques employed, the latest available analytical results, and the emerging implications of the research.

Approaches to Identifying health disparities by ethnicity using linked Australian Census data

BackgroundEthnicity is not collected routinely in Australian health data. Ancestry data is collected in the Census which is now linked to health data. We aimed to develop an approach to using ancestry data to examine health disparities. MethodsAn expert panel was formed with representatives from the Federation of Ethnic Communities’ Councils, Australian Bureau of Statistics (ABS) and researchers. The work was also informed by a community panel and yarning circles led by Aboriginal and Torres Strait Islander academics. We analysed 2016 Census data linked to death registrations for 2016-2021 in 20.9 million people and compared how different approaches to categorising ethnicity impacted on detection of health inequalities between groups. ResultsWe developed the following approach: (1) Recategorise those reporting Australian only or New Zealand only ancestry from the Oceania to the European category; (2) For those reporting two ancestries: prioritise ethnic minority over national identities (e.g. Australian) and for the remainder create multiethnic groups based on the combined ancestries; (3) First analyse data at the maximum level of granularity, but then collapse up granularity where no disparities are identified to simplify results and messaging. Analysis of mortality data demonstrated that these approaches improved identification of ethnic mortality inequalities. DiscussionWe developed a set of principles to use Australian Census Ancestry data to identify health disparities by ethnicity. The recommendations facilitate harnessing valuable Census data to identify important health disparities and better inform future health policy in Australia.

Mortality inequality in Chile

AbstractThis paper analyses trends in mortality inequality in 330 Chilean communes from 1990 to 2010 for different age groups and both genders. Chile had substantial inequalities in local‐level mortality rates in 1990 but by 2010 these disparities had significantly decreased, especially among infants, children and the elderly. The only exception was Chilean men aged 20–39, for whom inequality in mortality remained persistently high. Robust economic growth and targeted health interventions in the 1990s contributed to declining mortality rates and mortality inequality. From 2000 to 2010, efforts to expand safety nets and improve health‐care access continued, with a greater impact on adults aged 49 years and above. Despite these advances, child mortality remains significantly higher than in developed countries, and the increasing number of female suicides in younger age groups represents a concerning trend.

Severe Maternal Morbidity: The Impact of Race on Tricare Beneficiaries.

Maternal morbidity and mortality rates in the United States have increased in the last two decades with a disproportionate impact on women of color. While numerous factors contribute to the inequities in pregnancy-related mortality, access to health insurance is among the most significant. Military Tricare models universal health care access; however, in studies looking at births in military treatment facilities, disparities still exist for women of color. This study analyzed maternal delivery outcomes for all women with Tricare coverage, including deliveries in the civilian sector. We analyzed data from6.2 million births in the Centers for Disease Control (CDC) Wide-ranging Online Data for Epidemiology Research (WONDER) Linked Birth/Infant Death Records for 2017-2019. Data included all-cause morbidity (transfusions, perineal lacerations, uterine rupture, unplanned hysterectomy, and ICU admissions), severe maternal morbidity (SMM) excluding lacerations, and SMM excluding transfusion. Risk ratios were calculated by comparing overall maternal morbidity rates between Tricare, Medicaid, self-pay, and private insurance. In addition, risk ratios were calculated between insurance types stratified by race. In conclusion, there is an increased risk for women identifying as racial minorities for SMM and SMM excluding transfusion. While Tricare coverage seems to decrease the risk, the decrease is not significant and disparities in outcomes persist among women identifying as minorities. The risk of severe maternal morbidity remains elevated for women of color despite access to Tricare health insurance.

Lung cancer mortality trends and disparities: A cross-sectional analysis 1999–2020

BackgroundLung cancer remains a leading cause of morbidity and mortality in the United States. Given the importance of epidemiological insight on lung cancer outcomes as the foundation for targeted interventions, we aimed to examine lung cancer death trends in the United States in the recent 22-year period, exploring demographic disparities and yearly mortality shifts. MethodsMortality information was obtained from the CDC Wide-ranging Online Data for Epidemiologic Research database from the years 1999–2020. Demographic information included age, sex, race or ethnicity, and area of residence. We performed log-linear regression models to assess temporal mortality shifts and calculated average annual percentage change (AAPC) and compared age-adjusted mortality rates (AAMR) across demographic subpopulations. ResultsA total of 3,380,830 lung cancer deaths were identified. The AAMR decreased from 55.4 in 1999-31.8 in 2020 (p<0.001). Males (AAMR 57.6) and non-Hispanic (NH) (AAMR 47.5) populations were disproportionately impacted compared to females (AAMR 36.0) and Hispanic (AAMR 19.1) populations, respectively. NH Black populations had the highest AAMR (48.5) despite an overall reduction in lung cancer deaths (AAPC −3.3 %) over the study period. Although non-metropolitan regions were affected by higher mortality rates, the annual decrease in mortality among metropolitan regions (AAPC −2.8 %, p<0.001) was greater compared to non-metropolitan regions (AAPC −1.7 %, p<0.001). Individuals living in the Western US (AAPC −3.4 %, p<0.001) experienced the greatest decline in lung cancer mortality compared to other US census regions. ConclusionsOur findings revealed lung cancer mortality inequalities in the US. By contextualizing these mortality shifts, we provide a larger framework of data-driven initiatives for societal and health policy changes for improving access to care, minimizing healthcare inequalities, and improving outcomes.

Regional inequalities in excess mortality and its community determinants during the early COVID-19 pandemic in South Korea

BackgroundExcess mortality during the COVID-19 pandemic provides a comprehensive measure of disease burden, and its local variation highlights regional health inequalities. We investigated local excess mortality in 2020 and its...

The physical health and premature mortality of Indigenous Māori following first-episode psychosis diagnosis: A 15-year follow-up study.

People experiencing psychosis are at greater risk of physical health conditions and premature mortality. It is likely that Indigenous Māori youth, who experience additional systemic inequities caused by settler-colonisation, face even greater physical health and mortality risks following a diagnosis of first-episode psychosis. Compare Māori and non-Māori for risk of hospitalisation and mortality for up to 15 years following first-episode psychosis diagnosis. A cohort (N = 14,122) of young people (16-24 years) with first-episode psychosis diagnosis between 2001 and 2019 were identified. Using crude Kaplan-Meier and adjusted Cox proportional hazards models, Māori (n = 5211) and non-Māori (n = 8911) were compared on hospitalisation and mortality outcomes for up to 15 years. In the 15 years following first-episode psychosis diagnosis, Māori had higher adjusted risk of all-cause mortality (hazard ratio = 1.21, 95% confidence interval = [1.01, 1.45]), hospitalisation with diabetes (hazard ratio = 1.44, 95% confidence interval = [1.15, 1.79]), injury/poisoning (hazard ratio = 1.11, 95% confidence interval = [1.05, 1.16]), general physical health conditions (hazard ratio = 1.07, 95% confidence interval = [1.02, 1.13]) and also appeared to be at greater risk of cardiovascular hospitalisations (hazard ratio = 1.34, 95% confidence interval = [0.97, 1.86]). Kaplan-Meier plots show hospitalisation and mortality inequities emerging approximately 4-7 years following first-episode psychosis diagnosis. Māori are at greater risk for hospitalisation and premature mortality outcomes following first-episode psychosis. Early screening and intervention, facilitated by culturally safe health service delivery, is needed to target these inequities early.

COVID-19 mortality: educational inequalities and socio-spatial context in two provinces of Argentina.

Motivation for the study. There are very few studies on the educational inequalities in COVID-19 mortality, taking into account social contextual factors. Main findings. We found educational inequalities of COVID-19 mortality during both the 2020 and 2021 waves, regardless of the level of poverty and urbanization in the departments of Mendoza and San Juan provinces (Argentina). Implications. Preventive policies should focus not only in areas with high levels of poverty, but also in areas with adults of low educational level. With the aim of describing the association between sociodemographic characteristics and contextual factors with COVID-19 mortality during 2020-2021 in the provinces of Mendoza and San Juan in Argentina, we conducted an ecological study, which included the sociodemographic factors: age, sex and educational level, and the contextual factors: poverty and urbanization at the departmental level. The analyses were estimated using negative binomial Bayesian hierarchical models. Educational inequalities existed regardless of socioeconomic context and level of urbanization. The exception was the age group 65 years and older during 2021, which, regardless of educational level, showed a higher risk of death by COVID-19 in departments with high levels of structural poverty. In conclusion, educational inequality is an indicator of social inequality that increases vulnerability to COVID-19 mortality.

Life expectancy and geographic variation in mortality: an observational comparison study of six high-income Anglophone countries

ObjectiveTo compare life expectancy levels and within-country geographic variation in life expectancy across six high-income Anglophone countries between 1990 and 2018.DesignDemographic analysis using aggregated mortality data.SettingSix high-income Anglophone countries (USA,...

Trends in educational inequalities in smoking-attributable mortality and their impact on changes in general mortality inequalities: evidence from England and Wales, Finland, and Italy (Turin)

BackgroundSocioeconomic mortality inequalities are persistent in Europe but have been changing over time. Smoking is a known contributor to inequality levels, but knowledge about its impact on time trends in...

Study protocol: a mixed-methods study of the implementation of doula care to address racial health equity in six state Medicaid programs

BackgroundRacial inequities in severe maternal morbidity (SMM) and mortality constitute a public health crisis in the United States. Doula care, defined as care from birth workers who provide culturally appropriate, non-clinical support during pregnancy and postpartum, has been proposed as an intervention to help disrupt obstetric racism as a driver of adverse pregnancy outcomes in Black and other birthing persons of colour. Many state Medicaid programs are implementing doula programs to address the continued increase in SMM and mortality. Medicaid programs are poised to play a major role in addressing the needs of these populations with the goal of closing the racial gaps in SMM and mortality. This study will investigate the most effective ways that Medicaid programs can implement doula care to improve racial health equity.MethodsWe describe the protocol for a mixed-methods study to understand how variation in implementation of doula programs in Medicaid may affect racial equity in pregnancy and postpartum health. Primary study outcomes include SMM, person-reported measures of respectful obstetric care, and receipt of evidence-based care for chronic conditions that are the primary causes of postpartum mortality (cardiovascular, mental health, and substance use conditions). Our research team includes doulas, university-based investigators, and Medicaid participants from six sites (Kentucky, Maryland, Michigan, Pennsylvania, South Carolina and Virginia) in the Medicaid Outcomes Distributed Research Network (MODRN). Study data will include policy analysis of doula program implementation, longitudinal data from a cohort of doulas, cross-sectional data from Medicaid beneficiaries, and Medicaid healthcare administrative data. Qualitative analysis will examine doula and beneficiary experiences with healthcare systems and Medicaid policies. Quantitative analyses (stratified by race groups) will use matching techniques to estimate the impact of using doula care on postpartum health outcomes, and will use time-series analyses to estimate the average treatment effect of doula programs on population postpartum health outcomes.DiscussionFindings will facilitate learning opportunities among Medicaid programs, doulas and Medicaid beneficiaries. Ultimately, we seek to understand the implementation and integration of doula care programs into Medicaid and how these processes may affect racial health equity.Study registration The study is registered with the Open Science Foundation (https://doi.org/10.17605/OSF.IO/NXZUF).

Occupational inequalities in mortality from cardiovascular disease, 2020-2021.

In recent years previous declines in cardiovascular disease (CVD) have stalled. There are occupational risk factors for CVD mortality. This study seeks to examine inequalities in CVD mortality for working-age adults in the United States by occupation. Death certificate data for CVD deaths were obtained from the National Center for Health Statistics. Occupation data from these death certificates were coded to major occupation groups. Using information about the number of workers employed in these occupations obtained from the American Community Survey, we calculated mortality rates and rate ratios (RRs), adjusted for covariates associated with CVD mortality. After adjusting for age, sex, race/ethnicity, and educational attainment, workers in 11 occupations had significantly elevated RRs: food preparation and serving; construction and extraction; arts, design, entertainment, sports, and media; life, physical, and social science; farming, fishing, and forestry; legal; protective services; building and grounds cleaning and maintenance; healthcare practitioners and technical; personal care and service; and community and social services. Occupation appears to be a significant predictor of CVD mortality. Further research is needed to assess how occupational risk factors contribute to changing trends for CVD mortality. Interventions are needed to address workplace risk factors for CVD.

Epigenetic Aging and Racialized, Economic, and Environmental Injustice

Epigenetic age acceleration is associated with exposure to social and economic adversity and may increase the risk of premature morbidity and mortality. However, no studies have included measures of structural racism, and few have compared estimates within or across the first and second generation of epigenetic clocks. To determine whether epigenetic age acceleration is positively associated with exposures to diverse measures of racialized, economic, and environmental injustice measured at different levels and time periods. This cross-sectional study used data from the My Body My Story (MBMS) study between August 8, 2008, and December 31, 2010, and examination 5 of the Multi-Ethnic Atherosclerosis Study (MESA) from April 1, 2010, to February 29, 2012. In the MBMS, DNA extraction was performed in 2021; linkage of structural measures to the MBMS and MESA, in 2022. US-born individuals were randomly selected from 4 community health centers in Boston, Massachusetts (MBMS), and 4 field sites in Baltimore, Maryland; Forsyth County, North Carolina; New York City, New York; and St Paul, Minnesota (MESA). Data were analyzed from November 13, 2021, to August 31, 2023. Ten epigenetic clocks (6 first-generation and 4 second-generation), computed using DNA methylation data (DNAm) from blood spots (MBMS) and purified monocytes (MESA). The US-born study population included 293 MBMS participants (109 men [37.2%], 184 women [62.8%]; mean [SD] age, 49.0 [8.0] years) with 224 Black non-Hispanic and 69 White non-Hispanic participants and 975 MESA participants (492 men [50.5%], 483 women [49.5%]; mean [SD] age, 70.0 [9.3] years) with 229 Black non-Hispanic, 191 Hispanic, and 555 White non-Hispanic participants. Of these, 140 (11.0%) exhibited accelerated aging for all 5 clocks whose estimates are interpretable on the age (years) scale. Among Black non-Hispanic MBMS participants, epigenetic age acceleration was associated with being born in a Jim Crow state by 0.14 (95% CI, 0.003-0.27) SDs and with birth state conservatism by 0.06 (95% CI, 0.01-0.12) SDs, pooling across all clocks. Low parental educational level was associated with epigenetic age acceleration, pooling across all clocks, for both Black non-Hispanic (0.24 [95% CI, 0.08-0.39] SDs) and White non-Hispanic (0.27 [95% CI, 0.03-0.51] SDs) MBMS participants. Adult impoverishment was positively associated with the pooled second-generation clocks among the MESA participants (Black non-Hispanic, 0.06 [95% CI, 0.01-0.12] SDs; Hispanic, 0.07 [95% CI, 0.01-0.14] SDs; White non-Hispanic, 0.05 [95% CI, 0.01-0.08] SDs). The findings of this cross-sectional study of MBMS and MESA participants suggest that epigenetic age acceleration was associated with racialized and economic injustice, potentially contributing to well-documented inequities in premature mortality. Future research should test the hypothesis that epigenetic accelerated aging may be one of the biological mechanisms underlying the well-documented elevated risk of premature morbidity and mortality among social groups subjected to racialized and economic injustice.

Levels, trends and inequalities in mortality among 5-19-year-olds in Tanzania: Magu Health and Demographic Surveillance Study (1995-2022).

For the past two decades, health priorities in Tanzania have focussed on children under-five, leaving behind the older children and adolescents (5-19 years). Understanding mortality patterns beyond 5 years is important in bridging a healthy gap between childhood to adulthood. We aimed to estimate mortality levels, trends, and inequalities among 5-19-year-olds using population data from the Magu Health and Demographic Surveillance Site (HDSS) in Tanzania and further compare the population level estimates with global estimates. Using data from the Magu HDSS from 1995 to 2022, from Kaplan Meir survival probabilities, we computed annual mortality probabilities for ages 5-9, 10-14 and 15-19 and determined the average annual rate of change in mortality by fitting the variance weighted least square regression on annual mortality probabilities. We compared 5-19 trends with younger children aged 1-4 years. We further disaggregated mortality by sex, area of residence and wealth tertiles, and we computed age-stratified risk ratios with respective 95% confidence intervals (CIs) using Cox proportional hazard model to determine inequalities. We further compared population-level estimates in all-cause mortality with global estimates from the United Nations Inter-agency Group for Child Mortality Estimation and the Global Burden of Disease study by computing the relative differences to the estimates. Mortality declined steadily among the three age groups from 1995 to 2022, whereby the average annual rate of decline increased with age (2.2%, 2.7%, and 2.9% for 5-9-, 10-14-, and 15-19-year-old age groups, respectively). The pace of this decline was lower than that of younger children aged 1-4 years (4.8% decline). We observed significant mortality inequalities with boys, those residing in rural areas, and those from poorest wealth tertiles lagging behind. While Magu estimates were close to global estimates for the 5-9-year-old age group, we observed divergent results for adolescents (10-19 years), with Magu estimates lying between the global estimates. The pace of mortality decline was lower for the 5-19-year-old age group compared to younger children, with observable inequalities by socio-demographic characteristics. Determining the burden of disease across different strata is important in the development of evidence-based targeted interventions to address the mortality burden and inequalities in this age group, as it is an important transition period to adulthood.

Cross-sectional Average Length of Life Entropy (HCAL\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\mathcal{H}}_{\ ext{CAL}}$$\\end{document}): International Comparisons and Decompositions

Keyfitz and Leser’s life table entropy was proposed to serve as a relative inequality in mortality measure. Entropy considers the variation around the age at death relative to the length of lifespan in a population, allowing comparisons across time and populations. It is used widely in period and cohort applications. Here, we propose extending this measure and present an index that incorporates the history of survival of all cohorts present at a given time, namely the cross-sectional average length of life entropy, or CAL-entropy (HCAL\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\mathcal{H}}_{\ ext{CAL}}$$\\end{document}). We decompose cross-population differences of CAL-entropy into the contribution of longevity and lifespan variation, and the change of those differences across time. Our illustrations show that populations are converging regarding lifespan inequality. Lifespan variation holds a noticeable share in the CAL-entropy gap among selected European populations. Longevity held once a pronounced share in CAL-entropy differences and their change, but its influence has receded over the years. The US demonstrates a unique trend where it performs worse across time compared to the selected European populations, and lifespan variation has played a major role in this process. This study signals the importance of lifespan variation in reducing inequality in mortality among developed and longevous populations.