Interview Survey Linked Mortality Files Research Articles

Economic Conditions in Early Life and Circulatory Disease Mortality

AbstractI test the Developmental Origins of Health and Disease hypothesis using a cohort perspective on mortality. I combine data from the National Health Interview Survey Linked Mortality Files, 1986–2006, and U.S. economic data between 1902 and 1956 (403,746 respondents and 39,439 deaths), to estimate how exposures to adverse economic conditions in utero and during the first three years of life affect circulatory disease mortality risk in adulthood. I also examine cohort‐based variation in these associations. Findings suggest that in utero exposures to poor economic conditions increased risk of death from circulatory diseases. Results are consistent with theory and evidence suggesting that developmental processes early in life are strongly associated with circulatory disease susceptibility in older adulthood. However, findings indicate that the mortality effects of these early‐life exposures have likely weakened across birth cohorts.

Trends in cause-specific mortality among adults with and without diagnosed diabetes in the USA: an epidemiological analysis of linked national survey and vital statistics data

Large reductions in diabetes complications have altered diabetes-related morbidity in the USA. It is unclear whether similar trends have occurred in causes of death. Using data from the National Health Interview Survey Linked Mortality files from 1985 to 2015, we estimated age-specific death rates and proportional mortality from all causes, vascular causes, cancers, and non-vascular, non-cancer causes among US adults by diabetes status. From 1988-94, to 2010-15, all-cause death rates declined by 20% every 10 years among US adults with diabetes (from 23·1 [95% CI 20·1-26·0] to 15·2 [14·6-15·8] per 1000 person-years), while death from vascular causes decreased 32% every 10 years (from 11·0 [9·2-12·2] to 5·2 [4·8-5·6] per 1000 person-years), deaths from cancers decreased 16% every 10 years (from 4·4 [3·2-5·5] to 3·0 [2·8-3·3] per 1000 person-years), and the rate of non-vascular, non-cancer deaths declined by 8% every 10 years (from 7·7 [6·3-9·2] to 7·1 [6·6-7·5]). Death rates also declined significantly among people without diagnosed diabetes for all four major mortality categories. However, the declines in death rates were significantly greater among people with diabetes for all-causes (pinteraction<0·0001), vascular causes (pinteraction=0·0214), and non-vascular, non-cancer causes (pinteration<0·0001), as differences in all-cause and vascular disease death between people with and without diabetes were reduced by about a half. Among people with diabetes, all-cause mortality rates declined most in men and adults aged 65-74 years of age, and there was no decline in death rates among adults aged 20-44 years. The different magnitude of changes in cause-specific mortality led to large changes in the proportional mortality. The proportion of total deaths among adults with diabetes from vascular causes declined from 47·8% (95% CI 38·9-58·8) in 1988-94 to 34·1% (31·4-37·1) in 2010-15; this decline was offset by large increases in the proportion of deaths from non-vascular, non-cancer causes, from 33·5% (26·7-42·1) to 46·5% (43·3-50·0). The proportion of deaths caused by cancer was relatively stable over time, ranging from 16% to 20%. Declining rates of vascular disease mortality are leading to a diversification of forms of diabetes-related mortality with implications for clinical management, prevention, and disease monitoring. None.

Mortality Among Veterans and Non-veterans: Does Type of Health Care Coverage Matter?

Recent studies examine veteran status differences in mortality, but none consider heterogeneity in military-veteran health care coverage. We use data from the 1997–2009 (2011) National Health Interview Survey-Linked Mortality Files (N = 624,610) to estimate Cox regression models of the association between veteran status and mortality taking into account the type of military-veteran health care coverage and sex/gender. Descriptive analyses provide further evidence that veterans who only use Veterans Affairs (VA) health care services are a distinctly disadvantaged subpopulation with substantially increased mortality risk. Results from multivariate analyses confirm a veteran mortality disadvantage, reveal that this disadvantage varies by type of military-veteran health coverage, and demonstrate that the disadvantage is largely but not totally explained by demographic, socioeconomic, and health status differences between groups. Results further indicate that the veteran mortality disadvantage is most pronounced among male veterans who only use VA health care or who have no military-veteran health coverage, respectively, relative to male non-veterans with no military-veteran health care coverage. There is a mortality disadvantage among female veterans who have no military-veteran health care coverage, and a mortality advantage among female non-veterans with military-veteran health care coverage, relative to female non-veterans with no military-veteran health care. Based on these findings, we argue that in order to fully understand veteran status differences in morbidity and mortality, future studies must move beyond the analysis of veteran- and VA-only samples, and should take into account variable connections of subpopulations to the military, resultant differences in types of health care coverage, and sex/gender.

Muscle-strengthening and aerobic activities and mortality among 3+ year cancer survivors in the U.S.

This study examined the association between adherence to American College of Sports Medicine and American Cancer Society guidelines on aerobic and muscle-strengthening activities and mortality risks among 3+ year cancer survivors in the U.S. The observational study was based on 1999-2009 National Health Interview Survey Linked Mortality Files with follow-up through 2011. After applying exclusion criteria, there were 13,997 observations. The hazard ratios (HRs) for meeting recommendations on muscle-strengthening activities only, on aerobic activities only, and on both types of physical activity (i.e., adhering to complete guidelines) were calculated using a reference group of cancer survivors engaging in neither. Unadjusted and adjusted HRs of all-cause, cancer-specific, and cardiovascular disease-specific mortalities were estimated using Cox proportional hazards models. In all models, compared to the reference group, cancer survivors adhering to complete guidelines had significantly decreased all-cause, cancer-specific, and cardiovascular disease-specific mortalities (HRs ranged from 0.37 to 0.64, p's < 0.05). There were no statistically significant differences between hazard rates of cancer survivors engaging in recommended levels of muscle-strengthening activities only and the reference group (HRs ranged from 0.76 to 0.94, p's > 0.05). Wald test statistics suggested a significant dose-response relationship between levels of adherence to complete guidelines and cancer-specific mortality. While muscle-strengthening activities by themselves do not appear to reduce mortality risks, such activities may provide added cancer-specific survival benefits to 3+ year cancer survivors who are already aerobically active.

Racial/Ethnic Differences in Early-Life Mortality in the United States

U.S. early-life (ages 1–24) deaths are tragic, far too common, and largely preventable. Yet demographers have focused scant attention on U.S. early-life mortality patterns, particularly as they vary across racial and ethnic groups. We employed the restricted-use 1999–2011 National Health Interview Survey–Linked Mortality Files and hazard models to examine racial/ethnic differences in early-life mortality. Our results reveal that these disparities are large, strongly related to differences in parental socioeconomic status, and expressed through different causes of death. Compared to non-Hispanic whites, non-Hispanic blacks experience 60 percent and Mexican Americans 32 percent higher risk of death over the follow-up period, with demographic controls. Our finding that Mexican Americans experience higher early-life mortality risk than non-Hispanic whites differs from much of the literature on adult mortality. We also show that these racial/ethnic differences attenuate with controls for family structure and especially with measures of socioeconomic status. For example, higher mortality risk among Mexican Americans than among non-Hispanic whites is no longer significant once we controlled for mother’s education or family income. Our results strongly suggest that eliminating socioeconomic gaps across groups is the key to enhanced survival for children and adolescents in racial/ethnic minority groups.

The Intellectual Disability Mortality Disadvantage: Diminishing With Age?

On average, adults with intellectual disability (ID) have higher mortality risk than their peers in the general population. However, the effect of age on this mortality disadvantage has received minimal attention. Using data from the 1986-2011 National Health Interview Survey-Linked Mortality Files (NHIS-LMF), discrete time hazard models were used to compare mortality risk for adults with and without ID by age and gender. Increased mortality risk was present for all adults with ID, but was most pronounced among younger age females. The mortality differential between those with and without ID diminished with increased age for both females and males. Findings support the argument that heterogeneity of frailty may explain differences in mortality risk between those with and without ID.

The effect of race and birth cohort on the veteran mortality differential

Research on veteran versus nonveteran mortality outcomes provides contrary results, with some studies reporting a veteran mortality advantage while others report a veteran mortality disadvantage. Life course scholars suggest these conflicting results may be explained by a crossover in the veteran-nonveteran mortality differential, with veterans having a mortality advantage during early and midlife and a mortality disadvantage during older age. We conducted discrete time hazard analysis of a veteran-nonveteran mortality crossover among black and white men in the United States by birth cohort using data from the 1986–2009(2011) National Health Interview Survey-Linked Mortality Files. Among men who turned age 18 during non-war eras, veterans had an early to midlife mortality advantage and later life mortality disadvantage, with differences more pronounced among black men. However, differences between veteran and nonveteran mortality risk were not significant among the majority of men who turned age 18 during war eras. Findings clarify that the mortality related benefits of military service may only apply to veterans who came of age during non-war eras. Furthermore, results suggest that military service may provide a greater mortality benefit to black veterans than white veterans.

A comprehensive analysis of the mortality experience of hispanic subgroups in the United States: Variation by age, country of origin, and nativity

Although those identifying as “Hispanic or Latino” experience lower adult mortality than the more socioeconomically advantaged non-Hispanic white population, the ethnic category Hispanic conceals variation by country of origin, nativity, age, and immigration experience. The current analysis examines adult mortality differentials among 12 Hispanic subgroups by region of origin and nativity, and non-Hispanic whites, adjusting for socioeconomic and demographic characteristics. We use the National Health Interview Survey Linked Mortality Files pooled 1990–2009 to obtain sufficient sample of each subgroup to calculate mortality estimates by sex and age group (25–64, 65+). Among adults aged 65 and over, all foreign born subgroups have an advantage over non-Hispanic whites, and many USB subgroups exhibit an advantage in the adjusted model. Foreign-born Dominicans, Central/South Americans, and other Hispanics exhibit consistent advantages across models for both men and women, aged 25–64 and 65 and over, and both unadjusted and adjusted for socioeconomic covariates. Both US-born and foreign-born Mexicans between ages 25 and 64 have mortality disadvantaged relative to non-Hispanic whites, while older Mexicans exhibit clear advantages. Our results complicate the traditional formulation of the Hispanic Paradox and cast doubt on the singularity of the mortality experience of those of Hispanic origin.

Regional variation in the predictive validity of self-rated health for mortality

Self-rated health (SRH) is a commonly used measure for assessing general health in surveys in the United States. However, individuals from different parts of the United States may vary in how they assess their health. Geographic differences in health care access and in the prevalence of illnesses may make it difficult to discern true regional differences in health when using SRH as a health measure. In this article, we use data from the 1986 and 1989–2006 National Health Interview Survey Linked Mortality Files and estimate Cox regression models to examine whether the relationship between SRH and five-year all-cause mortality differs by Census region. Contrary to hypotheses, there is no evidence of regional variation in the predictive validity of SRH for mortality. At all levels of SRH, and for both non-Hispanic white and non-Hispanic black respondents, SRH is equally and strongly associated with five-year mortality across regions. Our results suggest that differences in SRH across regions are not solely due to differences in how respondents assess their health across regions, but reflect true differences in health. Future research can, therefore, employ this common measure to investigate the geographic patterning of health in the United States.

Alcohol's Collateral Damage: Childhood Exposure to Problem Drinkers and Subsequent Adult Mortality Risk.

The importance of childhood circumstances, broadly defined, for shaping adult health and longevity is well-established. But the significance of one of the most prevalent childhood adversities-exposure to problem drinkers-has been understudied from a sociological perspective and remains poorly understood. We address this gap by drawing on cumulative inequality theory, using data from the 1988-2011 National Health Interview Survey-Linked Mortality Files, and estimating Cox proportional hazards models to examine the relationship between exposure to problem drinkers in childhood and adult mortality risk. Childhood exposure to problem drinkers is common (nearly 1 in 5 individuals were exposed) and elevates adult overall and cause-specific mortality risk. Compared to individuals who had not lived with a problem drinker during childhood, those who had done so suffered 17 percent higher risk of death (p<.001) over the follow-up period, net of age, sex, and race/ethnicity. We find compelling evidence that the duration, source, and intensity of exposure to problem drinkers in childhood contributes to inequality in adult mortality risk. Favorable socioeconomic status in adulthood does not ameliorate the consequences of childhood exposure to problem drinkers. The primary intervening mechanisms are risky behaviors, including adult drinking and smoking. The findings-which reveal that the influence of problem drinking is far-reaching and long-term-should inform policies to improve childhood circumstances, reduce detrimental effects of problem drinking, and increase life expectancy.

The Benefits of Educational Attainment for U.S. Adult Mortality: Are they Contingent on the Broader Environment?

The growing recognition that educational attainment is one of the strongest preventive factors for adult health and longevity has fueled an interest in educational attainment as a population health strategy. However, less attention has been given to identifying social, economic, and behavioral resources that may moderate the health and longevity benefits of education. We draw on theories of resource substitution and multiplication to examine the extent to which the education–mortality association is contingent on other resources (marriage, employment, income, healthy lifestyles). We use data on adults aged 30–84 in the 1997–2006 National Health Interview Survey Linked Mortality File and estimate discrete-time event history models stratified by gender (N = 146,558; deaths = 10,399). We find that the mortality benefits of education are generally largest for adults—especially women—who have other resources such as employment and marriage, supporting the theory of resource multiplication. Nonetheless, our results also imply that other resources can potentially attenuate the mortality disadvantages (advantages) associated with low (high) levels of education. The findings suggest that efforts to improve population health and longevity by raising education levels should be augmented with strategies that assure widespread access to social, economic, and behavioral resources.

Examination of Age Variations in the Predictive Validity of Self-Rated Health.

The high predictive validity of self-rated health (SRH) is a major strength of this widely used population health measure. Recent studies, however, noted that the predictive validity varies across population subgroups. The aim of this study is to examine respondents' age as a moderator of SRH predictive validity with respect to subsequent mortality risk. Using data from the National Health Interview Survey-Linked Mortality Files (NHIS-LMF) 1986-2006, we estimate Cox proportional hazard models of all-cause and cause-specific mortality for adults aged 45-84 years as a function of their health ratings (N = 574,008). The data show significant age moderation of the predictive validity of SRH across all levels of ratings: the hazard ratios for mortality decline by about a half between the ages of 50 and 80 years. This attenuation appears primarily among earlier birth cohorts; there is no significant age attenuation in more recent cohorts-however, this may be in part attributed to the earlier ages when the respondents are observed. The findings of declining predictive validity of SRH across age imply that individuals may evaluate their health differently as they age. The results also suggest caution in using SRH to capture age-related health changes in the older population.

Negative Acculturation and Nothing More? Cumulative Disadvantage and Mortality during the Immigrant Adaptation Process among Latinos in the United States.

Foreign- and U.S.-born Hispanic health deteriorates with increasing exposure and acculturation to mainstream U.S. society. Because these associations are robust to (static) socioeconomic controls, negative acculturation has become their primary explanation. This overemphasis, however, has neglected important alternative structural explanations. Examining Hispanic mortality using the 1998–2006 U.S. National Health Interview Survey-Linked Mortality File according to nativity, immigrant adaptation measures, and health behaviors, this study presents indirect but compelling evidence that suggests negative acculturation is not the only or main explanation for this deterioration.

Suicide in the City: Do Characteristics of Place Really Influence Risk?

This article investigates the role of social context on individual suicide mortality with attention paid to the possibility that contextual effects are simply the sum of individual characteristics associated with suicide. We use restricted data from the 1986-2006 National Health Interview Survey-Linked Mortality Files, which include nearly one million records and 1,300 suicides, to examine the role of familial and socioeconomic context on adult suicide. Results show that adults living in cities with more socioeconomic disadvantage and fewer families living together have higher odds of suicidal death than adults living in less disadvantaged cities and cities with more families living together, respectively, after controlling for individual-level socioeconomic status, marital status, and family size. The findings support classic sociological arguments that the risk of suicide is indeed influenced by the social milieu and cannot simply be explained by the aggregation of individual characteristics.

Drinking problems and mortality risk in the United States

ObjectiveWe examine the links between 41 problems related to alcohol consumption and the risk of death among adults in the United States. MethodWe use Cox proportional hazards models and data from the nationally representative prospective National Health Interview Survey-Linked Mortality Files (NHIS-LMF). ResultsDrinking problems are relatively common among moderate and heavy drinkers and these problems are associated with increases in the risk of death. The strongest associations between problem drinking and mortality involved cases in which physicians, family members, or friends intervened to suggest reduced drinking. Losing one's job because of drinking problems within their lifetime (HR=1.36, 95% confidence interval [CI]: 1.11, 1.65) was strongly linked to mortality risk. Social risks were equally or more strongly linked to mortality than physiological consequences of alcohol abuse such as lifetime reports of needing a drink to stop shaking or getting sick (HR=1.23, 95% CI: 1.09, 1.40). Most importantly, these associations were evident despite statistical controls for alcohol consumption levels and demographic, social, economic, behavioral, health, and geographic factors. ConclusionsOur results highlight the independent and additive effects of alcohol-related problems and alcohol consumption levels on the risk of death. We recommend that studies examining the mortality risks of alcohol consumption take into account drinking status and also specific drinking-related problems, paying particular attention to social problems related to alcohol use or abuse.

Estimating survival probabilities by exposure levels: utilizing vital statistics and complex survey data with mortality follow-up.

We present a two-step approach for estimating hazard rates and, consequently, survival probabilities, by levels of general categorical exposure. The resulting estimator utilizes three sources of data: vital statistics data and census data are used at the first step to estimate the overall hazard rate for a given combination of gender and age group, and cohort data constructed from a nationally representative complex survey with linked mortality records, are used at the second step to divide the overall hazard rate by exposure levels. We present an explicit expression for the resulting estimator and consider two methods for variance estimation that account for complex multistage sample design: (1) the leaving-one-out jackknife method, and (2) the Taylor linearization method, which provides an analytic formula for the variance estimator. The methods are illustrated with smoking and all-cause mortality data from the US National Health Interview Survey Linked Mortality Files, and the proposed estimator is compared with a previously studied crude hazard rate estimator that uses survey data only. The advantages of a two-step approach and possible extensions of the proposed estimator are discussed.

Hispanic older adult mortality in the United States: new estimates and an assessment of factors shaping the Hispanic paradox.

Hispanics make up a rapidly growing proportion of the U.S. older adult population, so a firm grasp of their mortality patterns is paramount for identifying racial/ethnic differences in life chances in the population as a whole. Documentation of Hispanic mortality is also essential for assessing whether the Hispanic paradox--the similarity in death rates between Hispanics and non-Hispanic whites despite Hispanics' socioeconomic disadvantage--characterizes all adult Hispanics or just some age, gender, nativity, or national-origin subgroups. We estimate age-/sex- and cause-specific mortality rate ratios and life expectancy for foreign-born and U.S.-born Hispanics, foreign-born and U.S.-born Mexican Americans, non-Hispanic blacks, and non-Hispanic whites ages 65 and older using the 1989-2006 National Health Interview Survey Linked Mortality Files. Results affirm that Hispanic mortality estimates are favorable relative to those of blacks and whites, but particularly so for foreign-born Hispanics and smoking-related causes. However, if not for Hispanics' socioeconomic disadvantage, their mortality levels would be even more favorable.

Work-Family Context and the Longevity Disadvantage of US Women.

Female life expectancy is currently shorter in the United States than in most high-income countries. This study examines work-family context as a potential explanation. While work-family context changed similarly across high-income countries during the past half century, the United States has not implemented institutional supports, such as universally available childcare and family leave, to help Americans contend with these changes. We compare the United States to Finland—a country with similar trends in work-family life but generous institutional supports—and test two hypotheses to explain US women's longevity disadvantage: (1) US women may be less likely than Finnish women to combine employment with childrearing; and (2) US women's longevity may benefit less than Finnish women's longevity from combining employment with childrearing. We used data from women aged 30–60 years during 1988–2006 in the US National Health Interview Survey Linked Mortality File and harmonized it with data from Finnish national registers. We found stronger support for hypothesis 1, especially among low-educated women. Contrary to hypothesis 2, combining employment and childrearing was not less beneficial for US women's longevity. In a simulation exercise, more than 75 percent of US women's longevity disadvantage was eliminated by raising their employment levels to Finnish levels and reducing mortality rates of non-married/non-employed US women to Finnish rates.

Trends in education gradients of ‘preventable’ mortality: A test of fundamental cause theory

Fundamental cause theory explains persisting associations between socioeconomic status and mortality in terms of personal resources such as knowledge, money, power, prestige, and social connections, as well as disparate social contexts related to these resources. We review evidence concerning fundamental cause theory and test three central claims using the National Health Interview Survey Linked Mortality Files 1986–2004. We then examine cohort-based variation in the associations between a fundamental social cause of disease, educational attainment, and mortality rates from heart disease, other “preventable” causes of death, and less preventable causes of death. We further explore race/ethnic and gender variation in these associations. Overall, findings are consistent with nearly all features of fundamental cause theory. Results show, first, larger education gradients in mortality risk for causes of death that are under greater human control than for less preventable causes of death, and, second, that these gradients grew more rapidly across successive cohorts than gradients for less preventable causes. Results also show that relative sizes and cohort-based changes in the education gradients vary substantially by race/ethnicity and gender.

Lifetime abstainers and mortality risk in the United States

We examine variability in mortality risk among heterogeneous nondrinking statuses. We employ Cox proportional hazard models and the United States National Health Interview Survey-Linked Mortality Files (NHIS-LMF) to examine the risk of death associated with drinking and nondrinking statuses, net of demographic, socioeconomic, behavioural, health and geographic factors. Mortality risk is low for light drinkers and many individuals who abstain from drinking&#x2014;including those who abstain for religious and moral reasons, have a responsibility to family, were brought up not to drink and are not social. Mortality is higher among former, infrequent and moderate drinkers, and among individuals who abstain because they do not like the taste of alcohol, are concerned that they will lose control or are concerned about adverse consequences. Unsurprisingly, mortality risk is by far the highest for heavy drinkers. Our results show that reasons for abstention capture heterogeneity in the risk of death among lifetime abstainers.