Life Disparity Research Articles

Describing Mortality Differentials from the Perspective of Various Effects on Life Expectancy and Life Disparity Using Decomposition Methods: The Case of Czechia

The growth in life expectancy has accelerated since the 1990s in Czechia, which preceded a long period of stagnation or even a decrease during the communist era from the 1960s. This article aims to evaluate differences in mortality in terms of the impact of various effects on life expectancy and life disparity before and after the Velvet Revolution in Czechia. Three indicators were considered – life expectancy at birth, temporary life expectancy between ages 0 and 65, and the life disparity measure e-dagger (e†). In the article, we followed the decomposition method according to Arriaga (1984). Based on this method, the effect of mortality was further decomposed into an exclusive effect reflecting improved or worsened mortality in the given age group and into an interaction effect reflecting changes in mortality as a whole. Based on the results, it was found that the indirect effect prevailed in the case of life expectancy, while the direct effect dominated in the life disparity measure. Furthermore, we focused on the differences in life expectancy at birth between the sexes and between the two countries forming parts of the former Czechoslovakia – Czechia and Slovakia. For this purpose, we followed the contour decomposition method, so that we distinguished the effect of changes in mortality corresponding to the initial period and the effect of changes corresponding to changes in mortality in terms of time.

Association of Incarceration With Mortality by Race From a National Longitudinal Cohort Study

The association between incarceration and long-term mortality risk is unknown and may contribute to racial disparities in overall life expectancy. To determine whether incarceration in the US is associated with an increase in mortality risk and whether this association is different for Black compared with non-Black populations. This generational retrospective cohort study used data from the National Longitudinal Survey of Youth 1979, a nationally representative cohort of noninstitutionalized youths aged 15 to 22 years, from January 1 to December 31, 1979, with follow-up through December 31, 2018. A total of 7974 non-Hispanic Black and non-Hispanic non-Black participants were included. Statistical analysis was performed from October 26, 2019, to August 31, 2021. Time-varying exposure of having experienced incarceration during follow-up. The main outcome was time to death. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs, adjusted for baseline sociodemographic, economic, and behavioral risk factors. Models were evaluated for the full cohort and stratified by race. Of the 7974 individuals included in our sample, 4023 (50.5%) were male, and 2992 (37.5%) identified as Black (median age, 18 [IQR, 17-20] years). During a median follow-up of 35 years (IQR, 33-37 years), 478 participants were incarcerated and 818 died. Unadjusted exposure to at least 1 incarceration between 22 and 50 years of age was 11.5% (95% CI, 10.4%-12.7%) for Black participants compared with 2.5% (95% CI, 2.1%-2.9%) for non-Black participants. In the multivariable Cox proportional hazards model with the full cohort, time-varying exposure to incarceration was associated with an increased mortality rate (adjusted HR [aHR], 1.35; 95% CI, 0.97-1.88), a result that was not statistically significant. In the models stratified by race, incarceration was significantly associated with increased mortality among Black participants (aHR, 1.65; 95% CI, 1.18-2.31) but not among non-Black participants (aHR, 1.17; 95% CI, 0.68-2.03). In this cohort study with 4 decades of follow-up, incarceration was associated with a higher mortality rate among Black participants but not among non-Black participants. These findings suggest that incarceration, which was prevalent and unevenly distributed, may have contributed to the lower life expectancy of the non-Hispanic Black population in the US.

Race and Ethnic Group Differences in Social Engagement Among Older Adults

Social engagement is considered crucial for older adults’ well-being, generating social capital, connecting them to information about healthy lifestyles, and providing coping strategies for addressing daily challenges. Little is known about race and ethnic disparities regarding social engagement. This study examines the relationship between race, Hispanic ethnicity, and social engagement among community-dwelling adults age 65 or older. Data are taken from the Health and Retirement Study (2014) (n=6,221). Race and ethnic status are measured as: non-Hispanic white, non-Hispanic black, non-Hispanic “Asians and other race,” and Hispanic (any race). Social engagement includes frequency of contact with friends and family and participation in social activities (e.g. volunteering and attending religious services). Covariates included age, sex, education, number of co-morbidities, and alcohol consumption. Linear regression analyses were performed using SAS 9.4. The mean age was 74.6, and sixty percent of the sample was female. Race and ethnic distribution were 78.6% non-Hispanic white, 11.9% non-Hispanic black, 7.89% Hispanics, and 1.7% non-Hispanic “Asians and other race.” The mean score for our social engagement index was 3.3 (range 0-6). Hispanic persons, Asian persons, and persons from other race groups had lower social engagement compared with non-Hispanic white persons [β:-0.29, p<.0001; β:-0.27, p=0.04 respectively), after adjusting for covariates. These race and ethnic group differences in social engagement likely contribute to well-document health disparities in later life. Understanding racial and ethnic disparities in social engagement and the factors that create these differences can help identify appropriate social intervention programs regarding improving the well-being of all older adults.

Trajectories, Turning Points, and Interruptions: How Social Inequality Shapes Women’s Later-Life Health

We explore women’s health in midlife and later life at the nexus of structural sexism and the life course perspective, applying Dannefer’s (2018) concept of life course reflexivity, which emphasizes social dynamism with potential health-changing ‘input’ at all ages. We present three types of reflexive changes in the gendered life course that shape women’s health as they age: (1) trajectories of lifetime labor market disadvantage leading to limited health-protective resources in later life; (2) turning points in family structure and need, with draining caregiving demands; (3) interruptions in midlife, such as divorce, erasing the social and economic benefits of marriage. We provide support for critical arguments that theoretical work on the life course has too-often utilized the ‘privileged’ or the ‘male’ life course with insufficient attention to structural sexism as a fundamental cause of women’s health disparities in later life.

Trajectories, Turning Points, and Interruptions: How Social Inequality Shapes Women’s Later-Life Health

As the Hmong community continues to grow and age in the United States (US), mainstream healthcare providers may encounter Hmong older adults who prefer their cultural end-of-life (EOL) care. The challenge for these providers is to offer culturally sensitive EOL care to Hmong older adults within the realm of the Western healthcare system. One factor contributing to this challenge may be the lack of knowledge regarding Hmong older adults’ EOL care preferences. Another is Hmong EOL care is interwoven with care from domains such as culture, religion, and spirituality. The purpose of this study is to garner an understanding of the care preferences of Hmong older adults during the dying process. A qualitative study using inductive content analysis was conducted. Thirty Hmong older adults who reside in Wisconsin participated in semi-structured interviews that were audio recorded and transcribed. Data was analyzed using inductive content analysis by Elo & Kyngäs (2008). The findings revealed that participants preferred care at EOL in the domains: physical, psychosocial, cultural, religious, and spiritual. Physical care included ADL’s while psychosocial care related to communication and companionship. Cultural care included children as caregivers and decision-makers. Religious and spiritual care surrounded Animism and Christian beliefs such as soul calling and prayers. Findings also suggest Hmong older adults’ care preferences as heterogenous and holistic. The findings have implications for the Hmong community and formal care services to collaborate on how culturally sensitive care can be provided to Hmong older adults at end of life.

Disparities in Basic Housing Needs as a Predictor of Psychological Well-Being Among Older Adults

Adequate housing and safe environments are among older adults’ foundational needs. Prior research suggests minority older adults face significant barriers to accessing affordable and appropriate housing. However, the effects of this environmental press on their psychological well-being are rarely addressed. This project examined racial disparities between minority and white older adults’ housing and environment conditions and the differential impact on their psychological well-being. Using nationally representative data from the National Health & Aging Trends Study (NHATS), older adults' reported rating of the quality of housing conditions, financial security, neighborhood security, and the interviewer’s rating of the home environment were analyzed. A total of 4,048 community-dwelling older adults aged 65 and over were selected for analysis. The sample demographics are predominantly white (77.5%), female (61.4%), and residing in the community (82%). Results found minority older adults reported poorer housing conditions, fewer home modifications, and lower financial and neighborhood security, compared to white counterparts. The impact of housing quality was more detrimental to minority older adults’ psychological well-being, compared to white counterparts. These findings suggest a significant negative impact of home conditions on the psychological well-being of minority older adults. Home modifications are a viable option to increase or preserve functional status in the home, which could lessen the deleterious effects of environmental press on older adults’ psychological outcomes, especially minorities. This study’s findings provide information that bolsters our knowledge of housing and environment conditions, which are critical in efforts to reduce health disparities in late life.

The Influence of Gendered Social Position on Cohort Differences in Smoking Among Older Mexican Adults

Disparities throughout the life course, including social position, result in gendered pathways to health, which ultimately result in gender disparities in late life. Using data from the Mexican Health and Aging Study, we explore the concept of gendered social position over the life course (educational achievement, marital history, employment history) and its association with smoking status in old age (current, former, never). We compare two cohorts by gender, those aged 60 to 71 in 2001 (n=4,383) and 60-71 in 2012 (n=5,970), as these cohorts experienced vastly different life courses. Overall, current smoking decreased from 2001 to 2012, but men consistently report higher rates of current and past smoking, compared to women. This presentation will widen the lens of gender to consider the influence of social position established over the life course, on gender differences in smoking, a risk factor for poor health and function in old age.

Health Disparities Research With the National Institute on Aging (NIA)

The National Institute on Aging has taken special efforts to support research endeavors that explore ways to address health disparities. For example, the NIA Health Disparities Research Framework was developed in 2015 to provide a visualization of priority areas in Aging Research. The Framework can help researchers assess advances and potential opportunities for stimulating and supporting rigorous methods to address health disparities in Aging Research among the phases of research. The goal of this symposium is to highlight the different resources and research opportunities that NIA offers to support aging researchers, centers, and institutions for health disparities-related research or programs. Dr. Ron Kohanski will present a concept piece on how laboratory animals might be leveraged to mimic the impact of early life disparities on aging over the life-course, based on research in the hallmarks of aging support by NIA’s Extramural Division of Aging Biology. Dr. Damali Martin will identify the different resources focused on health disparities related research within the Division of Neuroscience. Dr. Lyndon Joseph will discuss the different health disparities research opportunities that are available from the Division of Geriatrics and Clinical Geriatrics. Dr. Frank Bandiera will highlight the different resources and research opportunities that are available to address health disparities within the Division of Behavior and Social Research. These presentations, taken together, will provide important information that bolsters knowledge of resources and research opportunities to address health disparities over the lifecourse and in late life.

Ceci n'est pas une Mormon Studies Book

Ceci n'est pas une Mormon Studies Book

Living with pain in ‘age-(un)friendly’ housing environments: A qualitative study with African American older adults

Understanding the dynamic relationship between housing environment and older adults’ pain may identify important factors that influence disparities in later life. We used a qualitative description approach to examine the context of environmental lifespaces in older African Americans (ages 61–81) with chronic osteoarthritis pain living in income-adjusted housing. Environmental inequity, healthcare needs, and mobility limitations influenced their perceptions of lifespace equity and interfered with their vitality and feeling of security. Their housing environments lacked age-friendly amenities, and specific enhancements to assist aging individuals with everyday function and reduction of pain were identified. This study contributes new evidence on the impact of macro, meso, and micro environments on pain management while also calling for greater attention to parity in infusing age-friendly resources into minority housing.

Racial/Ethnic Differences in Women's Life Event Exposure Across Midlife.

Stressful life events are associated with poorer physical, cognitive, and mental health. Examining life events trends across midlife illustrates normative experiences of stress in a critical life period for intervention and disease prevention. Further, there is a critical need for research with racially/ethnically diverse samples to identify differences in life event exposure, as they may relate to later health disparities. Annual life event reports were analyzed from 3,066 White, Black, Hispanic, Chinese, and Japanese women in the Study of Women's Health Across the Nation. Across ages 43-65, longitudinal trajectories were fit to annual number of life events and 9 subcategories of life events (i.e., work problems, economic problems, partner unemployment, illness/accident of loved one, caregiving, bereavement, relationship problems, family legal/police problems, and violent events that happened to the self or family). Racial/ethnic differences were examined, controlling for education. Number of annual life events declined with age and plateaued in later midlife. This pattern was largely consistent across types of life events, though family health and bereavement-related life events increased in later midlife. Compared to White women, Black women experienced more life events, while Chinese, Hispanic, and Japanese women experienced fewer life events. Racial/ethnic differences were amplified in specific subtypes of life events. Racial/ethnic differences in exposure to life events across midlife may contribute to racial/ethnic health disparities in later life.

Measurement of Inequality and Compression of Mortality in India for 4 Decades: 1970–2015

The studies relating to measurement of compression of Mortality in India is scarce. Most of the studies relating to mortality in India are focused on either life expectancy, or adult, and child mortality. We have used methods suggested by Kannisto (2000) and Canudos (2008) to measure the compression of mortality phenomenon for India for four decades viz. 1970-2015. Dispersion measures like simple mean, median, modal age at death; and some complicated measures like life disparity, standard deviation above mode, standard deviation in highest quartile, Interquartile range, Gini coefficient, AID and C-family were calculated for India from 1970-2015. We used the age specific death rates from abridged Life tables given by Sample Registration System published by Govt. of India. Our results show that inequality in mortality is decreasing in general but the gap between male and female is increasing. There was an average of three years difference in mean and modal age at death between male females in 2011-15. Overall, mean, median and modal age at death has increased in four decades but other inequality measures like Gini coefficient, AID, Standard deviation (SD) and coefficient of variation has decreased in four decades in India. C50 indicator, which indicates that 50 percent of deaths are happening in that age interval, declined from 26 years to 20 years for males and 27 years to 17 years for females, thus indicating the rate of compression of mortality is higher for females than males in India during 1970-75 till 2011-15.

Racial/ethnic/gender-based Disparities in Health Trajectories among American Older Adults

Numerous studies have examined racial/ethnic- or gender-based disparities in health. However, few examined health outcomes based on a combination of individuals’ race, ethnicity, and gender. Guided by an intersectionality framework, this study explores racial/ethnic/gender-based differences in older adults’ health trajectories over a ten-year period. Longitudinal data from the Health and Retirement Study (2004-2014) were used (n=16,654). Older adults (65+) were stratified into six groups based on their race, ethnicity, and gender, including (1) Non-Hispanic (NH) White Men; (2) NH White Women; (3) NH Black Men; (4) NH Black Women; (5) Hispanic Men; and (6) Hispanic Women. Growth curve models were used to examine the trajectories of three health indicators over time, including cognitive function, physical function (i.e. the sum of activities of daily living and instrumental activities of daily living), and depressive symptoms. The results indicated that NH White men and women outperformed racial/ethnic minority groups in cognition and physical function trajectories. Females in all racial/ethnic groups had more depressive symptoms but better cognition than their male counterparts. Hispanic women reported the most depressive symptoms. Hispanic women and NH Black women had the poorest physical function. NH Black men/women had the lowest cognition. Study findings highlighted the utility of an intersectionality framework in understanding health disparities in later life. Multiple social identities intersect with each other and generate protective and/or risk effects on cognitive, mental, and physical health status. Multilevel intervention strategies are warranted to close the health equity gap among various marginalized population groups.

The ratio of expansion to compression: A new measure of lifespan disparity.

Numerous studies have shown that high life expectancy is closely related to low life disparity. Unlike life expectancy, which can be increased by mortality decline at any age, life disparity can either increase or decrease in response to mortality decline. Disparity can thus be decomposed into two opposite components, called compression and expansion, depending on the effect of mortality decline on the age distribution of mortality. Without specifying the two components, various conventional measures of disparity may provide misleading information relating to how life chances in society can be equalized. Based on the relevant properties of changes in disparity, we develop a new measure of disparity-the ratio of expansion to compression-that can account for the relative importance of the two components. This simple measure not only provides a clear view of the evolution of disparity, but also permits changes in disparity related to mortality decline to be interpreted in a consistent manner similar to life expectancy. Simulations and an empirical analysis demonstrated the advantages of this new measure over conventional measures of disparity.

Quality of Life Outcome and Support Disparities Among People With More Severe Impairments.

People with intellectual and developmental disabilities (IDD) with more severe impairments often face service disparities. The aim of this study was to explore not only disparities in quality of life outcomes for people with IDD with severe impairments, but also disparities in the supports they receive from disability service organizations. Our analysis of Personal Outcome Measures interviews from 1,300 people revealed people with severe impairments experienced quality of life disparities in most domains, attributed to the fact that they also received fewer organizational supports than people with less severe impairments. By paying attention to person-centered outcomes, including these disparities, organizations' roles can shift from just providing services to supporting people to achieve the outcomes that are truly important to them.

Still Feeling Better? Trends in Self-Rated Health of Older Adults in the U.S.

Previous analyses showed an overall pattern of improvement in self-rated health of U.S. older adults in the 1980s and the 1990s, but it was uncertain if the declining shares of elderly persons reporting fair or poor health would continue over the next decades. Using the 2000-2018 pooled data from the National Health Interview Survey, this study examined recent trends in self-rated health of adults aged 45 and older. The results showed important variations in self-rated health trends across age groups. Between 2000 and 2018, the shares of adults aged 60 and above reporting fair or poor health declined significantly while self-rated health trends for middle-aged adults worsened over time. Educational and racial/ethnic differentials in self-rated health persisted over time but there were important group variations. To further improve the health of the elderly population, it is important to consider changing health disparities in later life.

Empowerment through Accessibility: Community Needs Assessment Data for LGBTQ Communities

ABSTRACT LGBTQ individuals disproportionally experience a variety of adverse health outcomes as compared to heterosexual individuals with similar backgrounds. New Orleans has the fourth-highest concentration of LGBTQ individuals in American metropolitan areas. This research defined, measured, and prioritized LGBTQ community needs based on reports from professionals currently involved in healthcare and social service provision. A total of 22 interviews were completed with service providers located in the Greater New Orleans area. The project outlines the greatest programming needs to reduce health and quality of life disparities currently observed in LGBTQ populations. Major service barriers and considerations for research with minority populations are also discussed. Affordable housing, mental health service accessibility, service provider cultural competence, and transportation management were found to play major roles in LGBTQ focused program efficacy. Researchers include suggestions for implementing participatory research methodology into future studies.

What has contributed to the large sex differentials in lifespan variation and life expectancy in South Korea?

To date, research on sex differentials in lifespan variation and life expectancy has mainly been conducted in Western countries and there is a dearth of data from South Korea. This study aimed to further the understanding of mortality transition and life expectancy in South Korea, and the associated trajectories of age-at-death variation, through an analysis of life disparity by gender. Using complete life tables for South Korea for 1970-2015, sex differentials (female-male differences) in life disparity and life expectancy at birth were estimated, and sex differentials in life expectancy were decomposed by age and cause of death. The results showed that sex differentials in life expectancy at birth have not reduced significantly in the last 45 years (1970: 7.1 years; 2015: 6.2 years). Life disparity has reduced more rapidly for females than males, and the difference increased from -0.1 year in 1981 to -1.6 years in 2015. Sex differentials in life expectancy and life disparity in South Korea were higher during 1970-2015 than in several Western countries with high life expectancy. The elderly age group (60 and above) contributed 50% of the total sex difference in life expectancy at birth in 1970, and this increased to 70% in 2015. The contribution of the age group 15-59 years reduced significantly over the period. Decomposition of life expectancy at birth by cause revealed that diseases of the circulatory system (2.2 years), followed by external causes (1.3 years), were the most important causes of the sex differences in life expectancy at birth in 1983, and in 2015 neoplasms (2.2 years) and external causes (1.1 years) explained half of the total sex differences. There has been a significant shift in the age-specific pattern of the contribution towards each cause of death. Overall, sex differentials in life disparity and life expectancy at birth have remained significant in South Korea in the last 45 years.

Gender Disparity in Trauma Surgery: Compensation, Practice Patterns, Personal Life, and Wellness

BackgroundWe sought to understand differences in surgical practice, compensation, personal life, and health and wellness between male and female trauma surgeons. MethodsAn electronic survey study of members of The Eastern Association for the Surgery of Trauma was carried out. Using univariate and bivariate analyses, we compared the differences in surgical practice, compensation, family life, and health status among female and male trauma surgeons and used chi-squared tests for categorical variables. Analyses were performed using SPSS (Version 25, IBM). ResultsThe overall response rate was 37.4%. Women reported working more than 80 h a week more commonly (30% versus 23%; P < 0.001), yet reported lower incomes, with 57% of female surgeons reporting before-tax incomes of $300,000 or higher, compared with 83% of male surgeons (P < 0.001). These differences persisted when adjusting for academic versus nonacademic practices. Gender-based salary disparity remained significant when adjusting for the age of the respondent. Divorce rates and never married status were significantly higher for women (9% versus 4%; P < 0.001 and 19% versus 4%; P < 0.001, respectively). Women surgeons also report higher rates of not having children compared with male surgeons (48% versus 13%; P < 0.001). There were no major age-adjusted health status differences reported between male and female surgeons. ConclusionsThis study highlights contemporary disparities in salaries, practice, and family life between male and female trauma surgeons. Overall, trauma surgeons do not report gender-based differences in health and wellness metrics but have ongoing disparity in compensation and family life.

A Decomposition of Life Expectancy and Life Disparity: Comparison Between Hong Kong and Japan.

Background: Life expectancy and life disparity are 2 useful indicators to assess the health condition of a society. Both Hong Kong and Japan have one of the longest life expectancies in the world. Recently, Hong Kong has overtaken Japan and topped the life expectancy rankings. However, whether Hong Kong has also outperformed Japan in life disparity is still unknown. Methods: Decomposition analyses have been conducted to evaluate age-specific contributions to the changes in life expectancy and life disparity for each of the populations. Furthermore, the differences between the 2 populations were examined over the period 1977-2016. Results: Reduction in mortality of the adult and the old age groups contributes most to the increase in life expectancy for the study period. Hong Kong has a higher life disparity than Japan, and due to the great improvement in reducing premature deaths, the Hong Kong-Japan gap has been narrowing. However, in recent years, further reduction in mortality of the oldest elderly in Hong Kong has actually contributed to the increase in its disparity, thus widening its gap with Japan again. Conclusion: Increasing dominant influence of "saving lives at late ages" is very likely to cause the reemergence of increasing life disparity in these 2 long-lived populations.