Lower Average Education Research Articles

Biological risk factors for dementia in India

AbstractBackgroundMany clinical biomarkers have been associated with dementia. This paper uses a novel data set from an understudied population – a national sample of older Indians ‐ to assess the relative importance of 41 biomarkers using a variety of approaches. The value of these data is the extensiveness of the biomarker collection, the validated classification of dementia, and the uniqueness of the population with low average education. Many approaches to both summarizing and reducing data complexity have been suggested. Some of these are based on theory about biological mechanisms and some are agnostic and based on machine‐learning approaches. The results are informative for others collecting and analyzing biomarker data in population samples.MethodWe use 6 approaches to assessing the value of the biomarkers in explaining variance in dementia diagnosis and cognitive functioning – some traditional social science approaches and some based on machine learning. The aim of the different approaches is to determine how to best characterize the influence of biology as well as how to trim and combine the data. The five approaches to measuring biological risk: 41 individual biomarkers; identification of subsets of biomarkers with elastic net; support vector machine learning; factors developed with factor analysis; a principal components approach; and a factor classification based on a theoretical approach.ResultsResults indicate if the aim is explain variance in dementia, all the biomarkers or a reduced set of biomarkers identified by elastic net do the best job at explaining variability. However, biological markers chosen as most important do not fit well our understanding of biological mechanisms.ConclusionIf the aim is understanding the relative importance of biological systems, traditional social science approaches, e.g. the factor analysis and principal components approach, allow better understanding and interpretation of the biomarkers associated with cognitive performance.

Transportation Infrastructure and Family Educational Expectations: An Empirical Analysis Based on the China Family Panel Survey

Based on data from the China Statistical Yearbook and China Family Panel Survey (CFPS), this article investigated the influence of regional transportation infrastructure development on family education expectations. Research results show that there is a significant positive correlation between transportation infrastructure and family educational expectations and that the improvement of transportation infrastructure can enhance the family’s willingness to engage their children in higher education. According to the results of influencing mechanism analysis, transportation infrastructure development affects family education expectations by increasing family income and changing family reproduction concepts and educational ideas. In addition, the impact of transportation infrastructure construction on family education expectations is heterogeneous: the positive correlation between them is particularly significant in rural areas with less developed transportation infrastructure, in areas with low average education level of parents and slow information communication, and among families of lower social classes; however, the relationship between the two variables is not prominent in urban areas, in areas where information communication is fast and parents have a higher average education level, and among families with higher social classes. These research findings offer the nation and government new implications for better promoting poverty alleviation through education and rural revitalization in underdeveloped areas.

Factors associated with organized and non-organized colorectal cancer screening

Abstract Background Data on non-organized colorectal cancer screening using fecal occult blood tests (FOBTs) is currently lacking. We identified factors associated with organized and non-organized FOBT screening. Methods Data of 308 municipalities in Flanders (6.6 million residents, 57% of Belgium) during 2015-2017 were analyzed. Logistic regression with generalized estimating equations was used to assess associations between municipal characteristics and organized and non-organized screening coverages. Results Median organized screening coverage increased (36.4% to 40.1%) while non-organized screening coverage decreased (4.8% to 3.3%) in 2015-2017. Organized screening coverage was negatively associated with average income (OR = 0.97, 95%CI: 0.96-0.98) and percentage of people with a non-Belgian/Dutch nationality (OR = 0.962, 95%CI: 0.957-0.967). More older people (70-74) in the target screening population were related to lower coverages by both organized (OR = 0.98, 95%CI: 0.97-0.99) and non-organized screening (OR = 0.98, 95%CI: 0.96-0.999). Education level was positively associated with organized screening coverage (OR = 1.010, 95%CI: 1.008-1.011). While GP visit was positively associated with both organized and non-organized screening coverages, average number of patients per GP and having a global medical dossier handled by preferred GP showed more pronounced associations with non-organized screening (OR = 1.021, 95%CI: 1.016-1.026 and OR = 1.025, 95%CI: 1.018-1.031, respectively) compared to organized screening coverage. Conclusions Higher average income, lower average education level, more older people and people with foreign nationality were associated with lower organized screening coverage. GP involvement showed a positive association with non-organized screening. It seems that some GPs and screening-invited individuals are still not fully aware of the benefits of organized screening. Available instruments in screening programs should be optimized to fill this gap in knowledge. Key messages We identified factors associated with both organized and non-organized colorectal cancer screening using fecal occult blood tests (FOBTs). Based on this knowledge, strategies can be developed to promote screening among non-participants and encourage non-organized participants to switch to organized screening.

Pollution, Global Diseases, Government, and Inequality

Minorities and poor people have higher rates of mortality due to various causes of deaths. Part of this phenomenon is due their higher exposure to unhealthy environments. In this paper we show that the onset of Covid-19 was associated with higher death rates among the disadvantaged population. Specifically, we document that the environmental air quality can affect the spread of the novel coronavirus and that this effect is more pronounced in low-income neighborhoods and for counties with lower average education and higher share of blacks. The fact that environment is more impactful among the disadvantaged population calls for policies that protect the poor and minorities during a global disease.

International Trade and Public Protest: Evidence from Russian Regions

Abstract How does economic globalization influence domestic political stability? Building on innovations in trade theory, we argue that international trade amplifies political discontent and protest in contexts in which trade losers concentrate, but has a pacifying effect in contexts dominated by beneficiaries of free trade. We examine this argument focusing on variation in Russian regions. Using negative binomial regression models on data from 2007 to 2012, we show that regional education levels condition the effect of trade intensity on protest frequency. High exposure to trade leads to more protests in regions with low average education levels, but fewer protests in regions in which residents are well-educated. Probing the underlying mechanism, we find that the effect of trade on regional economic welfare is conditioned by education levels, that poorly educated Russians face more economic difficulties when they live in regions exposed to trade, and that economically aggrieved individuals participate more in protests.

A brief transdiagnostic psychological intervention for Afghan asylum seekers and refugees in Austria: a randomized controlled trial

BackgroundAsylum seekers and refugees are at great risk for developing mental disorders. Afghan refugees are a particularly vulnerable group with a low average education and mental health literacy level. Traumatic experiences and hardship before and during migration are predictive of mental health problems. However, post-migration living difficulties (PMLDs) also account for a large proportion of mental distress in such populations, which, critically, are not sufficiently considered in treatment protocols and research investigations. Indeed, the evidence base for the treatment of refugees and asylum seekers is sparse and limited mainly to trauma-specific treatments, where refugees may likely suffer from other mental health problems such as depression or anxiety.Methods/designThis trial is the first evaluation of a short-term, transdiagnostic treatment protocol for treatment-seeking Afghan refugees which addresses mental health problems and PMLDs while using an adapted version of the Problem Management Plus (PM+) protocol. Here, we will investigate the efficacy of an intervention manual with a prospective, single-center, randomized, assessor-blind, two-group trial among refugees who are on a waiting list for professional mental health treatment. Furthermore, we will investigate participants’ subjective experiences with the intervention manual via in-depth interviews. One hundred twenty people will be assessed and randomly allocated to either the intervention arm or a treatment-as-usual arm. Clinical psychologists will conduct the treatment, and the sessions will take place with a Dari interpreter. The protocol consists of six 90-min sessions. The primary endpoint is the general symptom distress measure, assessed with the General Health Questionnaire 28 (GHQ-28). Secondary endpoints are the Post-Migration Living Difficulties Checklist (PMLDC), the International Trauma Questionnaire (ITQ), the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), the Psychological Outcome Profile (PSYCHLOPS), service and health care use (assessed with several items), and the Immigrant Integration Index (IPL-12).DiscussionThis trial may provide substantial evidence for a brief transdiagnostic psychological intervention. Here, we intend to contribute to the treatment of mental health problems among Afghan refugees. The assessment of subjective experience with this treatment manual, as well as the evaluation of its clinical applicability, may optimize treatment acceptance and outcomes across a wide range of mental health problems among refugees.Trial registrationGerman Clinical Trials Register (DRKS) registration number: DRKS00016538. Universal Trial Number: U1111-1226-3285. Registered on January 7, 2019. https://www.drks.de/drks_web/setLocale_EN.do

Racial and Socioeconomic Disparities in Mantle Cell Lymphoma

BackgroundAlthough race and socioeconomic factors are associated with outcome in many malignancies, few studies have examined the effect of race and socioeconomic status on patients with mantle cell lymphoma (MCL). Patients and MethodsWe used the National Cancer Database to identify patients with MCL diagnosed between 2004 and 2013. We used χ2 and analysis of variance to assess associations of covariates with race/ethnicity. For univariate and multivariable analyses of overall survival (OS) we used Cox proportional hazards models. OS from the time of diagnosis was the primary end point. ResultsOf 18,120 MCL patients, 14,984 (83%) were white non-Hispanic (NH), 709 (4%) black NH, and 1096 (6%) Hispanic. Of these patients, 6798 (39%) had private insurance, 9520 (55%) Medicare, and 635 (4%) Medicaid. Compared with white NH race, black race was associated with treatment at an academic/research program (347 of 681 patients [51%] vs. 5577 of 14,851 [38%]), B symptoms (196 patients [28%] vs. 3 [25%]), Medicaid/uninsured status (101 patients [15%] vs. 642 [5%]), and residence in regions with lower average education and income (all P < .001). Compared with NH black and Hispanic patients, more white NH patients received stem cell transplantation (73 patients [10%] vs. 114 [10%] vs. 1891 [13%]; P < .001). In multivariable analysis, Hispanic ethnicity, private insurance, and treatment at an academic center were associated with better OS (5-year OS 55.8%, 66.2%, and 56.6%, respectively), whereas black race was associated with inferior OS (5-year OS 46.8%). ConclusionWe identified disparities according to race and ethnicity in OS, independent of insurance and socioeconomic status. Further assessment of treatment patterns might elucidate new targets for improving access to care and health outcomes for rare cancers.

Twelve-month prevalence rates of mental disorders and service use in the Argentinean Study of Mental Health Epidemiology.

Community surveys of mental disorders and service use are important for public health policy and planning. There is a dearth of information for Latin America. This is the first representative community survey in the Argentinean population. The purpose is to estimate the 12-month prevalence and severity of mental disorders, socio-demographic correlates and service use in a general population survey of adults from urban areas of Argentina. The World Mental Health Composite International Diagnostic Interview was administered to 3927 individuals aged 18years and older participating in a multistage clustered area probability household survey. The response rate was 77%. The 12-month prevalence of any disorder was 14.8%, and a quarter of those disorders were classified as severe. Younger participants and those with lower education had greater odds of any disorder and most classes of disorder. 11.6% of the total population received treatment in the prior 12months and only 30.2% of those with a severe disorder. Women and those never married were more likely to receive or seek treatment, whereas those with low and low-average education were less likely. Most individuals with a mental disorder in the past year, even those with a severe disorder, have not received treatment. Because low education is a barrier to treatment, initiatives aimed at mental health education might help timely detection and treatment of these disorders in Argentina.

Family, Schools, or Culture: What Explains Differences in U.S. Student Achievement Across Ethnic Groups on PISA 2012?

U.S. students in different ethnic groups have very different average scores on the PISA 2012 mathematics and reading tests, with Blacks and Hispanics showing negative gaps relative to White students and Asians showing a positive gap. I investigate whether a student’s family characteristics or the school attended can explain these differences. I find that Hispanic parents’ low average education explains the largest share of the Hispanic achievement gap. In contrast, most of the larger negative gap for Blacks and the positive gap for Asians cannot be explained by family characteristics or the school they attend. Attendance at “bad” schools explains relatively little of the negative gaps, but Black students’ mathematics scores are substantially lower when they compose more than 50% of the class, which is not the case for Hispanic students. This evidence suggests that ethnic group culture is an important cause of Black and Asian student achievement gaps.

Assessing the Individual, Neighborhood, and Policy Predictors of Disparities in Mental Health Care.

This study assesses individual- and area-level predictors of racial/ethnic disparities in mental health care episodes for adults with psychiatric illness. Multilevel regression models are estimated using data from the Medical Expenditure Panel Surveys linked to area-level data sets. Compared with Whites, Blacks and Latinos live in neighborhoods with higher minority density, lower average education, and greater specialist mental health provider density, all of which predict lesser mental health care initiation. Neighborhood-level variables do not have differential effects on mental health care by race/ethnicity. Racial/ethnic disparities arise because minorities are more likely to live in neighborhoods where treatment initiation is low, rather than because of a differential influence of neighborhood disadvantage on treatment initiation for minorities compared with Whites. Low rates of initiation in neighborhoods with a high density of specialists suggest that interventions to increase mental health care specialists, without a focus on treating racial/ethnic minorities, may not reduce access disparities.

CMF-regimen Preferred as First-course Chemotherapy for Older and Sicker Women With Breast Cancer

The objective of this study was to determine the sociodemographic and clinical characteristics associated with Cyclophosphamide, Methotrexate, and 5-Fluorouracil (CMF) utilization as a first-course chemotherapy regimen among female Medicare patients with early-stage breast cancer. A longitudinal study was conducted with women 66 years and older, diagnosed with stage I to III breast cancer from 1993 to 2004, and receiving chemotherapy using the Surveillance, Epidemiology, and End Result-Medicare data. First-course CMF chemotherapy was defined as chemotherapy initiation within 6 months of breast cancer diagnosis, with at least 1 claim of CMF each within 1 year of diagnosis. Logistic regression was used to perform the analysis. Older and sicker women, living in census tracts with lower average education, and diagnosed with advanced stage, hormone receptor-negative tumors have a higher probability of CMF administration. Receipt of lymph node dissection and nonreceipt of radiation therapy were also associated with CMF administration. CMF administration has declined over the years and has significant regional variation. Reduction in CMF use overtime indicates the increased use of newer and more effective systemic therapies among breast cancer patients. In spite of the reduction in CMF use over time, CMF is more frequently administered to older and sicker women, possibly because of higher risk of anthracycline-induced toxicities in these patients. Clinical guidelines have no recommendations for CMF administration in breast cancer patients with certain clinical characteristics. Hence, it is important to understand if the associations observed in this study can be clinically justified in order to reduce unjustified use of less-effective regimens.

Association between witnessing traumatic events and psychopathology in the South African Stress and Health Study.

The high burden of witnessing traumatic events has been demonstrated in previous research in South Africa. However, previous work has focused on PTSD rather than a broader range of psychopathological outcomes. This study examined the association between witnessing trauma and multiple outcomes including mood, anxiety, and substance use disorders. Regression models measured the odds of mood, anxiety, and substance use disorders among those who reported witnessing in the South African Stress and Health Study. Discrete-time survival analysis was used to examine whether witnessing was associated with earlier onset of mental disorders. Witnessing trauma was more commonly reported among males and those with low-average education. Posttraumatic stress disorder, mood, and anxiety disorders varied significantly with witnessing status, and witnessing was associated with exposure to a higher number of traumatic events compared to other types of traumatic events. Respondents reporting witnessing trauma had elevated odds of mood and anxiety disorders, but not substance use disorders. Witnessing trauma is common in the South African population and results in increased risk of mood and anxiety disorders. Interventions aimed at reducing the burden of trauma and its outcomes must now increase their focus on bystanders and other observers, rather than just focusing on those directly affected.

The Effects of Voting Costs on the Democratic Process and Public Finances

Increasing the attractiveness of voting is often seen as a remedy for unequal participation and the influence of special-interest groups on public policy. However, lower voting costs may also bring less informed citizens to the poll, thereby inviting efforts to sway these voters. We substantiate this argument in a probabilistic voting model with campaign contributions. In an empirical analysis for the 26 Swiss cantons, we find that lower voting costs due to postal voting are related to higher turnout, lower average education and political knowledge of participants as well as lower government welfare expenditures and lower business taxation. (JEL D72, H25, H75, I20, I38)

Indices of socioeconomic position across the life course as predictors of coronary calcification in black and white men and women: Coronary artery risk development in young adults study

Few studies have investigated the association of socioeconomic status (SES) and coronary artery calcification (CAC) and only one study has examined African Americans separately from Caucasians, despite empirical evidence suggesting that blacks have equivalent or lower CAC, relative to whites. We tested the hypotheses that lower childhood SES and lower average education, occupation, and income and change in SES (slope) in adulthood are related to risk of CAC in blacks and whites in the US CARDIA study. Parental education and occupation were measured at study entry (Year 0 in 1985–1986) and participant education, occupation, and household income were evaluated multiple times throughout a 20 year follow-up period at four sites in the United States. CAC was measured at Year 20 in 3138 (45% black) participants in CARDIA; 19% had CAC. Latent growth models and multivariate logistic regression analyses adjusted for the major risk factors for CAC. Multivariate models showed that lower paternal education in blacks and lower maternal occupational status in the full sample and in whites were related to higher risk of any CAC, independent of adult SES. Lower average adult education, occupation, and income were related to higher risk of any CAC, with the effects primarily in blacks. Our results are the first to show that SES, measured retrospectively and prospectively in multiple ways, is related to CAC, and the first to document the effects primarily in blacks.

Ethnoracial Differences in the Clinical Characteristics of Alzheimer's Disease at Initial Presentation at an Urban Alzheimer's Disease Center

To compare presentation of Alzheimer disease (AD) at the time of initial evaluation at a university specialty clinic across three ethnoracial groups in order to understand similarities and differences in the demographic, clinical, cognitive, psychiatric, and biologic features. Cross-sectional study. A total of 1,341 self-identified African American, Latino (primarily of Caribbean origin), and white non-Hispanic ("WNH") subjects were recruited from primary care sites or by referral by primary care physicians. Demographic variables and age of onset of AD, as well as cognitive, functional, and mood impairments at the time of initial presentation and frequencies of apolipoprotein E genotypes, were compared across groups. Differences among ethnoracial groups were found for nearly all variables of interest. In particular, the largely immigrant Puerto Rican Latino group had an earlier age of onset of AD, more cognitive impairment, and greater severity of cognitive impairment at the time of initial evaluation in the setting of low average education and socioeconomic status. There was more depression in the Latinos compared with African Americans and WNHs. Greater severity of symptoms was not accounted for by a difference in lag time between onset of symptoms and initial evaluation. The apolipoprotein E-4 genotype was not associated with AD in the Latino cohort. Minority groups in Philadelphia, especially Latinos, exhibit a more severe profile of AD at the time of presentation than WNHs. Important potential confounds need to be considered and future research comparing immigrant and nonimmigrant Latino groups will be necessary to elucidate the highly significant differences reported.

What characterizes persons with high levels of perceived stress in Denmark? A national representative study

Stress is a growing public health problem, but there are only a few studies with national representative samples on the occurrence of stress. The aim of this study was to assess the level of stress, measured by the Perceived Stress Scale, in Denmark, and to identify and characterize the group with high levels of stress by factors measured at both the individual and neighbourhood levels in a national representative sample of the Danish population. The 10,022 participants in the National Health Interview Survey 2005 were asked about perceived stress and individual factors in a cross-sectional design. Information on neighbourhood factors was derived from a national registry. Data were analysed by means of logistic regression models. Low education, heavy smoking, physical inactivity, lack of social network and poor working conditions were associated with perceived stress. For women, living in a neighbourhood with low average education, and for men, living in a neighbourhood with a high rate of crime and a low degree of ethnic diversity, were associated with higher perceived stress. Perceived stress was also related to indicators of morbidity. The group with high perceived stress is characterized by individual and neighbourhood factors with negative impacts on quality of life and risk of illness. This knowledge can guide future stress prevention efforts. Additionally, the results suggest a negative social component where perceived stress, unhealthy lifestyle and low social status are accumulated, and perceived stress might be used as a measure to identify groups characterized by accumulation of risk factors.

Reply: Making the Most of Ideas, Facts, and Data About Age and Depression

Normally, a critical comment begins by summarizing the results or conclusions being challenged. Then, each challenged finding or inference is addressed, citing counter-arguments and their supporting principles and evidence. Professor Angel's comments are not this direct. What, specifically, does he regard as implausible and unsupported? That depression is highest among the old and young, and lowest among the middle aged? That life-cycle differences in marital, employment, and economic statuses explain the association between age and depression? He clearly doubts that these findings demonstrate anything about the effects of age on depression, or that they are relevant to views of age as maturity, decline, life-cycle stage, survival, and historical trend. We disagree with his view. To the extent we can extract them, these seem to be Professor Angel's main points: (1) the article adds little to preexisting knowledge; (2) the model and analysis are too clever and complicated; (3) the measures are unreliable, imprecise, and invalid; (4) the cross-sectional data confound age with cohort, cause with selection, and outcome with process; (5) the model should include interaction terms and additional variables; and (6) quantitative models do not represent people's lives and feelings, so they do not mean much. Our responses follow. 1. Our analysis integrates and advances the ideas and observations of earlier studies. Prior studies took a variety of views, with apparently contradictory results. Feinson documented those contradictions in 1985. Newmann found a clue to an explanation of the contradictions in her meta-analysis published in 1989, which pieces together a U-shaped association from a number of age-limited samples. At a minimum, our results make the following worthwhile contributions to the literature: (1) depression among the elderly is not a scientific myth; (2) the U-shaped age curve, hypothesized based on Newmann's meta-analysis, is confirmed in two samples (one statewide and one national) that represent the whole range of adult ages (from 18 to 90); (3) the U-shaped curve does not disappear with adjustment for the fixed attributes of sex, minority status, and education; and (4) the U-shaped curve flattens with adjustment for social statuses that rise and fall over the lifetime-employment, marital and economic status. To our knowledge, no previous survey demonstrates the pattern of depression falling and then rising in successive age groups over the whole range of adult ages, and no previous analysis explains the pattern by adjusting for the links between age and depression. We also found clear results consistent with the proposition that some of the depression among the old reflects more difficult lifetime conditions associated with lower average education. We found only inconsistent support for the proposition that survival differences across status groups produce some of the age curve, possibly because survival effects are small until old age. To our knowledge, all of this is new. Professor Angel cites no evidence that it is not. 2. Our model and analysis are as clever as they need to be and as simple as they can be. When thinking about the different views and results of earlier studies, we realized that an analysis of depression by age must do several things. It must compare adults across the whole range of ages. It must adjust progressively for ascribed status, the stable trait of education, the main social statuses contingent on age, and the spiraling dysfunction and demoralization that might plague the very old. It must consider carefully the form of the age curve and the changes with specific adjustments predicted by each view of age. To do that, it must distinguish the falling from the rising component, and specify an