Lower Levels Of Educational Attainment Research Articles

Longitudinal gambling risk transitions: evidence from a nationally representative Australian sample

Aims Problem gambling has downstream consequences on individuals, families and the community. While a strong research base now exists on predictors and outcomes of problem gambling risk and severity, few studies have examined the transitions in gambling risk status over time, and factors associated with these transitions. Methods The current study addresses this knowledge gap by examining gambling transitions using two waves of longitudinal, population-representative Australian data (N = 12,364) collected in 2015 and 2018. Focal to our approach is the assessment of predictors of gambling risk status including demographics, and key psychosocial factors that might attenuate the risk of transition into more severe gambling. Results The results show significant stability in gambling risk over time, particularly among individuals who reported no or low gambling risk. Gambling risk transitions were more likely to occur toward less severe than more severe levels of gambling. Furthermore, gambling problems tended to persist in more severe levels of gambling risk. Financial hardship, younger age, male gender, experience of hardship, lower levels of educational attainment, chronic health conditions, risky levels of alcohol consumption, living in low SES areas, and low sense of mastery were associated with transitions from low to more severe gambling over the three-year period. There were no significant predictors of transitions to lower levels of gambling risk in the current data. Conclusions Our findings can help inform public health interventions by better targeting individuals at elevated risk for more severe gambling over time, and we outline a method for analyzing transitions in longitudinal datasets that can be applied in future studies in addiction.

Urban-Rural Health Insurance Integration and China's Rural Household Savings.

A linchpin to realizing the internal circulation (referring to the domestic cycle of production, distribution and consumption) is reducing residents' saving rate and expanding the domestic needs. However, rural residents in China demonstrate a strong propensity to save money. In light of practical characteristics of urban-rural health integration promoted in different places, the three-phase data (from 2014 to 2018) and the dual difference-in-differences model of the China Labor-force Dynamics Survey (CLDS) are used to empirically investigate the impact of urban-rural health insurance integration on rural household savings. Research reveals that urban-rural health integration can reduce the health risks and medical risks facing rural households, thus weakening the motivation of precautionary savings. The analysis of heterogeneity reveals that the integration of urban-rural health insurance significantly influences the savings rates of households headed by older individuals, particularly women, with lower levels of educational attainment. Besides, the single-tier health insurance system can have a more significant impact, whereas the multi-tier insurance system may not significantly affect the savings rate. Based on the aforesaid research conclusions, this article believes that in order to reduce the savings rate of rural households and expand consumption, the health insurance system should be further improved.

Effect of demographic characteristics of enterprises on the implementation of corporate social responsibility in SMEs context

Research background: Corporate social responsibility (CSR) is a rapidly developing field within business management, the effects of which manifest themselves in the practical management of organisations. At present, research within academia is focusing on the analysis and evaluation of the demographic characteristics of enterprises on entrepreneurs’ attitudes towards the implementation of socially responsible business management practices. Purpose of the article: The purpose of the article is to quantify the influence of the demographic characteristics of an enterprise on the implementation of corporate social responsibility. Demographic characteristics, such as the country of business, company size, business sector, gender of the entrepreneur, their age and educational attainment level, are all thought to play important roles in this. Methods: The research was conducted in three European countries on a selected sample set. The research hypotheses were verified by non-parametric testing using the parametric One-way ANOVA test and the Scheffe method. Findings & value added: The results confirm that the country in which a company conducts its business activities and company size are significant factors affecting perceptions concerning the implementation of CSR. Entrepreneurs in the Czech Republic are significantly less likely to agree with the importance and implementation of CSR than entrepreneurs in Poland. Similar results were attained when comparing micro-enterprises and medium-sized enterprises, with micro-enterprises significantly less likely to agree with statements on CSR. Between men and women, no significant differences were found in their attitudes towards the incorporation of CSR into business management practices. The result was likewise with regards to the entrepreneur’s age. However, the business sector in which a company operates and the entrepreneur’s educational attainment level do have an influence on selected CSR indicators, with the impact on financial performance most positively perceived by those companies operating in retail. Those companies operating in the services sector attached the least importance to the implementation of CSR for acquiring new customers and improving financial performance than other sectors. Of interest is also the finding that enterprises run by owners or managers with lower levels of educational attainment neither perceive the concept of CSR nor the implementation thereof as a significant element of future business management.

PERSPECTIVES ON TECHNOLOGY ADOPTION AMONG SPANISH-SPEAKING HISPANIC ADULTS AGE 60+

Abstract By 2060, Hispanics aged 65+ are projected to be 21% (19.9 million) of the total US age 65+ population. Despite the benefits of technology use, such as facilitating social engagement and access to health services, few studies have explored attitudes of older Spanish-Speaking Hispanic adults toward technology adoption. In this secondary analysis of a larger diverse study of attitudes toward technology, we reviewed audio recordings and transcripts of Spanish-language interviews and focus groups with adults ages 63-89. Participants (n=21) self-identified as Hispanic, 67% had less than a high school education, and almost half (n=10) lived alone. Connecting with family members abroad was the primary motivator and a “necessity” for using technology; excess use of a device was negative. As one participant stated: “Technology brings you closer to those far away and pushes you away from those near you.” Those without relatives living with or near them reported greater difficulty using technology and identified living alone as a barrier to adoption. Finally, although the sample had low levels of English proficiency and low educational attainment, characteristics associated with lower use and knowledge of technology, findings challenge stereotypes that these older adults lack the capacity or interest to adopt the technology. Rather, the study identified multiple social factors that may hinder adoption. Understanding these cultural and linguistic barriers is important to promote digital inclusion; overcoming the digital divide will involve more than providing free tablets or classes. It will also require addressing barriers with adequate, culturally competent understanding, training and support.

The impact of training and development facilities on job commitment among entry-level employees: Bangladeshi RMG perspectives

Purpose: The study intended to ascertain whether providing training and development facilities positively impacted the job commitment of entry-level garment employees in Bangladesh. Research Methodology: The response rate for the survey was 44.89%, derived from a sample size of 450 data points obtained by a basic random sampling technique. The study employed Microsoft Excel 2007, SPSS 22.0, and AMOS 23.0 to conduct exploratory and confirmatory factor analysis and structural equation modeling to assess the strength and reliability of the suggested research framework. Results: The study revealed a significant enhancement in the level of commitment among lower-level employees in the Bangladeshi garment industry when provided with training and development potential. Limitations: One primary constraint encountered in this study pertained to issues associated with data collection. The target demographic consists exclusively of individuals with lower levels of educational attainment. Allocating funds for research in finance remained a significant area of focus. As a result of these limitations, the survey was unable to gather nationwide data. Contribution: This study is distinctive as it focuses on individuals occupying lower-level positions within the Bangladeshi garment sector, exploring the potential avenues for professional advancement. Practical Implication: The study may benefit Bangladeshi garment firms' HR strategy and training and development plans. Environmental and internal variables can stress workers. Professional progress and quality training will help dedicated workers overcome these challenges. Novelty: The study is unique in two perspectives: the bottom-level employees and the emerging economy like Bangladesh.

Medical help-seeking intentions among patients with early Alzheimer's disease.

Limited information is available on the active process of seeking medical help in patients with Alzheimer's disease (AD) at early stages. The aim of this study was to assess the phenomenon of medical help-seeking in early AD and to identify associated factors. A multicenter, non-interventional study was conducted including patients of 50-90 years of age with prodromal or mild AD (National Institute on Aging/Alzheimer's Association criteria), a Mini-Mental State Examination (MMSE) score ≥ 22, and a Clinical Dementia Rating-Global score (CDR-GS) of 0.5-1.0. A multivariate logistic regression analysis was conducted. A total of 149 patients were included. Mean age (SD) was 72.3 (7.0) years, 50.3% were female, and 87.2% had a CDR-GS score of 0.5. Mean disease duration was 1.4 (1.8) years. Ninety-four (63.1%) patients sought medical help, mostly from neurologists. Patients with help-seeking intentions were mostly female (60.6%) with a CDR-GS score of 0.5 (91.5%) and had a greater awareness of diagnosis, poorer quality of life, more depressive symptoms, and a more severe perception of their condition than their counterparts. Lack of help-seeking intentions was associated with male sex (p = 0.003), fewer years of education (p = 0.005), a low awareness of diagnosis (p = 0.005), and a low emotional consequence of the condition (p = 0.016). Understanding the phenomenon of active medical help-seeking may facilitate the design of specific strategies to improve the detection of cognitive impairment, especially in patients with a lower level of educational attainment and poor awareness of their condition.

More Choices, More Problems? Ranked Choice Voting Errors in New York City

Examining the impacts of ranked choice voting (RCV) on voter efficacy is important as more areas consider adoption. The greater number of choices provided by longer RCV ballots may introduce opportunities for voters to misunderstand the ballot, make errant marks, or accidentally mark two or more candidates for one ranking, resulting in voidable ballots due to “overvoting.” Using ballot data from the 2013 general election, the 2017, and 2021 New York City democratic mayoral primaries, this paper asks whether voidable overvote ballots are more concentrated in constituencies with lower levels of educational attainment, average household incomes, and differing racial make-ups, and if this relationship is more pronounced under RCV than traditional elections. In the first RCV election in 2021, voters in locations with lower levels of educational attainment and median household incomes had higher shares of overvote voidable ballots than those in locations with higher educational attainment and incomes.

Violence among pregnant women in Denmark from 2019 to 2021 – A hospital-based cross-sectional study

We examined the prevalence of lifetime physical and any recent violence and related maternal characteristics and health in pregnant women. We used Patient Reported Outcomes data retrieved from the Copenhagen Pregnancy Cohort (n = 7,361). The prevalence of lifetime physical and any recent violence was 4.0 % and 1.6 %, respectively. For both lifetime and any recent violence, the highest prevalence rates were seen among women aged 18–24, non-cohabiting, smokers, low levels of educational attainment, and women with chronic medical and psychiatric disease and lower psychological well-being. The prevalence may potentially be underestimated in this study, highlighting the need for improving screening for violence.

Spouses of individuals living with mild cognitive impairment or dementia in the United States: A descriptive, population-based study.

Little is known about the population of individuals who live with a spouse with cognitive impairment (CI) or dementia. Using the US Health and Retirement Study, 2000 to 2018, we estimated the population of adults ≥ 50 years old co-residing with a spouse with probable CI/dementia. We described their socio-demographic and health characteristics and quantified socio-demographic inequities. Among community-dwelling adults ≥ 50 years old, 6% of women and 4% of men co-resided with a spouse with probable CI/dementia. Among those who were married/partnered, the prevalence of spousal dementia was greater for Black and Hispanic adults compared to their White counterparts, and for those with lower versus higher educational attainment. Among spouses, activities of daily living disability, depression, and past 2-year hospitalization was common. Millions of older adults, disproportionately Black and Hispanic people and people with lower levels of educational attainment, live with a spouse with CI while also facing their own major health challenges.

Impact of Racial, Age, Marital, and Socioeconomic Status Disparities on the Survival of Hairy Cell Leukemia: A Population-Based Study

Introduction Several studies report excellent long-term overall survival (OS) for patients with hairy cell leukemia (HCL). Other studies show that racial and socioeconomic disparities impact outcomes among cancer patients. In the US, healthcare access is closely related to insurance coverage. Hispanics are the least likely to have insurance of any racial or ethnic group; they have lower levels of educational attainment and had a poverty rate of 17% in 2019-2020. Age and Marital status were also demonstrated to be independent prognostic factors in other cancers. We assessed the effect of race, age, marital and socioeconomic status on the overall survival and cause-specific mortality of HCL, which is generally associated with a good outcome. Methods We queried the Surveillance, Epidemiology, and End Results (SEER) registry for patients diagnosed with HCL between 2000 and 2020. Data were collected on age at diagnosis, race/ethnicity, marital status, socioeconomic status as defined by the annual household income data, time and cause of death. The chi-squared test was used to assess the association between two categorical variables, the Mann-Whitney U test and the Kruskal-Wallis test were used for continuous data that were non-normally distributed. The Kaplan-Meier method was used for survival analysis. Statistically significant differences between the curves were estimated using the 2 tailed log-rank test. Cox proportional hazard models were used for multivariable analysis. Results We identified 5299 HCL patients, survival data was available for 5280 patients. The median age was 59; interquartile range (IQR) (49-71) In the study population, 38% (2019) patients were ≥ 65 years at diagnosis, and 61% (3259) were married. Male patients (4188) represented 79% of HCL. Hispanic patients (491) represented 9% of patients. Eight percent (427) had an annual household income of <$50K. The median OS for the study population was 84 months; IQR (32-148.8). The HCL case fatality rate was 11% for the entire study population. Hispanic ethnicity was associated with reduced OS with a median OS of 70 months; IQR (23.5-134.5) compared to 86 months; IQR (32-150) for the rest of the population (p ≤0.001). Patients diagnosed at age <65 years old had a higher median OS of 105 months; IQR (47-170) vs 55 months; IQR (20-106) in patients ≥65 years old (p ≤0.001). Married patients had a better median OS of 89 months; IQR (36-156) compared to 69 months; IQR (24-134) in the unmarried group (p <0.001). Patients with an annual household income ≥$50K had a better median OS of 85 months; IQR (32-150) than patients with a lower household annual income of 76 months; IQR (27-136) (p=0.012). HCL cause-specific mortality was significantly better in the patients diagnosed at age <65 (5%), married group (10%) and household annual income ≥$50K (11%) compared to patients diagnosed ≥65 (22%), unmarried (15%) and patients with household annual income <$50K (16%) (p ≤0.001, ≤0.001, ≤0.001 respectively), but was not significant based on race, Hispanic (10%) versus Non-Hispanic ethnicity (11%) (p =0.492). Conclusions Our analysis shows a significantly better effect of age <65, marital status being married, and socioeconomic status with household annual income ≥$50K on the overall survival and cause-specific mortality of patients with HCL. Patients of Hispanic ethnicity had reduced overall survival but no difference in HCL cause-specific mortality. Hispanic, older, unmarried, and patients with low annual income may need more support, and resources to improve their outcomes and eliminate disparities.

Early marriage and its associated factors among women in Ethiopia: Systematic reviews and meta-analysis.

Early marriage is defined as the union of one or both partners before reaching the age of 18 for the first time. This practice is widely prevalent in underdeveloped countries, particularly in Ethiopia, and has been observed to have detrimental effects on the educational and personal development of both male and female individuals. The present study conducted a comprehensive search of the Science Direct, Scopus, Google Scholar, EMBASE, and PubMed databases. The data were extracted using Microsoft Excel (version 14) and analyzed using STATA statistical software. To examine publication bias, a forest plot, rank test, and Egger's regression test were utilized. Heterogeneity was assessed by calculating I2 and conducting an overall estimated analysis. Additionally, subgroup analysis was performed based on the study region and sample size. The pooled odds ratio was calculated. Out of a total of 654 articles, 14 papers with 67,040 research participants were included in this analysis. The pooled prevalence of early marriage among women in Ethiopia was 56.34% (95% CI: 51.34-61.34), I2 = 78.3%). The Amhara region exhibited the highest prevalence of early marriage, with a rate of 59.01%, whereas the Oromia region demonstrated the lowest incidence, with a prevalence rate of 53.88%. The prevalence of early marriage was found to be 58.1% for a sample size exceeding 1000, and 50.9% for a sample size below 1000. No formal education (AOR = 5.49; 95%CI: 2.99, 10.07), primary education (AOR = 3.65; 95%CI: 2.11, 6.32), secondary education (AOR = 2.49; 95%CI: 1.60, 3.87), rural residency (AOR = 4.52; 95%CI: 1.90, 10.74) and decision made by parents (AOR = 2.44; 95%CI: 1.36, 4.39) were associated factors. In Ethiopia, there was a high rate of early marriage among women. The research findings indicate that early marriage is more prevalent among mothers who possess lower levels of educational attainment, reside in rural areas, and are subject to parental decision-making. Our stance is firmly in favor of expanding the availability of maternal education and promoting urban residency. Furthermore, the promotion of autonomous decision-making by clients regarding their marital affairs is of paramount importance to family leaders.

Social interactions and COVID-19 vaccine hesitancy: Evidence from a full population study in Sweden.

We investigate whether an individual's information milieu-an individual's residential neighborhood and co-workers-affects the decision to get a COVID-19 vaccine. The decision to accept or refuse a vaccine is intensely personal and involves the processing of information about phenomena likely to be unfamiliar to most individuals. One can thus expect an interplay between an individual's level of education and skills and the information processing of others whom with whom she can interact and whose decision she can probe and observe. Using individual-level data for adults in Sweden, we can identify the proportion of an individual's neighborhood and workplace who are unvaccinated as indicators of possible peer effects. We find that individuals with low levels of educational attainment and occupational skills are more likely to be unvaccinated when exposed to other unvaccinated individuals at work and in the residential neighborhood. The peer effects in each of these information milieus further increases the likelihood of not getting vaccinated-with the two acting as information channels that reinforce one another.

Study shows growth in overdoses accelerating at lower education levels

In findings that the author called “glaring” and “startling,” a newly published study documents an association between lower levels of educational attainment and steeper increases in recent drug overdose deaths. The disparities in overdose deaths based on education level have become particularly prominent since 2018, a finding that the investigator has attributed in part to the effects of a dynamic opioid market.

Factors associated with daily use of benzodiazepines/tranquilizers and opioids among people who use drugs.

Co-use of benzodiazepines and opioids significantly increases fatal overdose risk, yet few studies have examined co-use of these drugs when obtained both with and without a prescription. We examined associations of daily co-use of prescribed benzodiazepines/tranquilizers (BZD/TRQ) and prescribed and nonprescribed opioids among people who use street opioids (PWUO). PWUO (N = 417) were recruited from Baltimore City and neighboring Anne Arundel County, Maryland, and surveyed on sociodemographic characteristics, structural vulnerabilities, healthcare access and utilization, substance use, and overdose experiences. Multivariable logistic regression was used to identify factors associated with self-reported co-use. Participants were 46 years old on average, and predominantly Black (74%) males (62%). Daily co-use was reported by 22%. In multivariable analyses, odds of co-use were significantly higher among participants who did not have a high school degree/GED (adjusted odds ratio [aOR]: 1.71, 95% confidence interval [CI]: 1.02-2.88), endorsed receiving mental health treatment in the past 6 months (aOR: 2.13, 95%CI: 1.28-3.56), reported daily use of powdered cocaine (aOR: 3.57, 95% CI: 1.98-6.45), and synthetic cannabinoids (aOR: 3.11, 95% CI: 1.40-6.93). Odds of co-use were significantly lower among Black participants compared to white participants (aOR: 0.39, 95% CI: 0.19-0.82). Clinicians working with PWUO or who prescribe BZDs or opioids should screen patients who use cocaine or synthetic cannabinoids, have low level of educational attainment, or recently accessed mental health services, as these patients may be at higher risk for daily co-use of BZD/TRQ and opioids, and therefore lethal overdose.

The Genetic Causal Association between Educational Attainment and Risk of 12 Common Musculoskeletal Disorders: A Two-Sample Mendelian Randomization.

In numerous observational studies, there has been an indication that educational attainment (EA) can impact the intensity of pain and disability resulting from chronic musculoskeletal disorders. Nonetheless, the association observed in these studies is not entirely conclusive. The aim of this study was to investigate the genetic causal relationship between educational attainment and 12 musculoskeletal disorders using Mendelian randomization (MR). The meta-analysis of genome-wide association studies (GWAS) identified 3952 single-nucleotide polymorphisms (SNPs) associated with educational attainment (EA) from the Social Science Genetic Association Consortium (SSGAC). Genetic data for 12 musculoskeletal disorders, including osteonecrosis, osteoporosis, osteomyelitis, low back pain, gout, spinal stenosis, rheumatoid arthritis, meniscus derangement, rotator cuff syndrome, ankylosing spondylitis, cervicobrachial syndrome, and lateral epicondylitis, were obtained from the FinnGen consortium. We conducted a two-sample Mendelian randomization analysis to examine the causal effect of EA on the risk of these musculoskeletal disorders using the TwoSampleMR package in R. Based on the inverse-variance weighted (IVW) method, we found that a genetically predicted per standard deviation (SD) increase in EA was inversely associated with low back pain [odds ratio (OR) 0.46, 95% confidence interval (Cl) 0.51-0.61, p < 0.001], spinal stenosis (OR 0.62, 95% Cl 0.54-0.71, p < 0.001), rheumatoid arthritis (OR 0.65, 95% Cl 0.55-0.76, p < 0.001), meniscus derangement (OR 0.73, 95% Cl 0.65-0.82, p < 0.001), rotator cuff syndrome (OR 0.55, 95% Cl 0.49-0.61, p < 0.001), cervicobrachial syndrome (OR 0.50, 95% Cl 0.42-0.60, p < 0.001), and lateral epicondylitis (OR 0.30, 95% Cl 0.24-0.37, p < 0.001). There was no causal association between EA and osteonecrosis (OR 1.11, 95% CI 0.76-1.72, p = 0.60), osteoporosis (OR 0.91, 95% CI 0.65-1.27, p = 0.59), or osteomyelitis (OR 0.90, 95% CI 0.75-1.01, p = 0.22). Genetic predisposition to EA had a suggestive causal association with gout (OR 0.80, 95% CI 0.68-0.95, p = 0.01) and ankylosing spondylitis (OR 0.64, 95% CI 0.45-0.91, p = 0.01) after Bonferroni correction. None of the analyses revealed any horizontal pleiotropy or heterogeneity. In our investigation, we have uncovered evidence supporting a causal relationship between low level of EA and the incidence of certain musculoskeletal disorders. In the future, it is imperative to ascertain risk factors such as lifestyle patterns linked with EA to uncover the underlying causal relationship and offer informed interventions for individuals.

The Long-Run Effects of the 1930s Redlining Maps on Children

We estimate the long-run effects of the 1930s Home Owners Loan Corporation (HOLC) redlining maps by linking children in the full count 1940 census to 1) the universe of Internal Revenue Service (IRS) tax data in 1974 and 1979 and 2) the long form 2000 census. We use two identification strategies to estimate the potential long-run effects of differential access to credit along HOLC boundaries. The first strategy compares cross-boundary differences along HOLC boundaries to a comparison group of boundaries that had statistically similar preexisting differences as the actual boundaries. A second approach only uses boundaries that were least likely to have been chosen by the HOLC based on our statistical model. We find that children living on the lower-graded side of HOLC boundaries had significantly lower levels of educational attainment, reduced income in adulthood, and lived in neighborhoods during adulthood characterized by lower educational attainment, higher poverty rates, and higher rates of single-parent households. (JEL G21, I26, I32, J13, N32, R23, R31)

Are people interested in receiving advice from their general practitioner on how to protect their health during heatwaves? A survey of the German population

ObjectiveClimate change increases the frequency, intensity and length of heatwaves, which puts a particular strain on the health of vulnerable population groups. General practitioners (GPs) could reach these people and...

Sociodemographic profiles and determinants of relapse risks among people with substance use disorders in the Philippines: A survey in community and residential care settings

BackgroundMethamphetamine use is a major social and health issue in the Philippines. Former president Rodrigo Duterte prioritized combating illicit drugs, and the government launched an anti-drug campaign. People with substance use disorders (SUD) receive treatment and care in the community or residential treatment at Treatment and Rehabilitation Centers (TRCs) established by the Department of Health. However, since the content and quality of service are not sufficient, there is an urgent need for improvement. To this end, it is necessary to understand demographic characteristics, the severity of drug use, and treatment needs of this population. MethodsWe conducted a questionnaire survey of people with SUD in the community (n=308) and all TRC patients (n=1770) to obtain their demographic profiles. We also used the Drug Abuse Screening Test-20 (DAST-20) and the Stimulant Relapse Risk Scale (SRRS). ResultsBased on DAST-20 scores, the severity of dependence was not well-matched to the care provided; 12.4% of the community sample was in the severe or substantial categories and 14.2% of the TRC sample was in the low category. The TRC sample had a significantly higher relapse risk than the community sample, which was associated with a lower educational attainment level and comorbid alcohol dependence. ConclusionsIt is important to use standardized psychometric tools to match treatment with the severity of drug dependence. In addition, a wide variety of medical and social services need to be provided based on consideration of treatment needs to improve the well-being of this population.

Impact of adverse childhood experiences on life expectancy with depression in the U.K. population: The mitigating role of educational attainment

BackgroundAdverse childhood experiences (ACEs) are associated with depression in later life. ObjectiveThis study aimed to measure the impact of ACEs on life expectancy with depression (DLE) and to assess how educational attainment affected expectations. Participants and settingThe study used data on 5597 participants from the English Longitudinal Study of Aging (2006–2013). MethodsDepression was assessed through the eight-item short version of the Centre for Epidemiologic Studies Depression. We used discrete-multistate life table models to estimate total life expectancy and life expectancy with depression. ResultsOlder adults with ACEs had longer DLE and a higher proportion of remaining life with depression compared with those without ACEs. For example, men aged 60 years with ACEs could expect to live 5.2 (95 % confidence interval (CI): 4.2, 6.2) years with depression compared with 2.8 (95 % CI: 2.3, 3.3) years for men without ACEs. Women aged 60 years who reported ACEs could expect to live 9.4 (95 % CI: 7.6, 11.1) years with depression compared with 6.0 (95 % CI: 5.1, 7.0) years for women without ACEs. With a high level of educational attainment, older adults from younger cohorts with ACEs lived fewer depression years and spent a higher proportion of their life being free of depression than adults with ACEs and had a low level of educational attainment. ConclusionOur results indicated that ACEs may increase years of life with depression among U.K. adults. Meanwhile, high educational attainment could mitigate the mental health burden associated with ACEs.

Perspectives About Racism and Patient-Clinician Communication Among Black Adults With Serious Illness

Black patients with serious illness experience higher-intensity care at the end of life. Little research has used critical, race-conscious approaches to examine factors associated with these outcomes. To investigate the lived experiences of Black patients with serious illness and how various factors may be associated with patient-clinician communication and medical decision-making. In this qualitative study, one-on-one, semistructured interviews were conducted with 25 Black patients with serious illness hospitalized at an urban academic medical center in Washington State between January 2021 and February 2023. Patients were asked to discuss experiences with racism, how those experiences affected the way they communicated with clinicians, and how racism impacted medical decision-making. Public Health Critical Race Praxis was used as framework and process. The experience and of racism and its association, as described by Black patients who had serious illness, with patient-clinician communication and medical decision-making within a racialized health care setting. A total of 25 Black patients (mean [SD] age, 62.0 [10.3] years; 20 males [80.0%]) with serious illness were interviewed. Participants had substantial socioeconomic disadvantage, with low levels of wealth (10 patients with 0 assets [40.0%]), income (annual income <$25 000 among 19 of 24 patients with income data [79.2%]), educational attainment (mean [SD] 13.4 [2.7] years of schooling), and health literacy (mean [SD] score in the Rapid Estimate of Adult Literacy in Medicine-Short Form, 5.8 [2.0]). Participants reported high levels of medical mistrust and high frequency of discrimination and microaggressions experienced in health care settings. Participants reported epistemic injustice as the most common manifestation of racism: silencing of their own knowledge and lived experiences about their bodies and illness by health care workers. Participants reported that these experiences made them feel isolated and devalued, especially if they had intersecting, marginalized identities, such as being underinsured or unhoused. These experiences were associated with exacerbation of existing medical mistrust and poor patient-clinician communication. Participants described various mechanisms of self-advocacy and medical decision-making based on prior experiences with mistreatment from health care workers and medical trauma. This study found that Black patients' experiences with racism, specifically epistemic injustice, were associated with their perspectives on medical care and decision-making during serious illness and end of life. These findings suggest that race-conscious, intersectional approaches may be needed to improve patient-clinician communication and support Black patients with serious illness to alleviate the distress and trauma of racism as these patients near the end of life.