Recent Birth Cohorts Research Articles

Socioeconomic pathways to inequalities in mental and functional health: a comparative study of three birth cohorts

BackgroundAlthough the educational expansion is often seen as a mechanism that might reduce health inequalities, socioeconomic inequalities in health (SEIH) have persisted or increased over the past decades. Theories suggest that this persistence could be due to a changing role of education as a ‘gatekeeper’ to access other socioeconomic resources such as occupation and income that are also associated with health outcomes. To test this, we examine whether the mediating role of occupation and income in the education–health relationship differs between three cohorts of 55–64 year old adults.MethodsWe used cross-sectional data from three cohorts of 988, 1002, and 1023 adults born in 1928/37, 1938/47 and 1948/57 and observed in 1992/93, 2002/03, 2012/13 respectively, who participated in the Longitudinal Aging Study Amsterdam, the Netherlands. We used multigroup structural equation modelling to compare the strength of indirect effects of education via occupational skill level and income to functional limitations and depressive symptoms between cohorts.ResultsAbsolute educational inequalities in functional limitations increased for men and women in later cohorts, and in depressive symptoms only for men. Relative inequalities in functional limitations increased only for women and in depressive symptoms only for men. The indirect effect of education via income on both health outcomes was weaker in the most recent birth cohort compared to the earlier cohorts. In contrast, the indirect effect of education via occupation on functional limitations was stronger in the most recent cohort compared to the earlier cohorts. These differences were mainly due to a decreasing direct effect of education on income and an increasing direct effect of education on occupational skill level, rather than to changes in the direct effects of occupation and income on health.ConclusionsThe role of education in determining inequalities in health appears to have changed across cohorts. While education became a less important determinant of income, it became a more important determinant of occupational level. This changing role of education in producing health inequalities should be considered in research and policy.

A century of sexual abuse victimisation: A birth cohort analysis.

This study examined changes in the reported prevalence of adult and child sexual abuse over the last century and explored how changes in social and political circumstances may have affected rates. Data from two population-based face-to-face surveys conducted in New Zealand (samples of 2855 women in 2003 and 1464 women in 2019) were used to produce birth cohort prevalence estimates of three forms of sexual abuse including by an intimate partner (lifetime and 12-month), by non-partners, and child sexual abuse. A timeline of major population influences that might be associated with violence occurrence was developed. There were no changes in reported lifetime intimate partner sexual abuse prevalence estimates found over the past century. The most recent birth cohort reported the lowest rates of 12-month prevalence estimates for intimate partner sexual abuse, lifetime rates of non-partner sexual abuse, and also suggest lower reported rates of child sexual abuse. Macro-social events including feminist movements, changes in legislation, and an increase in public awareness might have contributed to women's awareness about the non-acceptability of violent behaviour, and their ability to leave relationships after violence has occurred. This may have contributed to the small recent decreases in reported 12-month rate of sexual IPV and CSA, as women's ability to leave relationships may be protective for their children. The recent decrease in reported non-partner sexual violence may also be attributed to women's greater awareness of, and agency to avoid sexual abuse. The lack of change for the lifetime prevalence of sexual IPV over the past century highlights the need for ongoing prevention efforts. While recent reductions in reported rates of child and adult sexual abuse are encouraging, even reduced rates are high and warrant sustained implementation of prevention policies and programs.

High and Higher: Fertility of Black and White Women with College and Postgraduate Education in the United States

A postponement of first births among college graduates, and increases in childlessness in the US are well documented, as are black-white fertility differentials. However, little is known on how first birth postponement and childlessness differ between women with college and postgraduate education. Likewise, black-white fertility differentials among women with college and post-graduate education, in particular among recent birth cohorts, have not yet been addressed in the literature. We use the CPS Fertility Supplement 1979-2012 to estimate first birth survival functions for black and white women with college and post-graduate education for birth cohorts 1931-1980. Our findings show a significant postponement of the first birth by about 2 years among women with postgraduate education compared to college graduates. Median ages at first birth plateau around age 32-33 for this group. Differentials in childlessness between college graduates and women with postgraduate education are present in the 1940s and 1950s birth cohorts, but disappear for women born after 1960. Furthermore, black highly educated women have significantly more first births early in the life course and higher rates of non-marital fertility than their white counterparts across all birth cohorts. Our findings thus suggest diverging pathways into motherhood between black and white women, even among this most highly educated segment of the population.

Gender Inequality in STEM Employment and Earnings at Career Entry: Evidence from Millennial Birth Cohorts

Although science, technology, engineering, and mathematics (STEM) majors remain male dominated, women’s greater enrollment in STEM is one of the greatest transformations to occur in U.S. higher education in the past half century. But to what extent have women’s gains in STEM enrollment translated to greater parity in labor market outcomes? Although the challenges women face in STEM have been well documented, questions about the influence of gender for STEM employment and earnings differences remain. In the present research, the authors use data from recent birth cohorts in the American Community Survey between 2009 and 2018 (starting with the first year college majors were available in the survey) and a reweighting technique from labor economics to track the evolution of gender inequalities in STEM employment and earnings inequality among STEM work at the onset of labor market entry. Even among a sample expected to produce highly conservative gender differences, sizable gender inequalities in STEM employment are observed. The authors show that despite women’s gains in STEM education among recent cohorts, women with STEM degrees face employment prospects in STEM work that more closely resemble those of men without STEM degrees than men with STEM degrees. Moreover, although modest gender earnings gaps eventually emerge for those without STEM degrees, large gaps occur at the outset of employment for STEM workers. Thus, although STEM education provides important opportunities for women’s earning potential, it may be less effective in itself to address significant gender inequalities among STEM employment.

1064. Hepatitis C Epidemiology at the Dallas County Jail: A Changing Demographic

BackgroundNearly 1 in 3 people living with HCV pass through the CJ system each year. As a result, the CJ system is a crucial location for Hepatitis C screening, education and linkage to care. We aim to 1) identify the prevalence and incidence of HCV and 2) evaluate HCV demographic trends at a large urban jail.MethodsUniversal opt-out HCV testing was offered in four separate testing cycles from 2015 to 2019 to any individual undergoing a routine blood draw at the Dallas County Jail (N=14490; Figure 1). HCV antibody (Ab) assay (LabCorp) was used with reflex RNA testing added on in 2017. Demographic variables were extracted from the electronic medical record for all tested, with risk factors collected from those who tested positive for HCV Ab (HCV Ab+). Multivariate logistic regression was performed.Figure 1. HCV Ab and HCV RNA positivity among people screened for HCV in the Dallas County Jail from 2015 to 2019 (N=14490). ResultsThe prevalence of HCV Ab+ was 16.7% in the Dallas County Jail; 75.3% of those who tested HCV Ab+ were also HCV RNA+ (Figure 1). The HCV Ab+ incidence rate was 13.5 cases per 1000 person-years. People who were HCV Ab+ were more frequently (adjusted odds ratio [95% confidence interval], p-value): older (1.07 (1.06-1.07), p< 0.001), female (1.24 [1.07-1.44], p=0.004), white (2.12 [1.83-2.45], p< 0.001), and in the birth cohort 1945-65 (1.79 [1.44-2.23], p< 0.001; Table 1). In earlier birth cohorts (1940s), black men were more often HCV Ab+; in more recent birth cohorts (1990s), white and Hispanic females were more often HCV Ab+ (Figure 2). Among individuals who tested HCV Ab+, IDU was more frequently reported by white individuals, particularly women, compared to black individuals (p< 0.001; Figure 3).Table 1. Demographic predictors of Hepatitis C Antibody positivity among those undergoing routine blood draws from 2015-19 at the Dallas County Jail (AIC 7041; BIC 7048; df 10; p<0.001). Figure 2. Trends of Hepatitis C Antibody prevalence and demographic prevalence ratios by birth year (prevalence ratio= proportion with disease/proportion with exposure) among people at the Dallas County Jail screened from 2017-2019 (N=10183). Demographic prevalence ratios were categorized by race (White, Hispanic, Black) and gender (Male, Female) into six categories. Gray bars represent the overall prevalence of HCV Ab+ by birth year. Figure 3. The racial demographics of injection drug use by gender among those who tested HCV Ab positive at the Dallas County Jail in 2017-2018 (n=672; total population p<0.001; male p=0.004; female p=0.008). ConclusionThe high prevalence and incidence of HCV at the Dallas County Jail argues for routine, universal testing and linkage to treatment. Additionally, demographic trends mirror the IDU epidemic and have valuable implications for risk reduction and treatment interventions.Disclosures Ank E. Nijhawan, MD, MPH, Gilead (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)

Are there birth cohort effects in disparities in child obesity by maternal education?

Children belonging to the same birth cohort (i.e., born in the same year) experience shared exposure to a common obesity-related milieu during the critical early years of development-e.g., secular beliefs and feeding practices, adverse chemical exposures, food access and nutrition assistance policies-that set the stage for a shared trajectory of obesity as they mature. Fundamental cause theory suggests that inequitable distribution of recent efforts to stem the rise in child obesity may exacerbate cohort-based disparities over time. Data were from electronic health records spanning 2007-2016 linked to birth records for children ages 2-19 years. We used hierarchical age-period-cohort models to investigate cohort effects on disparities in obesity related to maternal education. We hypothesized that maternal education-based disparities in prevalence of obesity would be larger among more recent birth cohorts. Sex-stratified models adjusted for race/ethnicity showed substantial obesity disparities by maternal education that were evident even at young ages: prevalence among children with maternal education < high school compared to maternal college degree was approximately three times as high among girls and twice as high among boys. For maternal education < high school, disparities compared to maternal college degree were higher in more recent birth cohorts. Among girls, this disparity cohort effect was evident at younger ages (at age 4, the disparity increased by 4 [0.1-8] percentage points per 5 birth years), while among boys it was larger at older ages (at age 16, the disparity increased by 7 [1-14] percentage points per 5 birth years). There may be widening maternal education-based disparities in child obesity by birth cohort at some ages.

Long-run health trends in Europe

Abstract Long-run health trends are worsening for middle-aged baby-boomers in the US. In contrast to this alarming development, Abeliansky and Strulik (2019, A&S), in one of the few studies of long-term health developments in Europe, find improving health trends in Europe across a broad range of cohorts. We conducted a cohort analysis of health deficits similar to A&S but focused on middle-aged individuals. We find that the positive health trend has all but stalled for the more recent birth cohorts in Europe. Our results are robust to a large range of different definitions of the health index. We argue that the difference between A&S and our results is due to longitudinal sample selectivity bias. Our findings have implications for future public and private costs of health care, and they are relevant for the ongoing discussion on how to achieve longer healthy working lives.

Assessment of Age, Period, and Birth Cohort Effects and Trends in Merkel Cell Carcinoma Incidence in the United States

Merkel cell carcinoma is an aggressive, cutaneous, neuroendocrine cancer that is increasing in incidence. Understanding why the incidence of Merkel cell carcinoma is increasing through underlying factors, such as age effects, calendar period of diagnosis effects, and birth cohort effects, can help guide resource allocation and design of screening programs. To evaluate the associations of patient age, calendar period of diagnosis, and birth cohort with the increasing incidence of Merkel cell carcinoma and to provide new incidence projections to 2030. A cross-sectional retrospective study with age-period-cohort analysis and incidence projection modeling using data from the Surveillance, Epidemiology, and End Results Program database of 9 registries from 1987 to 2016 was conducted among 3720 patients with Merkel cell carcinoma. Statistical analysis was conducted from October 20, 2019, to July 29, 2020. Age effects (ie, physiology), period of diagnosis effects (ie, changes in diagnostics and clinical awareness), and birth cohort effects (ie, environmental risk factors) over time were assessed. Incidence rates of Merkel cell carcinoma. Among the 3720 patients in the study (2200 male patients [59.1%]; median age, 77 years [interquartile range, 68-84 years]), during the period from 2012 to 2016, the age-adjusted Merkel cell carcinoma incidence rate was 0.66 per 100 000 (95% CI, 0.62-0.70), which represented a 3.5-times (95% CI, 3.0-4.2) increase from 1987 to 1991. The incidence of Merkel cell carcinoma increased with patient age across calendar periods and birth cohorts; the highest incidence rate was observed for those aged 85 years or older, with an age-adjusted rate from 2012 to 2016 of 14.6 per 100 000 for men and 5.5 per 100 000 for women. Although the birth cohort effect has continued to increase over time, the calendar period of diagnosis effect has started to plateau. It is projected that there will be 3023 new cases of Merkel cell carcinoma in 2020 and 5130 new cases in 2030, increased from an estimated 1933 cases in 2010. The slowing down of the period effect (ie, changes in diagnostics and awareness) found in this longitudinal cohort study suggests that part of the initial increased incidence of Merkel cell carcinoma was associated with increased detection. However, the projected increase in incidence rate is likely associated with the aging population and increasing risk factor exposure in more recent birth cohorts.

Trends in the Burden of Untreated Caries of Permanent Teeth in China, 1993–2017: An Age–Period–Cohort Modeling Study

This study aims to identify the trends in incidence and prevalence of untreated caries in permanent teeth in China during 1993-2017. Data representing >31 billion person-years of observation from the Global Burden of Disease study 2017 were analyzed. Age-period-cohort modeling was performed to investigate the trends in untreated caries that may be of value to policymakers. Analyses were conducted in 2019-2020. Prevalence of untreated caries in permanent teeth decreased steadily before 2010; after which, an increasing trend was noted without the signs of plateauing (age-adjusted annual percentage change, 1993-2017: -0.54%, 95% CI= -0.75%, -0.33%; declining period RR, 1993-2017: p=6.33 × 10-9; declining cohort RR, 1993-2017: p=3.46 × 10-6). Although untreated caries prevalence declined overall among multiple age groups (p<0.05), an increase in prevalence after 2010 was noted. This was driven by the deteriorating oral health condition in recent birth cohorts aged <25 years. Estimates of the longitudinal age trend (incidence: -0.013, 95% CI= -0.015, -0.011; prevalence: -0.0038, 95% CI= -0.0060, -0.0015) suggested that the highest untreated caries incidence and prevalence rate were both observed among young adults aged 20-24 years. No differences between incidence and prevalence of untreated caries were observed among adults aged >55 years (p>0.05). The increased burden of untreated caries in China after 2010 is driven by those aged <25 years. Untreated caries data from the Global Burden of Disease study are a valid complement to the data from the Chinese National Oral Health Epidemiology Surveys.

Age, period and cohort trends in oral health status in South Korean adults.

The purpose of this study was to identify the age, period and cohort effects on the changes in oral health status in South Koreans. The age, period and cohort analysis (APC analysis) of the oral health status was conducted using an aggregated age-by-time period table. The age-by-time period table was formulated using data from the Korea National Oral Health Survey (KNOHS) 2000 and 2006, and the Korea National Health and Nutrition Examination Survey (KNHANES) 2010 and 2015. Two oral health outcomes were measured: the number of teeth and Decayed-Missing-Filled Teeth (DMFT) index. Descriptive analysis by graphical representation and partial least square (PLS) regression was used for APC analysis. Both graphical description and PLS regression showed age and cohort effects in oral health status with the number of teeth decreasing and the DMFT index increasing with age. No period effects were found in either index. The number of teeth increased in the recent birth cohorts. However, the DMFT index showed a reverse J-shaped trend, which worsened in recent birth cohorts. The DMFT index increase in the recent cohort was mainly attributed by an increase in the FT index. The effects of age on the number of teeth and caries highlight the importance of oral health in adulthood. The increased caries experience in recent cohorts may indicate the limitations of the current oral health policy. It would be relevant to explore what determinants cause the changes in oral health status. Future oral health policies should address the new directions to reduce the burden of oral diseases.

Secular Trends of Physical Fitness in Twenty-Five Birth Cohorts of Slovenian Children: A Population-Based Study.

In Slovenia, the national SLOfit surveillance system of the somatic and motor development of children and youth has been enabling researchers to observe the developmental trends of the entire population of school-aged children since 1987. The national database currently incorporates over 7.2 million sets of measurements of eight fitness tests and three anthropometric measurements. Since 1991, as in the rest of the world, in Slovenia, there is a common perception that the physical fitness of contemporary children is in decline and below the level of the physical fitness of the previous generation's childhood fitness. Our paper examines the trends of physical fitness in 26 birth cohorts of 7–10-year-olds. The analysis shows that the secular trends of physical fitness in boys and especially in girls have been positive and that the level of physical fitness of recent birth cohorts exceeds the national average of physical fitness of the 1989–2019 period. At the same time, the analysis reveals that the distribution of physical fitness has been changing from almost normal in the cohorts born in the first half of the 1980s, toward positively skewed in the subsequent cohorts born before the year 2000, and bimodal distribution in the later cohorts, indicating growing inequality and polarization of the motor development of children.

Community context, birth cohorts and childhood body mass index trajectories: Evidence from the China nutrition and health survey 1991-2011.

Childhood overweight and obesity have shown an increase in recent birth cohorts. China has undergone rapid socioeconomic transitions accompanied by lifestyle changes that have profoundly affected the physical growth of children. Less empirical research has considered the role of community context on the cohort effects of children's body mass index (BMI) z-score trajectories. We used the mixed effect models for repeated measurements with restricted cubic spline to predict the BMI z-score trajectories in children aged 1-17 years, influenced by different birth cohorts and community context using data from the China Health and Nutrition Survey from 1991 to 2011, and stratified by sex. Results indicated that the mean of BMI z-scores of children aged 1-17 years have increased in the 2000s cohort. Community context contributed to significant differences in BMI z-score increase with age from middle childhood, and this trend of community inequalities divergences in middle childhood in recent birth cohorts. Therefore, to promote equitable growth for all children in China, policy interventions focusing on the community context may have far-reaching effects on the health of children and adolescents.

The effect of sibship size on educational attainment of the first born: evidence from three decennial censuses of Taiwan

There exists extensive literature analyzing the effect of sibship size and a child’s educational attainment, termed the quantity-quality (QQ) trade-off. Studies using data from developed countries tend to find limited or nonexistent effects, while studies that use data from developing countries find a wide range of relationships. We study a possible explanation for these seemingly contradictory findings that the existence or non-existence of a QQ trade-off is correlated with the socioeconomic context within which the family resides. We use the census files comprised of the entire Taiwan population in the years 1980, 1990, and 2000, reflecting different levels of economic growth across time, coupled with an instrumental variable approach and more than 7000 village fixed effects. Our results indicate that sibship size has large and significant effects on educational outcomes, measured in terms of high school and college enrollments, for early birth cohorts, and the effects diminish for more recent birth cohorts. In addition, we find that areas in different developmental stages face different QQ trade-offs: areas with higher levels of development only have trade-offs among higher measures of quality.

Elusive Longer-Run Impacts of Head Start: Replications Within and Across Cohorts

Using an additional decade of data from the National Longitudinal Survey of Youth 1979 Children and Young Adults (CNLSY), this study replicated and extended Deming’s evaluation of Head Start’s life cycle skill formation impacts in three ways. Extending the measurement interval for Deming’s adulthood outcomes, we found no statistically significant impacts on earnings and mixed evidence of impacts on other adult outcomes. Applying Deming’s sibling comparison framework to more recent birth cohorts born to CNLSY mothers revealed mostly negative Head Start impacts. Combining all cohorts showed generally null impacts on school-age and early adulthood outcomes.

Emerging cancer incidence trends in Canada: The growing burden of young adult cancers.

Recent studies have identified increases in cancer incidence among younger adults for some cancers. This study examined incidence trends for 28 cancers in Canada by age and birth cohort from 1983 to 2012. Canadian incidence data for 20 to 84 year-olds were obtained from the Cancer Incidence in Five Continents Plus database. Age-period-cohort modeling was used to estimate the average annual percentage changes (AAPCs) and incidence rate ratios (IRRs) for 10-year birth cohorts (reference cohort, 1943) for 28 cancer types. Incidence increased for 13 cancer sites among adults younger than 50years (1983-2012), with the largest increase occurring for rectal cancer (AAPC20-24 , 5.62; 95% confidence interval [CI], 3.77-7.51) and colon cancer (AAPC20-24 , 4.08; 95% CI, 2.89-5.29). Compared with the 1943 birth cohort, persons born circa 1988 had approximately 5- and 2-fold greater risks of rectal cancer (IRR, 4.98; 95% CI, 2.87-8.63) and colon cancer (IRR, 2.31; 95% CI, 1.62-3.30), respectively. Incidence decreased among younger adults for 9 sites (1983-2012), with the largest decreases observed for lung cancer (AAPC25-29 ,-2.29; 95% CI, -3.57 to -0.98), cervical cancer (AAPC25-29 , -1.29; 95% CI, -1.67 to -0.90), and melanoma (AAPC25-29 , -0.61; 95% CI, -0.97 to -0.24). Decreased risks in recent birth cohorts were observed for all sites with decreasing trends in younger adults. For example, the risk of lung cancer was 60% lower in the 1988 birth cohort than the 1943 birth cohort (IRR, 0.42; 95% CI, 0.23-0.78). Incidence among young adults is increasing for some cancers associated with obesity but decreasing for many cancers associated with infections or smoking. Although further studies are needed to replicate these findings and understand the etiology of early-onset cancers, measures to promote healthy behaviors in young adults warranted.

Better Hearing in Norway: A Comparison of Two HUNT Cohorts 20 Years Apart.

To obtain updated robust data on a age-specific prevalence of hearing loss in Norway and determine whether more recent birth cohorts have better hearing compared with earlier birth cohorts. Cross-sectional analyzes of Norwegian representative demographic and audiometric data from the Nord-Trøndelag Health Study (HUNT)-HUNT2 Hearing (1996-1998) and HUNT4 Hearing (2017-2019), with the following distribution: HUNT2 Hearing (N=50,277, 53% women, aged 20 to 101 years, mean = 50.1, standard deviation = 16.9); HUNT4 Hearing (N=28,339, 56% women, aged 19 to 100 years, mean = 53.2, standard deviation = 16.9). Pure-tone hearing thresholds were estimated using linear and quantile regressions with age and cohort as explanatory variables. Prevalences were estimated using logistic regression models for different severities of hearing loss averaged over 0.5, 1, 2, and 4 kHz in the better ear (BE PTA4). We also estimated prevalences at the population-level of Norway in 1997 and 2018. Disabling hearing loss (BE PTA4 ≥ 35 dB) was less prevalent in the more recent born cohort at all ages in both men and women (p < 0.0001), with the largest absolute decrease at age 75 in men and at age 85 in women. The age- and sex-adjusted prevalence of disabling hearing loss was 7.7% (95% confidence interval [CI] 7.5 to 7.9) and 5.3% (95% CI 5.0 to 5.5) in HUNT2 and HUNT4, respectively. Hearing thresholds were better in the more recent born cohorts at all frequencies for both men and women (p < 0.0001), with the largest improvement at high frequencies in more recent born 60- to 70-year old men (10 to 11 dB at 3 to 4 kHz), and at low frequencies among the oldest. The age- and sex-specific prevalence of hearing impairment has decreased in Norway from 1996-1998 to 2017-2019.

Black-White differences in vocational interests: Meta-analysis and boundary conditions

The present study investigated whether Black and White Americans differed on the dimensions of Holland’s RIASEC model of vocational interests. Theoretical explanations of why racial differences in interests may occur are advanced drawing on Gottfredson’s (1981) theory of circumscription and compromise, and social identity theory (Tajfel & Turner, 1986). A meta-analysis of 54 studies was conducted that included 926,462 participants and 306 effect sizes. Our results showed that, on average, Black Americans have stronger Social, Enterprising, and Conventional interests than White Americans; and White Americans have stronger Realistic and Investigative interests than Black Americans (no differences found on Artistic interests). Further, moderator analyses revealed that: (a) the Black-White gaps in Realistic, Investigative, Social, Enterprising, and Conventional interests all increase with education (in particular, with the onset of college), (b) the gaps in Social, Enterprising, and Conventional interests favoring Black Americans increase with age, and the gap in Realistic interests favoring White Americans decreases with age (although age and education effects tend to be confounded), (c) race gaps in Realistic and Social interests are larger in male samples, and (d) race gaps in Social, Enterprising, and Conventional interests may have decreased (but not disappeared) in more recent birth cohorts. We discuss these findings highlighting the roles of access to opportunity and of social identity in potentially giving rise to racial differences in interests. This research helps us discern factors that may contribute to diversity recruiting and the building of diverse talent pipelines in various careers.

The emerging risk of oropharyngeal and oral cavity cancer in HPV-related subsites in young people in Brazil.

Human papillomavirus (HPV) is responsible for the rise in the incidence of cancer in the oropharynx, tonsils, and base of the tongue (i.e., HPV-related subsites). HPV triggered the changes in the epidemiology of oropharyngeal and oral cavity cancer (OPC/OCC) in Asia, Europe, North America, and Oceania. Hence, the incidence of cancer in HPV-related subsites is augmenting, while that in other HPV-unrelated subsites is decreasing. In South America, although the incidence of HPV-positive tumors has gradually increased, there is an atypically low prevalence of HPV in people with OPC/OCC. To clarify whether this dramatic shift in incidence trends also occurred in this population, we estimated the burden of HPV on the incidence trends of OPCs/OCCs in São Paulo city in Brazil. In this population-based study, we categorized OPCs/OCCs by HPV-related and HPV-unrelated subsites. We used Poisson regression to assess the age-standardized incidence rates (ASRs) stratified by sex and age groups, as well as to examine the age-period-cohort effects. There were 15,391 cases of OPCs/OCCs diagnosed in HPV-related (n = 5,898; 38.3%) and HPV-unrelated (n = 9,493; 61.7%) subsites. Overall, the ASRs decreased for most subsites, for both sexes and for all age groups, except for HPV-related OPC/OCC in young males and females, which increased by 3.8% and 8.6% per year, respectively. In the birth-cohort-effect analysis, we identified an increasing risk for HPV-related OPC/OCC in both sexes in recent birth cohorts; however, this risk was sharply decreased in HPV-unrelated subsites. Our data demonstrate an emerging risk for HPV-related OPC/OCC in young people, which supports prophylactic HPV vaccination in this group.

A Long-Term Trend Study of Tuberculosis Incidence in China, India and United States 1992-2017: A Joinpoint and Age-Period-Cohort Analysis.

Tuberculosis (TB) is one of the major infectious diseases with the largest number of morbidity and mortality. Based on the comparison of high and low burden countries of tuberculosis in China, India and the United States, the influence of age-period-cohort on the incidence of tuberculosis in three countries from 1992 to 2017 was studied based on the Global burden of Disease Study 2017. We studied the trends using Joinpoint regression in the age-standardized incidence rate (ASIR). The regression model showed a significant decreasing behavior in China, India and the United States between 1992 and 2017. Here, we analyzed the tuberculosis incidence trends in China, India, as well as the United States and distinguished age, period and cohort effects by using age-period-cohort (APC) model. We found that the relative risks (RRs) of tuberculosis in China and India have similar trends, but the United States was found different. The period effect showed that the incidence of the three countries as a whole declines with time. The incidence of tuberculosis had increased in most age group. The older the age, the higher the risk of TB incidence. The net age effect in China and India showed a negative trend, while the cohort effect decreased from the earlier birth cohort to the recent birth cohort. Aging may lead to a continuous increase in the incidence of tuberculosis. It is related to the aging of the population and the relative decline of the immune function in the elderly. This should be timely population intervention or vaccine measures, especially for the elderly. The net cohort effect in the United States showed an unfavorable trend, mainly due to rising smoking rates and the emergence of an economic crisis. Reducing tobacco consumption can effectively reduce the incidence.

From Aristocratic to Ordinary: Shifting Modes of Elite Distinction

How do elites signal their superior social position via the consumption of culture? We address this question by drawing on 120 years of “recreations” data ( N = 71,393) contained within Who’s Who, a unique catalogue of the British elite. Our results reveal three historical phases of elite cultural distinction: first, a mode of aristocratic practice forged around the leisure possibilities afforded by landed estates, which waned significantly in the late-nineteenth century; second, a highbrow mode dominated by the fine arts, which increased sharply in the early-twentieth century before gently receding in the most recent birth cohorts; and, third, a contemporary mode characterized by the blending of highbrow pursuits with everyday forms of cultural participation, such as spending time with family, friends, and pets. These shifts reveal changes not only in the contents of elite culture but also in the nature of elite distinction, in particular, (1) how the applicability of emulation and (mis)recognition theories has changed over time, and (2) the emergence of a contemporary mode that publicly emphasizes everyday cultural practice (to accentuate ordinariness, authenticity, and cultural connection) while retaining many tastes that continue to be (mis)recognized as legitimate.