Bad for you

Kevin Lewis

April 04, 2017

Changing Patterns in Rates and Means of Suicide in California, 2005 to 2013
Ellicott Matthay, Jessica Galin & Jennifer Ahern
American Journal of Public Health, March 2017, Pages 427-429

Methods: Data from statewide mortality records were used to estimate age-adjusted rates of suicide from 2005 to 2013, overall and by means, age, gender, race/ethnicity, urbanicity, and county.

Results: The suicide rate increased 12.6% between 2005 and 2013, from 11.2 to 12.6 per 100 000 population, but this overall trend masks substantial heterogeneity across subgroups. In particular, rapid increases were observed for individuals of multiple races/ethnicities. Means of suicide changed, trending away from firearms toward suffocation and drug poisoning.

Physical Functioning Trends among US Women and Men Age 45–64 by Education Level
Anna Zajacova & Jennifer Karas Montez
Biodemography and Social Biology, Spring 2017, Pages 21-30


Functional limitations and disability declined in the US during the 1980s and 1990s, but reports of early 21st century trends are mixed. Whether educational inequalities in functioning increased or decreased is also poorly understood. Given the importance of disability for productivity, independent living, and health care costs, these trends are critical to US social and health policies. We examine recent trends in functional limitations and disability among women and men aged 45–64. Using 2000–2015 National Health Interview Surveys data on over 155,000 respondents, semiparametric and logistic regression models visualize and test functioning trends by education. Among women and men with at least a college degree, there was no change in disability and mild increase in limitations over time. All other education levels experienced significant increases in functioning problems ranging from 18% higher odds of functional limitations in 2015 compared to 2000 among men with some college to about 80% increase in the odds of disability among women and men with less than high school education. The similar trends for both genders suggest common underlying causes, possibly including the worsening economic well-being of middle- and working-class families. The pervasive growth of functioning problems is a cause for concern that necessitates further scholarly investigation.

The Hidden Epidemic of Firearm Injury: Increasing Firearm Injury Rates During 2001–2013
Bindu Kalesan et al.
American Journal of Epidemiology, 1 April 2017, Pages 546-553


Investigating firearm injury trends over the past decade, we examined temporal trends overall and according to race/ethnicity and intent in fatal and nonfatal firearm injuries (FFIs and NFIs) in United States during 2001–2013. Counts of FFIs and estimated counts of NFIs were obtained from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System. Poisson regression was used to analyze overall and subgroup temporal trends and to estimate annual change per 100,000 persons (change). Total firearm injuries (n = 1,328,109) increased annually by 0.36 (Ptrend < 0.0001). FFIs remained constant (change = 0.02; Ptrend = 0.22) while NFIs increased (change = 0.35; Ptrend < 0.0001). Homicide FFIs declined (change = −0.05; Ptrend < 0.0001) while homicide NFIs increased (change = 0.43; Ptrend < 0.0001). Suicide FFIs increased (change = 0.07; Ptrend < 0.0001) while unintentional FFIs and NFIs declined (changes = −0.01 and −0.09, respectively; Ptrend < 0.0001 and 0.005). Among whites, FFIs (change = 0.15; Ptrend < 0.0001) and NFIs (change = 0.13; Ptrend < 0.0001) increased; among blacks, FFIs declined (change = −0.20; Ptrend < 0.0001). Among Hispanics, FFIs declined (change = −0.28; Ptrend < 0.0001) while NFIs increased (change = 0.55; Ptrend = 0.014). The endemic firearm-related injury rates during the first decade of the 21st century mask a shift from firearm deaths towards a rapid rise in nonfatal injuries.

Does gender inequity increase men's mortality risk in the United States? A multilevel analysis of data from the National Longitudinal Mortality Study
Shane Kavanagh, Julia Shelley & Christopher Stevenson
SSM - Population Health, forthcoming


A number of theoretical approaches suggest that gender inequity may give rise to health risks for men. This study undertook a multilevel analysis to ascertain if state-level measures of gender inequity are predictors of men's mortality in the United States. Data for the analysis were taken primarily from the National Longitudinal Mortality Study, which is based on a random sample of the non-institutionalised population. The full data set included 174,703 individuals nested within 50 states and had a six-year follow-up for mortality. Gender inequity was measured by nine variables: higher education, reproductive rights, abortion provider access, elected office, management, business ownership, labour force participation, earnings and relative poverty. Covariates at the individual level were age, income, education, race/ethnicity, marital status and employment status. Covariates at the state level were income inequality and per capita gross domestic product. The results of logistic multilevel modelling showed a number of measures of state-level gender inequity were significantly associated with men's mortality. In all of these cases greater gender inequity was associated with an increased mortality risk. In fully adjusted models for all-age adult men the elected office (OR 1.05 95% CI 1.01–1.09), business ownership (OR 1.04 95% CI 1.01–1.08), earnings (OR 1.04 95% CI 1.01–1.08) and relative poverty (OR 1.07 95% CI 1.03–1.10) measures all showed statistically significant effects for each 1 standard deviation increase in the gender inequity z-score. Similar effects were seen for working-age men. In older men (65+ years) only the elected office and earnings measures were statistically significant. This study provides evidence that gender inequity may increase men's health risks. The effect sizes while small are large enough across the range of gender inequity identified to have important population health implications.

Do U.S. states' socioeconomic and policy contexts shape adult disability?
Jennifer Karas Montez, Mark Hayward & Douglas Wolf
Social Science & Medicine, April 2017, Pages 115–126


Growing disparities in adult mortality across U.S. states point to the importance of assessing disparities in other domains of health. Here, we estimate state-level differences in disability, and draw on the WHO socio-ecological framework to assess the role of ecological factors in explaining these differences. Our study is based on data from 5.5 million adults aged 25–94 years in the 2010–2014 waves of the American Community Survey. Disability is defined as difficulty with mobility, independent living, self-care, vision, hearing, or cognition. We first provide estimates of age-standardized and age-specific disability prevalence by state. We then estimate multilevel models to assess how states' socioeconomic and policy contexts shape the probability of having a disability. Age-standardized disability prevalence differs markedly by state, from 12.9% in North Dakota and Minnesota to 23.5% in West Virginia. Disability was lower in states with stronger economic output, more income equality, longer histories of tax credits for low-income workers, and higher cigarette taxes (for middle-age women), net of individuals' socio-demographic characteristics. States' socioeconomic and policy contexts appear particularly important for older adults. Findings underscore the importance of socio-ecological influences on disability.

Trends in Automobile Travel, Motor Vehicle Fatalities, and Physical Activity: 2003−2015
Noreen McDonald
American Journal of Preventive Medicine, forthcoming

Methods: Minutes of auto travel and physical activity derived from active travel, sports, and exercise were obtained from the American Time Use Survey. Fatalities were measured using the Fatality Analysis Reporting System. Longitudinal change was assessed for adults aged 20–59 years by age group and sex. Significance of changes was assessed by absolute differences and unadjusted and adjusted linear trends. Analyses were conducted in 2016.

Results: Daily auto travel decreased by 9.2 minutes from 2003 to 2014 for all ages (p<0.001) with the largest decrease among men aged 20–29 years (Δ= −21.7, p<0.001). No significant changes were observed in total minutes of physical activity. Motor vehicle occupant fatalities per 100,000 population showed significant declines for all ages (Δ=−5.8, p<0.001) with the largest for young men (Δ= −15.3, p<0.001). Fatalities per million minutes of auto travel showed only modest declines across age groups and, for men aged 20–29 years, varied from 10.9 (95% CI=10.0, 11.7) in 2003 to 9.7 (95% CI=8.7, 10.8) in 2014.

Conclusions: Reduced motor vehicle fatalities are a public health co-benefit of decreased driving, especially for male millennials. Despite suggestions to the contrary, individuals did not switch from cars to active modes nor spend more time in sports and exercise. Maintenance of the safety benefits requires additional attention to road safety efforts, particularly as auto travel increases.

Sociodemographic disparities in chronic pain, based on 12-year longitudinal data
Hanna Grol-Prokopczyk
Pain, February 2017, Pages 313–322


Existing estimates of sociodemographic disparities in chronic pain in the United States are based on cross-sectional data, often treat pain as a binary construct, and rarely test for nonresponse or other types of bias. This study uses 7 biennial waves of national data from the Health and Retirement Study (1998-2010; n = 19,776) to describe long-term pain disparities among older (age 51+) American adults. It also investigates whether pain severity, reporting heterogeneity, survey nonresponse, and/or mortality selection might bias estimates of social disparities in pain. In the process, the article clarifies whether 2 unexpected patterns observed cross-sectionally — plateauing of pain above age 60, and lower pain among racial/ethnic minorities — are genuine or artefactual. Findings show high prevalence of chronic pain: 27.3% at baseline, increasing to 36.6% thereafter. Multivariate latent growth curve models reveal extremely large disparities in pain by sex, education, and wealth, which manifest primarily as differences in intercept. Net of these variables, there is no racial/ethnic minority disadvantage in pain scores, and indeed a black advantage vis-à-vis whites. Pain levels are predictive of subsequent death, even a decade in the future. No evidence of pain-related survey attrition is found, but surveys not accounting for pain severity and reporting heterogeneity are likely to underestimate socioeconomic disparities in pain. The lack of minority disadvantage (net of socioeconomic status) appears genuine. However, the age-related plateauing of pain observed cross-sectionally is not replicated longitudinally, and seems partially attributable to mortality selection, as well as to rising pain levels by birth cohort.

Primary Enforcement of Mandatory Seat Belt Laws and Motor Vehicle Crash Deaths
Sam Harper & Erin Strumpf
American Journal of Preventive Medicine, forthcoming

Methods: In 2016, researchers used motor vehicle crash death data from the Fatal Analysis Reporting System for 2000–2014 and calculated rates using both person- and exposure-based denominators. Researchers used a difference-in-differences design to estimate the effect of primary enforcement on death rates, and estimated negative binomial regression models, controlling for age, substance use involvement, fixed state characteristics, secular trends, state median household income, and other state-level traffic safety policies.

Results: Models adjusted only for crash characteristics and state-level covariates models showed a protective effect of primary enforcement (rate ratio, 0.88, 95% CI=0.77, 0.98; rate difference, –1.47 deaths per 100,000 population, 95% CI= –2.75, –0.19). After adjustment for fixed state characteristics and secular trends, there was no evidence of an effect of upgrading from secondary to primary enforcement in the whole population (rate ratio, 0.98, 95% CI=0.92, 1.04; rate difference, –0.22, 95% CI= –0.90, 0.46) or for any age group.

Conclusions: Upgrading to primary enforcement no longer appears protective for motor vehicle crash death rates.

The economic impact of the Food and Drug Administration’s Final Juice HACCP Rule
Travis Minor & Matt Parrett
Food Policy, April 2017, Pages 206–213


Using 1998–2008 data collected by the Centers for Disease Control and Prevention on foodborne illnesses and outbreaks, we examine the economic impact of the Food and Drug Administration’s final rule titled “Hazard Analysis and Critical Control Point (HACCP); Procedures for the Safe and Sanitary Processing and Importing of Juice” (the Final Juice Rule). Using a difference-in-differences approach, we find that the rule led to an annual reduction of between 462 and 508 foodborne illnesses associated with juice-bearing products. Furthermore, our reevaluated estimate of the rule’s benefits compares favorably to its estimated cost.

Segmented sleep in a nonelectric, small-scale agricultural society in Madagascar
David Samson et al.
American Journal of Human Biology, forthcoming

Objectives: We studied sleep in a rural population in Madagascar to (i) characterize sleep in an equatorial small-scale agricultural population without electricity, (ii) assess whether sleep is linked to noise levels in a dense population, and (iii) examine the effects of experimentally introduced artificial light on sleep timing.

Methods: Using actigraphy, sleep–wake patterns were analyzed for both daytime napping and nighttime wakefulness in 21 participants for a sum total of 292 days. Functional linear modeling was used to characterize 24-h time-averaged circadian patterns and to investigate the effect of experimentally introduced mobile field lights on sleep timing. We also obtained the first polysomnography (PSG) recordings of sleep in a traditional population.

Results: In every measure of sleep duration and quality, the Malagasy population experienced shorter and lower quality sleep when compared to similarly measured postindustrial values. The population slept for a total of 6.5 h per night and napped during 89% of recorded days. We observed a peak in activity after midnight for both sexes on 49% of nights, consistent with segmented sleep. Access to mobile field lights had no statistical effect on nighttime sleep timing. From PSG, we documented relatively short rapid eye movement (14%), poor sleep efficiency (66%), and high wake after sleep onset (162 min).

Conclusions: Sleep in this population is segmented, similar to the “first” sleep and “second” sleep reported in the historical record. Moreover, although average sleep duration and quality were lower than documented in Western populations, circadian rhythms were more stable across days.

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