Demographic Research

Background Vaccination programs have greatly reduced the burden of infectious diseases, particularly in childhood. As populations age, however, the burden of respiratory infections such as influenza A, respiratory syncytial virus (RSV), and SARS-CoV-2 increasingly falls on older adults. Because infection fatality rates rise steeply with age, vaccination strategies that alter the age distribution of infections may have complex population-level consequences. We used transmission models to examine how the timing and frequency of vaccination influence infection-induced mortality and years of life lost (YLL) in aging populations. Methods and findings We analyzed age-structured transmission models that incorporate demographic change, age-specific infection fatality rates, and waning immunity after infection or vaccination. We varied the age at first vaccination, vaccination intervals, and coverage across a wide range of pathogen characteristics, including transmissibility and the duration of natural and vaccine-induced immunity. For single-dose vaccination programs with long-lived protection (5-50 years), the age at vaccination minimizing mortality in older adults for pathogens with strongly age-increasing fatality risk typically ranges from 60 to 80 years. The optimal age shifted toward older ages when transmissibility was higher or natural immunity lasted longer. Repeated vaccination produced qualitatively different outcomes. When vaccine-induced immunity was short-lived ($<$5 years), vaccination can shift infections toward the oldest ages where fatality risks are highest, increasing both mortality and YLL compared with no vaccination. This study has limitations. Our analysis used stylized transmission models and assumed vaccines that fully prevent infection, which may overestimate age-shifting effects compared with real-world vaccines that primarily reduce disease severity. Conclusions Optimal adult vaccination strategies depend jointly on pathogen transmissibility, the duration of immunity, and population demography. Vaccination programs that suppress infections earlier in life without protecting individuals into late life may shift infections toward ages with higher fatality risk. These findings highlight the need to evaluate adult vaccination strategies across the full life course and have important implications for vaccination policies against influenza A and other pathogens with strongly age-dependent infection fatality rates.

Background Literature investigating mediation of the association between child abuse and dementia has largely considered composite adverse childhood experience scores rather than individual adverse experiences, despite evidence that different experiences have different impacts on dementia risk. Additionally, prior studies consider mediators in isolation, despite known associations between mediators which may impact indirect pathways from child abuse to dementia. Objectives To investigate whether potentially modifiable health and lifestyle factors mediate the association between child abuse and dementia. Methods We used data from the English Longitudinal Study of Ageing to investigate associations between child abuse and dementia (N:5,448). Indirect pathways through four mediator categories (education, health behaviours, mental health and cardiovascular health) were examined. We used regression modelling to estimate associations between child abuse, mediators and dementia, and causal mediation analysis using the g-formula to estimate the joint indirect effect through the mediators. Results Individuals who experienced child abuse had, on average, an 80% higher hazard of dementia, compared to those who did not (RTE HR:1.80, 95% CI:1.21-2.39). Mental health mediators showed strong associations with both child abuse and dementia. Evidence for other mediators was weaker. Education, health behaviours, mental health and cardiovascular health mediated approximately 18% of the association. Sensitivity analysis revealed that almost all this mediation occurred through mental health. Conclusions Child abuse was associated with higher risk of dementia. Joint mediation analysis suggested that education, health behaviours, cardiovascular health, and mental health accounted for a relatively small proportion of the observed association, with most mediation occurring through mental health. Future research must focus on other potential pathways from child abuse to dementia, including biological and social mechanisms.

Background. Given uncertainty about whether later-life health at similar ages is improving over time, we examined trends across multiple health domains. Methods. We analysed data from community-dwelling adults aged 50 and older in the English Longitudinal Study of Ageing in 2004/05, 2012/13, and 2023/24 (main survey: N=8389, 8549, and 6090, respectively). Outcomes included self-rated health, limiting long-standing illness, pain, mobility limitations, cardiometabolic and chronic conditions, obesity, inflammation, mental health, quality of life and memory. Weighted pooled modified Poisson and linear regressions compared outcomes over time, overall, and by age group and education, with additional adjustment for sex and wealth. Results. Adjusted estimates showed divergent trends. Fair/poor self-rated health increased from 27% to 34%, and any pain from 37% to 47%, whereas mobility impairments declined from 58% to 52%. Self-reported high cholesterol increased from 19% to 39%, while biomarker-defined high cholesterol declined from 78% to 54%; diabetes increased on both measures. Psychiatric problems increased from 6% to 10%, quality of life declined, and memory improved. However, trends differed by age and education, particularly for limiting long-standing illness, mobility limitations, cholesterol biomarkers, and mental health, indicating that aggregate trends masked unevenly distributed changes. Conclusion. Later-life health in England has not improved uniformly. Gains in functioning, biomarkers, and cognition coexist with rising pain and poorer mental health. Trends were also socially and age patterned, producing increasingly multidimensional and socially patterned health outcomes. Multidomain health monitoring is essential for interpreting population health trends and planning healthy ageing, prevention, long-term care, and work policies.

Socioeconomic, demographic, and health system structures may have shaped COVID-19 pandemic impact across populations, but past analyses typically examined few factors. We systematically examined correlates of COVID-era excess mortality, considering 2,745 county-level variables of demography, race/ethnicity, income, insurance, education, employment, housing, and health system. Pearson correlation coefficients (CCs) were obtained for the most recent available pre-pandemic value against age-standardized county excess-death for each year during 2020-2024. Counties were population-weighted. Variables were grouped by meaning into 11 semantic super-clusters. Overall, 17.3% of variables reached at least a moderate correlation level (|CC| > 0.30) and 2.8% reached strong correlations (|CC| > 0.45). Strongest correlations were seen for college attainment (CC -0.54), uninsurance among adults 40-64 (+0.53), and high income (-0.53). At least moderate correlations were seen for 9.1% of variables in 2020 and 8.5% in 2021, but only 1.8%, 0%, and 1.3% in 2022, 2023, and 2024, respectively. Similar patterns of concentration of moderate correlations in the first two pandemic years appeared in both elderly and non-elderly populations. Of 472 variables with |CC| > 0.30, 362/395 moderate-band and 77/77 strong-band variables belonged to demography and socioeconomic super-clusters. Only 7% of health system variables reached |CC| > 0.30, versus 31% of socioeconomic and demographic variables. Using the most recent available value until 2023 or 2015, different population weighting, and Spearman correlations yielded similar results. Overall, these ecological analyses suggest strong relationships of socioeconomic structure and demographics rather than health-care resources/supply with excess mortality across US counties especially during 2020-2021.

Age-dependent survival is central to understanding population dynamics and life-history evolution. We analysed carcass weight and age-at-harvest data from 6022 red foxes (Vulpes vulpes) collected across Sweden between 1967 and 1971 to evaluate latitudinal effects on body mass and age-dependent survival. Carcass weights decreased from south to north in both adults and sub-adults, contrary to Bergmann's rule, with southern foxes weighing approximately 1.27 times more than northern foxes. The latitudinal weight gradient exceeded the sex difference in both age classes, and no sex x region interaction was detected. The decrease in weight with latitude is consistent with reduced prey availability and harsher winter conditions in the north, which limit growth and body size during development. Using a Bayesian age-at-harvest model with region-specific population growth rates (lambda), we estimated age-dependent survival probabilities for four latitudinal regions and both sexes. Despite the strong latitudinal gradient in weight, survival did not show a corresponding pattern - regional differences were uncertain, with all credible intervals spanning zero. Regional population growth rates were consistent with slight decline in the north and near-stability in the south-central region, which suggests that body condition and population dynamics are coupled at the regional scale despite no survival gradient. The decoupling of body condition and survival across regions suggests that mortality patterns are similar across the latitudinal gradient. We discuss these patterns in terms of latitudinal productivity gradients, prey availability, and life-history trade-offs in a widely distributed carnivore.

Introduction Frailty is an ageing-related state associated with disability and mortality. Women often experience higher frailty but lower mortality than men, a pattern described as the male-female health-survival paradox. Evidence from low- and middle-income settings is limited. We examined sex differences in frailty trajectories and terminal decline in Mexico. Methods We analysed five waves (2001-2018) of the nationally representative Mexican Health and Aging Study (MHAS) including 12,440 adults ([&ge;]50 years at baseline). Frailty was measured using a 31-deficit frailty index (FI score; 0-1). We used survey-weighted linear mixed-effects models with time interactions, adjusted for sociodemographic, behavioural and health covariates to model sex differences in frailty trajectories. Terminal decline in FI was modelled among those who died using mixed-effects models on the time-to-death scale. Results A total of 12,440 adults aged 50 to 105 years were included, with a mean age of 62.1 years (SD 9.6); 5,698 men (45.8%) and 6,742 women (54.2%). Mean baseline FI was 0.17 (SD 0.12), higher in women than men (0.19 vs 0.16; P<0.001). After adjusting, women had a 0.014 higher mean FI than men at baseline (adjusted mean difference; 95%CI 0.008, 0.020), with difference widening over follow-up, increasing from 0.016 at 2 years to 0.029 at 17 years. Analysis of terminal decline found that accumulation of frailty accelerated in the years preceding death; with results suggesting that women reached death with higher frailty than men (difference 0.029; 95%CI 0.009, 0.048). Conclusion Women experienced higher and more rapidly increasing frailty compared to men and carried a greater frailty burden in the years preceding death. These findings underscore the importance of considering sex differences in frailty trajectories when developing healthy ageing strategies that address the life-course vulnerabilities disproportionately driving frailty accumulation in women in low- and middle-income countries.

Background: Cognitive function is crucial for healthy aging, and its impairment reduces quality of life and increases healthcare and societal burden. Social vulnerability, shaped by factors like income, education, and access to healthcare, has been associated with cognitive health, but reliance on community-level assessments may limit understanding of risk at the individual level. Objectives, Design, Setting, Participants: We examined the cross-sectional association between a proposed individual-level Social Vulnerability Index (iSVI) and cognitive function among 5,989 participants aged [&ge;]60 years in the US National Health and Nutrition Examination Survey (NHANES) 1999-2002 and 2011-2014 cycles. Measurements: Cognitive performance was measured using the Digit Symbol Substitution Test (DSST). iSVI was constructed by summing six risk indicators (income, education, health insurance, employment, housing tenure, and food security). Health insurance and employment were scored on a three-level scale (0/0.5/1); other indicators were binary (0/1). Survey-weighted linear regression estimated associations between iSVI and DSST scores, adjusting for age, sex, race and Hispanic origin, and survey cycle. Estimates were benchmarked against adjusted associations between age and DSST. Results: Higher iSVI was associated with poorer cognition, with each one-unit increase corresponding to a 5.30-point lower DSST score (95% CI: -5.71, -4.89). This difference was comparable to nearly 5 years of age-related difference in DSST performance, as each additional year of age was associated with a 1.08-point lower DSST score (95% CI: -1.14, -1.03). Conclusions: Increased iSVI was associated with lower cognitive function in older adults, highlighting individual-level social vulnerability as a key intervention opportunity to prevent cognitive impairment.

Background: Epigenetic clocks are markers of biological aging that may vary in their sensitivity to environmental stressors and lifestyle modifiers. To evaluate the utility of these biomarkers as sensors of the human exposome, we investigated how they respond to two powerful and opposing exposures: smoking, a source of oxidative stress, and the antioxidant-rich Mediterranean diet. Objectives: We assessed the sensitivity of eleven epigenetic clocks to diet and smoking and evaluated whether Mediterranean diet adherence modifies associations between smoking and epigenetic aging. Methods: We analysed 928 participants (mean age 41 years, 59% male) from the Airwave Health Monitoring Study. Linear regression models assessed associations between Mediterranean Diet Score (MDS) and epigenetic age acceleration (EAA), alongside smoking status and blood cotinine. Interaction terms between smoking status and MDS were included to detect dietary attenuation of smoking-related EAA. Models were adjusted for demographic, socioeconomic, lifestyle, and psychological covariates. Results: Higher MDS was associated with lower EAA for GrimAge ({beta} = -0.07 SD; 95% CI: -0.13, -0.01) and Bernabeu ({beta} = -0.08 SD; 95% CI: -0.14, -0.02) after false discovery rate correction. Smoking was strongly associated with increased EAA, particularly for GrimAge, Bernabeu, and DunedinPACE. Among current smokers, effect sizes were greater in those with lower dietary adherence (e.g. GrimAge: 1.79 SD, 95% CI: 1.54, 2.04) compared with those with higher adherence (1.35 SD, 95% CI: 1.01, 1.68; P_interaction < 0.001). Similar attenuation patterns were observed for Bernabeu. Higher intake of fruits, vegetables, and whole grains contributed most to the attenuation of smoking-related EAA. Conclusions: Our findings indicate that certain epigenetic clocks effectively capture the tension between harmful and protective exposures within the exposome. Rather than suggesting that diet neutralises the risks of tobacco, these results demonstrate that specific clocks are sensitive enough to monitor how lifestyle factors modify molecular responses to environmental toxins. This highlights the value of second-generation clocks in quantifying biological resilience.

People with Down syndrome have higher age-specific mortality rates compared to the general population as well as peers with other intellectual and developmental disabilities. While a large proportion of mortality is attributable to Alzheimers disease, many die prior to Alzheimers diagnosis and some live to old ages, dying without Alzheimers. Our objectives were to use 11 years of Medicaid and Medicare data to describe characteristics and factors related to death in adults with Down syndrome and use machine learning to identify which conditions most strongly predict death in the full population and stratified by age. We identified death using Center for Medicare and Medicaid Systems reported date of death health conditions using ICD 9 and 10 codes. We used a case-control design with risk set sampling to have that controls to mimic the distribution of times of incident Alzheimers disease. We trained gradient boosted trees to identify strongest predictors. Our cohort included 137,293 adults with Down syndrome. Among those, 30,894 (22.5%) died during the study period. Mean age at death among those who died was 55 years (SD=10). Mean age of death in those with Alzheimers disease was 59 (SD=7) and those without was 52 (SD=12). The most influential predictors of mortality were any claim for dementia, any claim for pneumonia, re-occurring claim for cardiovascular disease three years before index death, and any claim for heart failure and epilepsy. Our results align with previous clinical work and highlight intervenable areas to reduce mortality in the Down syndrome population.

ABSTRACT Background: Onset of cancer is linked to psychological distress and cancer is prevalent in older adults. Yet, the association to suicide is scarcely examined. The aim of this study was to assess whether cancer diagnosed in older adults is associated with suicide incidence. Methods: All older adults (65+ years) who lived in Austria in the years 2014-2021 (n=2,175,134) were followed. Of these, 223,932 were diagnosed with a new cancer. We used non-parametric survival models with inverse-probability-treatment weights to compare risk ratios (relative risk) and risk differences (absolute risk) of older adults with and without cancer. Results: Out of 2,158 suicide deaths, 442 (20.5%; 83.7% males) occurred among older adults with a new cancer diagnosis. The incidence rate was 74 among those with a new cancer diagnosis versus 23 per 100,000 person-years among those with no new cancer. One year after being diagnosed, older adults with a new cancer had a 4 times higher relative risk of dying by suicide compared to those without. The risk was highest within the first three months after diagnosis and for cancers with a poor prognosis (disseminated disease; lung, oesophagus, stomach, liver, pancreas, and brain cancers). The absolute risk of dying by suicide within 5 years after cancer diagnosis was 0.18% versus to 0.11% among those with no new cancer. Discussion: Older adults who received a new cancer diagnosis had elevated suicide risks. Provision of support to cope with mental distress should be considered at cancer diagnosis, especially for older adults with a poor prognosis.

Objectives: We tested how multi-level socioeconomic disadvantage relates to biological aging and systemic inflammation in women and men from the population-based Canadian Longitudinal Study on Aging (CLSA). Methods: We examined cross-sectional data from 8,516 CLSA participants with baseline measures on systemic inflammatory biomarkers (C-reactive protein, interleukin-6, and tumoral necrosis factor-) and biological aging (metabolomic and six DNA methylation [DNAm] age estimates). Plasma samples underwent metabolomic profiling by Metabolon, Inc. Metabolomic age was estimated separately in males and females using sex-stratified models based on age-correlated metabolite levels. DNAm data generated using the Illumina Infinium MethylationEPIC v1.0 array were used to estimate DNAm age across six established models, including Horvath, Hannum, PhenoAge, GrimAge, GrimAge2, and DunedinPACE. We used log-transformed metabolite levels to calculate metabolomic age by sex. We linked education, income, material and social deprivation to biomarkers of systemic inflammation and biological aging stratified by sex using generalized linear models. Multivariable models were adjusted by age, major behavioral risk factors, and chronic conditions. Results: Participants were aged on average of 62.6 years of age, and approximately 50% were females. In multivariable linear adjusted models, we found that in comparison to those earning [&ge;]$100K a year, women earning less <$20K were on average 1.14 (95%CI: 0.46, 1.82) year older with respect to metabolomic age; those earning [&ge;]$20K & <$50K were on average 0.90 (95%CI: 0.26, 1.53) years older; and those earning [&ge;]$50K & <$100K were on average 0.70 (95%CI: 0.05, 1.34) years older. We did not observe this dose response among men. A similar dose-response association was observed for interleukin-6 in both men and women. Discussion: These findings suggest that socioeconomic adversity influences not only inflammatory pathways but also distinct biological aging processes, including metabolomic aging.

OBJECTIVES: Population aging is a major contributor to increasing demand for emergency medical services (EMS), yet EMS workforce projections based on population data remain limited. This study projected future EMS incident volume and clinician workforce requirements in Florida from 2026 to 2035 based on historical data on EMS response records to inform workforce planning. METHODS: We conducted a retrospective, population-based secondary analysis and forecasting study using de-identified state-wide emergency EMS response records from Florida's Emergency Medical Services Tracking and Reporting System (EMSTARS) spanning January 1, 2017 through December 31, 2025. Incidents were assigned to seven age cohorts and aggregated into monthly time series. We used Seasonal Autoregressive Integrated Moving Average models with exogenous inputs (SARIMAX) to project age and cohort-specific incident volume for 2026 through 2035. Projected future incident volumes were translated into EMT and paramedic full-time equivalent (FTE) requirements using observed EMSTARS staffing configurations and target operational parameters. RESULTS: Annual EMS incidents increased from 4.10 million in 2017 to 5.22 million in 2025 and are projected to reach 7.76 million by 2035, a 48.8% increase over the 2025 baseline. By 2035, adults aged 60 and older are projected to represent 31.2% of Florida's population while accounting for 61.6% of all EMS incidents. Total estimated EMS workforce requirements are projected to increase from 9,542 FTEs in 2025 to 14,195 FTEs by 2035, requiring approximately 4,654 additional FTEs (a 48.8% increase). CONCLUSIONS: Florida's aging population is projected to drive a nearly 50% increase in EMS incident volume and associated workforce requirements over the next decade, with demand disproportionately concentrated among older adults. With a substantial concentration of adults aged 80 and older and a rapidly expanding oldest-old cohort, Florida is confronting the demographic conditions projected to emerge in other states over the next decade. The findings offer researchers and policymakers a replicable framework and a directly applicable planning reference for jurisdictions across the United States.

Background: Mortality analysis traditionally focuses on the single underlying cause of death (UCD), which obscures the wider morbidity process at the end of life. Multiple causes of death (MCoD) data, recording all conditions on the death certificate, are increasingly used as a proxy for end-of-life multimorbidity, yet how accurately they represent it remains underinvestigated. We assessed whether recorded causes reflect end-of-life health conditions or rather the chain of events leading to death. Methods: Using linked Danish registers (Population, Cause of Death, Chronic Diseases, and Cancer), we studied residents aged 50+ diagnosed with COPD, dementia, diabetes, or cancer who died in 2010-2022 (ranging from 38779 to 224330 per disease cohort). We examined how often each diagnosed disease appeared on the certificate, its location and selection as the UCD, factors associated with its appearance (logistic regression), disease-specific mortality (multiple decrement life tables), and disease associations (Cause of Death Association Indicator, CDAI). Results: Cancers appeared on the death certificate far more often than chronic diseases (around 75% versus 19-58%) and were usually recorded in Part 1 and selected as the UCD, whereas chronic diseases were rarely the UCD. The odds of a disease appearing depended on factors such as age at and time since diagnosis. When a diagnosed disease was recorded, the certificate traced a coherent path to death; when it was absent, ill-defined causes became more common. The CDAI highlighted specific association pathways between diseases. Conclusions: MCoD data capture only part of the chronic disease burden present at death and should be interpreted cautiously as a proxy for end-of-life multimorbidity. They are, however, well suited to describing the pathways leading to death.

Background: Cardiovascular disease (CVD) remains the leading cause of mortality among older U.S. adults, yet the contribution of neighborhood-based structural racism remains inadequately quantified. This study quantifies the association between the Structural Racism Effect Index (SREI) and CVD mortality among adults aged {greater than or equal to}65 years, evaluating how this relationship varies across U.S. geographic regions to identify key areas for intervention. Methods: This ecological study applied a hierarchical Bayesian spatiotemporal framework to 2017-2020 Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) data to estimate the association between SREI and CVD mortality across 3,007 U.S. counties. SREI was modeled continuously and categorically, adjusting for sociodemographic covariates. Population attributable fractions (PAF) and attributable deaths (AD) quantified the potentially preventable burden and its spatial disparities. Results: From 2017 to 2020, approximately 2.79 million CVD deaths were observed, with significant spatial clustering (Moran's I = 0.35, p < 0.001). Each standard-deviation increase in SREI was associated with 13% higher CVD mortality (IRR: 1.13, 95% CrI: 1.12-1.15). A positive dose-response gradient was observed across SREI quartiles, with mortality 24% higher in the highest quartile than in the lowest (IRR: 1.24, 95% CrI: 1.20-1.28). The PAF was 6.94% (95% CrI: 6.13-7.73), corresponding to 193,472 potentially preventable deaths. High exceedance probabilities (>0.95) were concentrated in the Southeast, Appalachia, and the Midwest. Conclusions: Structural racism is a spatially patterned, dose-dependent predictor of older adult CVD mortality, underscoring the need for public health monitoring and neighborhood-based upstream interventions where disease burden is concentrated. Keywords: Structural Racism Effect Index; Neighborhood disadvantage; Cardiovascular Disease Mortality; Bayesian Spatiotemporal Analysis; Population Attributable Fraction; Health Disparities; Health Equity.

Purpose: The Swedish Evaluation Through Follow-up study of Learning Later in Life (UGU-LIFE) was established to study the factors that shape lifelong learning and advance evidence-based means to facilitate learning in older age. Participants: UGU-LIFE builds on the Evaluation Through Follow-up (Utvardering Genom Uppfoljning, UGU, in Swedish) study, which consists of nationally representative samples of Swedish birth cohorts. The two oldest cohorts, born 1948 (N = 11,945) and 1953 (N = 9,927), were assessed at age 13 years and invited for follow-up assessments as part of UGU-LIFE in 2025 (age 72/77 years; N = 5,738). Findings to date: Data collection in childhood included a survey (on school and family conditions), cognitive tests, and school administrative data. The follow-up assessment in late adulthood included a survey (on personal and contextual factors), cognitive tests, learning tasks, and saliva sampling for DNA extraction. In addition, registry data was collected from Statistics Sweden (census), the National Board of Health and Welfare (medical records), and the Swedish National Archives (military conscription). Analysis of selectivity at follow-up showed higher retention rate among individuals with higher education and better cognitive ability in childhood, which was only partially explained by selectivity in survival. Future plans: Data collected in UGU-LIFE will be used to describe the predictors of lifelong learning, the factors that influence learning gains and engagement in learning in older age, and the mechanistic pathways through which these factors affect learning in older age. Work to add birth records and geocoding to the data is ongoing. A subsample of participants will be invited to take part in an in-depth data collection of learning an ecologically relevant task over several days. The findings will be used to design and test interventions aiming to facilitate learning in older age.

In 2022, Austria legalised physician-assisted suicide (PAS). Among 1,847,919 older adults, there were 92 PAS and 977 unassisted suicides (UAS) in 2022-2023. Compared to the general population, older adults who died by either PAS or UAS, were older and more likely to live alone. Compared with UAS, older adults who died by PAS were more likely to be female, higher-educated, live in urban areas, and diagnosed with cancer, or diseases of the nervous system, and less likely diagnosed with mental/ behavioural disorders. PAS and UAS among older adults in Austria showed different sociodemographic and comorbidity characteristics.

Objectives: To assess whether higher state-level community-based U.S. Immigration and Customs Enforcement (ICE) arrest rates are associated with adverse mental health outcomes among Hispanic and non-Hispanic adults in the United States. Design: Retrospective analysis using individual-level data from the 2023 and 2024 Behavioral Risk Factor Surveillance System (BRFSS) linked to monthly state-level ICE arrest records from the Deportation Data Project. Two-way fixed effects models assessed associations between mental health outcomes and ICE arrests, net of secular trends, state-specific time invariant factors, and individual covariates. Setting/participants: The sample included 534,099 US adults aged 18 years or older residing in all 50 states and the District of Columbia surveyed between September 2023 and December 2024. Analyses exploited within-state month-to-month variation in enforcement intensity with state and year-month fixed effects. Outcome measures: Number of poor mental health days in the past 30 days; any poor mental health days (binary); mental health status (3-level categorical); frequent mental distress ([&ge;]14 poor mental health days); and a composite indicator combining depressive disorder diagnosis with frequent mental distress. Results: Among 534,099 respondents (approximately 10% Hispanic), higher ICE arrest rates were significantly associated with worse mental health among Hispanic adults, including 0.19 additional poor mental health days per month (p < 0.05), a 2.2% higher likelihood of reporting any poor mental health days (p < 0.01), and a 2.4% increase in composite mental health problems (p < 0.01). Associations were concentrated among Hispanic women and those with a high school diploma or less. Among non-Hispanic adults, estimates were small and precisely centered around zero across outcomes. Similar findings obtained in difference-in-differences event study models, models including lagged exposures, and models with leave-one-out state exclusions. Conclusion: Higher community-based immigration enforcement was associated with worse mental health outcomes among Hispanic adults but not among non-Hispanic adults. Contemporary enforcement strategies may have broader psychological spillover effects within Hispanic communities, and mental health may be an underrecognized social cost of interior immigration enforcement.

Homicide is a leading cause of preventable death in the United States and disproportionately affects Black and Indigenous communities. Structural racism and neighborhood disinvestment are central drivers of these disparities, yet national evidence on whether the association between neighborhood opportunity and homicide risk varies by race/ethnicity remains limited. Using 2020 data from the restricted-use National Violent Death Reporting System linked to Child Opportunity Index (COI 3.0) scores and Census population denominators across 30,077 ZIP codes in 48 states, we estimated age-adjusted log-linked generalized linear models to examine racial/ethnic disparities in homicide rates and their interaction with neighborhood opportunity. Black men experienced homicide rates nearly 20 times those of White men; Indigenous men experienced rates approximately 6 times higher. Higher neighborhood opportunity was independently associated with lower homicide risk across all groups and explained 43-59% of excess risk for Black and Indigenous individuals. Crucially, the association between neighborhood opportunity and homicide was nonlinear and significantly heterogeneous by race/ethnicity, with the steepest rate reductions occurring at the lowest opportunity levels for Black and Indigenous men. These findings suggest that place-based investments in severely deprived communities may yield the greatest reductions in homicide and racial/ethnic health inequities.

Compartmental models of infectious disease transmission make assumptions about human behaviors. Specifically, they parameterize interactions across population groups, assumed to have distinct epidemiologically-relevant behavioral patterns, primarily through contact matrices stratified by demographic variables such as age, gender, or socioeconomic status. Although such demographic characteristics are readily measurable, they may inadequately capture the social and psychological forces that govern protective behaviors. Drawing on 20 waves of a national survey conducted throughout the COVID-19 pandemic in the United States, we show that institutional trust - particularly trust in public health agencies, physicians, and hospitals - is a dominant predictor of protective behavior adoption. For mask wearing during periods of strongest pandemic activity, for example, institutional trust explains more behavioral variance across population groups than age, income, education, and partisan affiliation combined. In unadjusted analyses, the difference in protective behavior adoption between individuals with the highest and lowest trust in the CDC was four- to six-fold larger than the corresponding differences by age, income, or educational attainment, and exceeded the difference between Democratic and Republican respondents. This association was institutionally specific (e.g., the relationship attenuates for trust in banks), and behaviorally specific (e.g., trust in the CDC is associated with protective behaviors but not visiting a doctor). The latter suggests that trust modifies voluntary compliance with public health recommendations rather than access to or use of healthcare. We conclude that compartmental models of disease transmission would be substantially improved by incorporating institutional trust as a stratifying variable. We additionally offer a trust-integrated mathematical modeling framework and recommendations for the data infrastructure needed for its implementation.

Relatively little is known regarding suicide among older adults in nursing homes. The aim of this study was to compare the incidence of suicide among older nursing home residents (NHR) with community-dwelling older people (CDP) using newly available, national, individual-level register data, and to assess differences with regard to socio-demographic characteristics. We obtained data on all older adults aged 65+ who were living in Austria at the end of October 2018 (n=1,665,450), including 155,020 NHR. Death by suicide was followed until the end of 2023. A total of 114 and 2,136 suicides were observed among NHR and CDP; corresponding to cumulative incidences of 14 and 27 per 100,000, respectively. Among NHR, suicide incidence was higher among males (28.0, 95% CI=22.1, 35.5), those aged 65-74 years (20.2, 95% CI=13.3, 30.6), with tertiary education (23.3, 95% CI=10.6, 50.6), divorced (25.0, 95% CI=16.2, 38.5), and residing in urban nursing homes (22.0, 95% CI=17.0, 28.4). Compared to CDP, more suicides in NHR occurred by poisoning and but few by firearms. In conclusion, we found that suicide incidence was lower among older NHR compared to CDP. More research on and preventive efforts against suicide among older NHR are needed.