SSM - Population Health

As the number of confirmed COVID-19 cases now exceeds 100 million cases in the United States and continues to climb, concerns have been increasingly raised over the future public health and economic burden of long COVID including disability and concomitant declines in labor force participation. Only a handful of US population-based studies have explored sociodemographic and socioeconomic characteristics that put people at risk of long COVID or have investigated its mental health and socioeconomi...

Background and objectivesPerceived uncertainty about future employment and work transitions during economic crises can negatively affect mental health of workers. This study examined the association between work expectations and psychological distress among "Baby Boomers" (born 1948-1965) in the United States and South Korea and explored how employment transitions moderated this association before, during, and after the Great Recession. Research Design and MethodsData came from 2006-2018 waves ...

Forty million U.S. residents lost their jobs in the first two months of the coronavirus disease 2019 (COVID-19) pandemic. In response, the Federal Government expanded unemployment insurance benefits in both size ($600/week supplement) and scope (to include caregivers and self-employed workers). We assessed the relationship between unemployment insurance and food insecurity among people who lost their jobs during the COVID-19 pandemic in the period when the federal unemployment insurance suppleme...

IntroductionExcess mortality does not depend on labeling the cause of death and is an accurate representation of the pandemic population-level effects. A comprehensive evaluation of all-cause excess mortality in the United States during the first two years of the COVID-19 pandemic, stratified by age, sex, region, and race/ethnicity can provide insight into the extent and variation in harm. MethodsWith Centers for Disease Control and Prevention (CDC)/National Center for Health Statistics (NCHS) ...

ImportanceAmid efforts in the United States to promote health equity, there is a need to assess progress in reducing excess deaths and years of potential life lost (YPLL) among Black people compared with White people. ObjectiveTo evaluate trends in excess mortality and YPLL among Black people compared with White people. DesignSerial cross-sectional. SettingNational data from the Centers for Disease Control and Prevention, 1999-2020 ParticipantsNon-Hispanic White and non-Hispanic Black people...

Abrupt changes in mortality rates and life expectancy allow us to understand how shocks like COVID-19 can exacerbate health inequalities across groups. We look at Washington, D.C., a major city with a diverse population and long-standing socio-economic divisions, to describe the all-cause mortality trends from 2015 to 2021 by age, sex, race, and ward of residence. We report differences in cause-specific mortality pre- and post-COVID-19 outbreak and estimate the Years of Life Lost (YLL) attributa...

The COVID-19 pandemic was a significant shock to United States mortality, and it is important to understand how the pandemic impacted other causes of death. We estimated monthly excess mortality in the US by cause of death, age, and sex, for official deaths at ages 15 and older. Data come from the CDC Wonder Multiple Cause of Death database. We used a compositionally robust Generalized Additive Model (GAM) to estimate expected mortality counts in March 2020-December 2022 for eight causes of deat...

BackgroundHistorical redlining policies enacted in the 1930s and 1940s that restricted investment in Black neighborhoods shaped neighborhood conditions that may contribute to inequities in health and mortality among older adults today. Areas "redlined" by the Home Owners Loan Corporation (HOLC) in the 1930s against Black neighborhoods are associated with worse present-day area-level health outcomes. We examined whether early, personal exposure to redlining close to when the maps were drawn is as...

IntroductionExperiences of discrimination and bias in health care contribute to health disparities for LGBTQ+ and other minority populations. To avoid discrimination, many LGBTQ+ people go to great lengths to find healthcare providers who they trust and are knowledgeable about their health needs. This study examines whether access to an LGBTQ+ affirming provider may improve health outcomes for LGBTQ+ populations across a range of preventive health and chronic disease management outcomes. Method...

Different estimation methods produce diverging accounts of racial/ethnic disparities in COVID-19 mortality in the United States. The CDCs decision to present the racial/ethnic distribution of COVID-19 deaths at the state level alongside re-weighted racial/ethnic population distributions--in effect, a geographic adjustment--makes it seem that Whites have the highest death rates. Age adjustment procedures used by others, including the New York City Department of Health and Mental Hygiene, lead to ...

BackgroundLife expectancy is a critical measure of population health. In the U.S., Black Americans have historically experienced lower life expectancy than White Americans due to factors such as health insurance inequities, socioeconomic disparities, and systemic barriers. Though the Black-White life expectancy gap narrowed after 1990, it has fluctuated in recent years, influenced by socioeconomic changes and the COVID-19 pandemic. ObjectiveThis study examines how national-level differences in ...

Several analyses have highlighted racial and ethnic disparities related to COVID-19 health outcomes across the United States. Less focus has been placed on more localized contexts, such as carceral settings, where racial and ethnic inequities in COVID-19 health outcomes also exist, but the proximal drivers of inequality are different. In this study, we analyzed mortality rates among incarcerated people in the Texas Department of Criminal Justice (TDCJ) to assess racial and ethnic differences in ...

ImportanceDiscrimination in healthcare disrupts trust and can negatively influence patients. However, the impact of experiencing discrimination on long-term patterns of healthcare utilization is unknown. ObjectiveTo assess how perceived discrimination in healthcare settings is associated with longitudinal patterns of doctor visits among middle-aged and older adults in the United States. DesignProspective cohort study of US adults in the Health and Retirement Study (HRS) who were followed every...

BackgroundDepression is a pressing public health issue and may be affected by multifaceted urban living, yet the specific urbanicity elements associated is unclear. Using a multidimensional urbanicity scale, we explored the association between urbanicity and its components with the risk of depressive symptoms. MethodsThis study used data from four waves of the China Health and Retirement Longitudinal Study, including 12,515 participants aged [≥]45 years at baseline in 2011 in 450 rural and u...

This paper provides the first nationally representative estimates of vulnerability to severe complications from COVID-19 overall and across race-ethnicity and socioeconomic status. We use the Panel Study of Income Dynamics (PSID) to examine the prevalence of specific health conditions associated with complications from COVID-19 and to calculate, for each individual, an index of the risk of severe complications from respiratory infections developed by DeCaprio et al. (2020). We show large dispari...

BackgroundExtant research has examined the roles of social position (SP) and social determinants of health (SDoH) on mental health outcomes. We add to this literature by focusing on major depressive disorder, investigating how race, ethnicity, gender, and sexual identity moderate the role of several social determinant domains on this common mental health condition. MethodsOur analysis is based on the All of Us (AoU) dataset. We use a staged multiple logistic regression design. In the first stag...

ObjectiveTo characterize associations between tattooing and health status. MethodsWe used data from [~]27,000 respondents to the 2020-2022 Utah Behavioral Risk Factor Surveillance System (BRFSS). Multivariable Poisson regression was used to calculate prevalence ratios (PR) and 95% confidence intervals (CI) associating ever receiving a tattoo with physical/mental health status. ResultsIn this cross-sectional study, ever receiving a tattoo was associated with self-reported "poorer" vs. "excellen...

Recent legislative proposals to impose nationwide work requirements for Medicaid eligibility could jeopardize health insurance coverage for over 36 million low-income Americans. To assess the potential mortality impact, we estimated annual excess deaths under a comprehensive set of scenarios reflecting varying policy implementations. These scenarios accounted for differences in age groups (19-55 vs. 19-64), eligibility based on Medicaid expansion status, and varying levels of automatic exemption...

IntroductionPermanent supportive housing, which combines stable housing with tailored wraparound services, has emerged as a critical intervention to combat chronic homelessness and promote health equity. This study focuses on Nashville, Tennessee, an area marked by rapid growth, poverty, and housing instability, to better understand the characteristics and service needs of residents in subsidized housing. MethodsA cross-sectional study (2023-2025) recruited 140 residents from four subsidized ho...

The behavioral economics literature suggests that exposure to traumatic events shifts preference features like risk aversion and time preference. Drawing on this literature, this study explored the relationship between early life exposure to traumatic events and self-control at older ages. The data were obtained from the Health and Retirement Study, which offers retrospective data on trauma exposure and a measure of self-control. The results showed that the experience of serious physical attacks...