Forecasting Inequalities in Survival to Retirement Age by Socioeconomic Status in Denmark and Sweden.

In Denmark and Sweden, statutory retirement age is indexed to life expectancy to account for mortality improvements in their populations. However, mortality improvements have not been uniform across different sub-populations. Notably, in both countries, individuals of lower socioeconomic status (SES) have experienced slower mortality improvements. As a result, a uniform rise in the statutory retirement age could disproportionally affect these low-SES groups and may unintentionally lead to a reverse redistribution effect, shifting benefits from short-lived low-SES individuals to long-lived high-SES individuals. The aim of this study is twofold: to quantify and contextualise mortality inequalities by SES in Denmark and Sweden, and to assess how indexing retirement age will affect future survival to retirement age by SES in these countries. We used Danish and Swedish registry data (1988-2019), to aggregate individuals aged 50 + based on their demographic characteristics and SES. We computed period life tables by year, sex, and SES to estimate the difference in survival across different SES groups. We then forecast mortality across SES groups to assess how indexing retirement age will affect survival inequalities to retirement age, using two forecasting models-the Mode model and the Li-Lee model. Mortality inequalities are comparable in Denmark and Sweden, even though the latter generally has higher survival. We also find that indexing retirement age to life expectancy will have two main consequences: it will reduce the probability of reaching retirement for all SES groups, particularly those of low SES, and time spent in retirement will be reduced, particularly for those of high SES.

The impact of COVID-19 on life expectancy across socioeconomic groups in Denmark.

BACKGROUND: Denmark was one of the few countries that experienced an increase in life expectancy in 2020, and one of the few to see a decrease in 2021. Because COVID-19 mortality is associated with socioeconomic status (SES), we hypothesize that certain subgroups of the Danish population experienced changes in life expectancy in 2020 and 2021 that differed from the country overall. We aim to quantify life expectancy in Denmark in 2020 and 2021 by SES and compare this to recent trends in life expectancy (2014-2019). METHODS: We used Danish registry data from 2014 to 2021 for all individuals aged 30+. We classified the study population into SES groups using income quartiles and calculated life expectancy at age 30 by year, sex, and SES, and the differences in life expectancy from 2019 to 2020 and 2020 to 2021. We compared these changes to the average 1-year changes from 2014 to 2019 with 95% confidence intervals. Lastly, we decomposed these changes by age and cause of death distinguishing seven causes, including COVID-19, and a residual category. RESULTS: We observed a mortality gradient in life expectancy changes across SES groups in both pandemic years. Among women, those of higher SES experienced a larger increase in life expectancy in 2020 and a smaller decrease in 2021 compared to those of lower SES. Among men, those of higher SES experienced an increase in life expectancy in both 2020 and 2021, while those of lower SES experienced a decrease in 2021. The impact of COVID-19 mortality on changes in life expectancy in 2020 was counterbalanced by improvements in non-COVID-19 mortality, especially driven by cancer and cardiovascular mortality. However, in 2021, non-COVID-19 mortality contributed negatively even for causes as cardiovascular mortality that has generally a positive impact on life expectancy changes, resulting in declines for most SES groups. CONCLUSIONS: COVID-19 mortality disproportionally affected those of lower SES and exacerbated existing social inequalities in Denmark. We conclude that in health emergencies, particular attention should be paid to those who are least socially advantaged to avoid widening the already existing mortality gap with those of higher SES. This research contributes to the discussion on social inequalities in mortality in high-income countries.

Benefits and harms of social media use: A latent profile analysis of emerging adults.

The rise in social media use among emerging adults in the United States has been well-documented, but researchers are still working on identifying how the type-not just the frequency-of use impacts psychological well-being. We identified "profiles" of social media use among young adults based on the frequency and purposes of use, and examined their associations with benefits and harms to psychosocial well-being, using data from 2828 incoming undergraduate students (M age = 18.29 years; age range: 17 to 25 years). Using Latent Profile Analysis, we identified three unique profiles of individuals who used social media with varying levels of intensity across different purposes: Active Users (32.4%), Passive Users (25.3%), and Average Users (42.4%). Each profile was associated with varying levels of beneficial and harmful psychosocial outcomes. Compared to Average Users, (a) Active Users reported significantly better psychosocial well-being, but also more harmful outcomes; and (b) Passive Users experienced significantly lower levels of perceived social media benefits and social connectedness, while also reporting less problematic social media use and social media stress. Implications of these findings for research and practice are discussed.

Quantifying the HIV treatment cascade in a South African health sub-district by gender: retrospective cohort study.

OBJECTIVES: To quantify the HIV care cascade in a Cape Town sub-district to understand rates of linkage to and engagement in HIV care. METHODS: We used routinely collected data to reconstruct the treatment cascade for 8382 infected individuals who tested HIV + in 2012/2013. We obtained data on patient gender, year of initial HIV-positive test, age at testing and initial CD4 cell count and defined five stages of the HIV care cascade. We quantified attrition across cascade stages. RESULTS: Two-thirds of the sample (5646) were women. Men were older at time of first testing (36.5 vs. 31.3 years) and had more advanced HIV disease at diagnosis (298 vs. 404 CD4 cells/µL for women). The median duration of follow-up was 818 days. Among women, 90.5% attended an initial HIV care visit, 54.6% became eligible for antiretroviral therapy under local guidelines during follow-up, 49.3% initiated ART and 45.6% achieved a therapeutic response. Among men, 88.0% attended an initial HIV care visit, 67.4% became ART eligible during follow-up, 48.0% initiated ART and 42.4% achieved a therapeutic response. Approximately 3% of women and 5% of men died during follow-up. CONCLUSIONS: We were able to reconstruct the HIV treatment cascade using routinely collected data. In this setting, rates of engagement in care differ by gender in key stages of the cascade, with men faring worse than women at each cascade point. This highlights the need for interventions aimed at encouraging earlier testing, linkage, ART initiation and retention among men.

OBJECTIFS: Quantifier la cascade des soins du VIH dans un sous-district de Cape Town pour comprendre les taux de liaisons et d'engagement avec les soins du VIH. MÉTHODES: Nous avons utilisé des données collectées en routine pour reconstruire la cascade de traitement pour 8.382 personnes infectées, testées positives pour le VIH en 2012/13. Nous avons obtenu des données sur le sexe du patient, l'année du premier test positif pour le VIH, l'âge au moment de ce test et le nombre initial de cellules CD4, et avons défini cinq étapes de la cascade des soins du VIH. Nous avons quantifié l'attrition au long des étapes de la cascade. RÉSULTATS: Deux tiers de l'échantillon (5.646) étaient des femmes. Les hommes étaient plus âgés au moment du premier test (36,5 contre 31,3 ans) et avaient la maladie du VIH plus avancée au moment du diagnostic (298 contre 404 cellules CD4/µL pour les femmes). La durée médiane de suivi était de 818 jours. Parmi les femmes, 90,5% ont pris part à une première visite pour des soins du VIH, 54,6% sont devenues éligibles au traitement antirétroviral selon les directives locales au cours du suivi, 49,3% ont commencé une ART et 45,6% ont atteint une réponse thérapeutique. Chez les hommes, 88,0% ont pris part à une première visite pour les soins du VIH; 67,4% sont devenus éligibles à l'ART au cours du suivi, 48,0% ont commencé l'ART et 42,4% ont atteint une réponse thérapeutique. Environ 3% des femmes et 5% des hommes sont décédés au cours du suivi. CONCLUSIONS: Nous avons pu reconstruire la cascade de traitement du VIH en utilisant des données collectées en routine. Dans ce contexte, les taux d'engagement dans les soins diffèrent selon le sexe dans les étapes clés de la cascade, les hommes s'en tirant moins bien que les femmes à chaque point de la cascade. Cela met en évidence la nécessité d'interventions visant à encourager le dépistage précoce, la liaison, l'initiation de l'ART et la rétention chez les hommes.