Older Adults' Unmet Needs at the End of Life: A Cross-Country Comparison of the United States and England.

Objectives: This study aimed to compare the end-of-life (EOL) experiences in concentration with place of death, for older adults in the U.S. and England. Methods: Weighted comparative analysis was conducted using harmonized Health and Retirement Study and English Longitudinal Study of Ageing datasets covering the period of 2006-2012. Results: At the EOL, more older adults in the U.S. (64.14%) than in England (54.09%) had unmet needs (I/ADLs). Home was the main place of death in the U.S. (47.34%), while it was the hospital in England (58.01%). Gender, marital status, income, place of death, previous hospitalization, memory-related diseases, self-rated health, and chronic diseases were linked to unmet needs in both countries. Discussion: These findings challenge the existing assumptions about EOL experiences and place of death outcomes, emphasizing the significance of developing integrated care models to bolster support for essential daily activities of older adults at the EOL.

Prevalence of Immunosuppression Among US Adults.

This analysis presents population prevalence estimates of immunosuppression among US adults using data from the 2021 National Health Interview Survey.

The intersection of welfare stigma, state contexts and health among mothers receiving public assistance benefits.

The stigmatizing nature of the US welfare system is of particular importance not only because it has shown to deter eligible applicants from participating in public assistance programs despite facing economic hardship, but also because stigma is an important fundamental cause of health inequities. Although scholars agree stigma is shaped by individual and contextual dimensions, the role of context is often overlooked. Given the heterogeneous nature of US state welfare environments, it may be critical to consider the ways in which state policy, social and economic contexts condition the relationship between welfare stigma and health. Using a multilevel lens, this study first examined the impact of experienced and perceived welfare stigma on self-reported health among female public assistance recipients with children. Second, we assessed the moderating effect of uneven state TANF policies, income inequality, and negative public welfare attitudes in shaping these associations. Using data from the Fragile Families and Child Wellbeing Study merged with state-level economic and social measures, we employed a series of multilevel logit models with random effects. Findings show experiences and perceptions of welfare stigma are significantly linked to poor health regardless of state contexts, and outcomes vary markedly by race, ethnicity and education. States with strong anti-welfare attitudes amplified the relationship between experienced welfare stigma and poor health for Black and Hispanic mothers, and state economic contexts modified the relationship between experienced welfare stigma and poor health for mothers with less than a high school education. TANF generosity had no moderating effect on health suggesting state policy environments have limited ability to protect welfare recipients against the stigmatizing effects of the US welfare system. Results have implications for explaining stigma related disparities in health within the context of U.S. welfare environments and informing policies that may be key levers for reducing health inequities.

Generational Shifts in Young Adult Cardiovascular Health? Millennials and Generation X in the United States and England.

OBJECTIVES: To compare cardiovascular (CV) risks/conditions of Millennials (born 1981-1996) to those of Generation X (Gen X; born 1965-1980) at ages 20-34 years, across 2 countries (United States, England), by gender. METHODS: Using data from the National Health and Nutrition Examination Survey (United States) and Health Survey for England, we estimated weighted unadjusted and adjusted gender-specific proportions of CV risk factors/conditions, separately for Millennials and Generation X in each country. We also further calculated sex-specific generational differences in CV risk factor/conditions by income tercile and for individuals with normal body weight. RESULTS: Millennials in the United States were more obese compared to their Gen X counterparts and more likely to have diabetes risk but less likely to smoke or have high cholesterol. Millennials in England had higher diabetes risk but similar or lower rates of other CV risk/conditions compared to their Gen X counterparts. Generational changes could not be fully attributed to increases in obesity or decreases in income. DISCUSSION: We expected that Millennial CV risk factors/conditions would be worse than those of Gen X, particularly in the United States, because Millennials came of age during the Great Recession and a period of increasing population obesity. Millennials generally fared worse than their Gen X counterparts in terms of obesity and diabetes risk, especially in the United States, but had lower rates of smoking and high cholesterol in both countries. Secular trends of increasing obesity and decreased economic opportunities did not appear to lead to uniform generational differences in CV risk factors.

Reports and Removals of Child Maltreatment-Related Hospitalizations: A Population-Based Study.

Despite U.S. child protective services (CPS) agencies relying on mandated reporters to refer concerns of child maltreatment to them, there is little data regarding which children mandated reporters decide to report and not to report. This study addresses this gap by utilizing a population-based linked administrative dataset to identify which children who are hospitalized for maltreatment-related reasons are reported to CPS and which are removed by CPS. The dataset was comprised of all children born in Washington State between 1999 and 2013 (N = 1,271,416), all hospitalizations for children under the age of three, and all CPS records. We identified maltreatment-related hospitalizations using standardized diagnostic codes. We examined the records for children with maltreatment-related hospitalizations to identify hospitalization-related CPS reports and if the child was removed from their parents. We tested for differences in these system responses using multinomial regression. About two-thirds of children identified as experiencing a child maltreatment-related hospitalization were not reported to CPS. We found differences in responses by maltreatment subtype and the type of diagnostic code. Children whose hospitalizations were related to abuse and associated with a specific maltreatment code had increased odds of being both reported to CPS and subsequently removed by CPS.

Racial-ethnic inequality in cardiovascular health in the United States: Does it mirror socioeconomic inequality?

PURPOSE: To document gender-specific racial-ethnic disparities in cardiovascular (CV) conditions and risk factors net of socioeconomic status (SES) across the lifespan. METHODS: Using pooled data from the 1999 to 2016 U.S. National Health and Nutrition Examination Survey, we document gender-specific proportions of non-Hispanic Whites, non-Hispanic Blacks, and Hispanics ages 12-69 years with various socioeconomic characteristics and CV conditions. We then further disaggregate into 10-year age groups and present unadjusted and SES-adjusted prevalence of each CV condition for each gender/racial-ethnic/age group. RESULTS: Racial-ethnic differences in the prevalence of CV conditions are large for some conditions, emerge early in adulthood, and remain relatively constant though age 69. Only small proportions of the differences can be attributed to differences in SES across groups; attenuation after adjusting for income, education, and available measures of wealth ranged from 0 to 2.3 percentage points. Black-White differences in prevalence of CV conditions differ substantially and systematically by gender; White females have larger advantages or smaller disadvantages (depending on indicator) relative to Black females than White males do relative to Black males. CONCLUSIONS: Racial-ethnic disparities in CV conditions are rooted early in the life course, do not mirror socioeconomic disparities, and vary considerably by gender. Explanations likely involve early life experiences such as racial discrimination and entrenched inequality.

The Incidence of Child Maltreatment Resulting in Hospitalizations for Children Under Age 3 Years.

OBJECTIVE: To assess the incidence of child maltreatment-related hospitalizations for children under 3 years for the population of Washington State. STUDY DESIGN: A population-based study using retrospective linked administrative data for all children born in Washington State from 2000 through 2013 (n = 1 191 802). The dataset was composed of linked birth and hospitalization records for the entire state. Child maltreatment-related hospitalizations were identified using diagnostic codes, both specifically attributed to and suggestive of maltreatment. Incidence were calculated for the population, by birth year, by sex, and by maltreatment subtype. RESULTS: A total of 3885 hospitalizations related to child maltreatment were identified for an incidence of 10.87 per 10 000 person-years. Hospitalizations related to child maltreatment accounted for 2.1% of all hospitalizations for children under the age of 3 years. This percentage doubled over time, reaching a high in 2012 (3.6%). More than one-half of all hospitalizations were related to neglect. Maltreatment-related hospitalizations occurred most frequently in the first year of life for all subtypes except for neglect, which occurred the most between 1 and 2 years of age. Male children had higher incidence than female children in general (11.97 vs 9.70 per 10 000 person-years) and across all subtypes. CONCLUSIONS: Hospitalizations can be a useful source of population-based child maltreatment surveillance. The identification of neglect-related hospitalizations, likely the result of supervisory neglect, because the most common subtype is an important finding for the development of prevention programming.

Incidence and Risk Factors for Abusive Head Trauma: A Population-Based Study.

Previous studies on Abusive Head Trauma (AHT) suggest incidence may vary by geographic location and there is limited information regarding population-based risk factors on this form of child maltreatment. This study provides new knowledge regarding these two aspects using the population of the US state of Washington born between 1999 and 2013. We used a linked administrative dataset comprised of birth, hospital discharge, child protective services (CPS) and death records to identify the scale and risk factors for AHT for the state population using quantitative survival methods. We identified AHT using diagnostic codes in hospital discharge records defined by the US Centers for Disease Control. A total of 354 AHT hospitalisations were identified and the incidence for the state was 22.8 per 100 000 children under the age of one. Over 11 per cent of these children died. Risk factors included a teenaged mother at the time of birth, births paid for using public insurance, child's low birth weight, and maternal Native American race. The strongest risk factor was a prior CPS allegation, a similar finding to a California study on injury mortality. The practice and policy implications of these findings are discussed.

The impact of socioeconomic position (SEP) on women's health over the lifetime.

The "social gradient of health" refers to the steep inverse associations between socioeconomic position (SEP) and the risk of premature mortality and morbidity. In many societies, due to cultural and structural factors, women and girls have reduced access to the socioeconomic resources that ensure good health and wellbeing when compared with their male counterparts. Thus, the objective of this paper is to review how SEP - a construct at the heart of the Social Determinants of Health (SDoH) theory - shapes the health and longevity of women and girls at all stages of the lifespan. Using literature identified from PubMed, Cochrane, CINAHL and EMBASE databases, we first describe the SDoH theory. We then use examples from each stage of the life course to demonstrate how SEP can differentially shape girls' and women's health outcomes compared with boys' and men's, as well as between sub-groups of girls and women when other axes of inequalities are considered, including ethnicity, race and residential setting. We also explore the key consideration of whether conventional SEP markers are appropriate for understanding the social determinants of women's health. We conclude by making key recommendations in the context of clinical, research and policy development.

Low birth weight and childhood health: the role of maternal education.

PURPOSE: Low birth weight (LBW) is associated with myriad health and developmental problems in childhood and later in life. Less well-documented is the variation in the relationship between LBW status and subsequent child health by socioeconomic status-such as education levels and income. This article examines whether differences exist in the relationship between LBW and subsequent child health by maternal education. METHODS: We used data from the 1998-2017 National Health Interview Survey to estimate multivariate logistic regression models to determine whether the association between LBW and subsequent child health as measured by general health status, developmental disability, and asthma diagnosis differed by maternal education, net of differences in children's sociodemographic factors, family background, and medical access. RESULTS: The negative association between LBW and subsequent health was typically weaker for children of mothers with less than high school education than it was for children of mothers with higher levels of education. CONCLUSIONS: The findings on the enduring impact of LBW status on child health for all children, especially those born to mothers with higher levels of education, suggest that all children born LBW should be provided appropriate medical and support services to reduce the lifelong repercussions of poor health at birth.

Transdisciplinarity in Research: Perspectives of Early Career Faculty.

BACKGROUND: Early career faculty experiences and perspectives on transdisciplinary research are important yet understudied. METHODS: Assistant professors at 50 top-ranked social work programs completed an online survey assessing perspectives on the salience of transdisciplinary training in their field, obstacles to or negative impacts of transdisciplinary training, and current environments. Content analysis and descriptive statistics were used. RESULTS: A large majority of all participants (N » 118) believed that transdisciplinary research is important, that greater training is needed, and that they are relatively well prepared in related skill sets. They are expected to build cross-disciplinary collaborations, yet only a small minority believed that social work researchers are nationally recognized as important collaborators, or that they are prepared to navigate tensions on research teams. CONCLUSIONS: We offer a multilevel framework of structural and training supports needed to realize transdisciplinary research in social work with relevance to other disciplines.

The relationship between low birthweight and childhood health: disparities by race, ethnicity, and national origin.

PURPOSE: Racial/ethnic disparities in rates of low birthweight (LBW) are well established, as are racial/ethnic differences in health outcomes over the life course. Yet, there is little empirical work examining whether the consequences of LBW for subsequent child health vary by race, ethnicity, and national origin. METHODS: Using data from the 1998-2016 National Health Interview Survey, we examined whether racial, ethnic, and national differences existed in the association between LBW and subsequent health outcomes, namely being diagnosed with a developmental disability, asthma diagnosis, and poorer general health. RESULTS: Children born with LBW consistently had poorer health relative to children born with normal birthweight. There was no systematic evidence that the linkages between LBW and subsequent health were weaker for one racial/ethnic/national origin group relative to others. CONCLUSIONS: LBW was associated with subsequent poorer health. There was no systematic evidence that the link between LBW and subsequent child health were weaker for one racial/ethnic/national origin group relative to others. Together, these findings highlight the importance of reducing race/ethnic disparities in rates of LBW as a way of eradicating inequalities in childhood health.

Child Overweight and Obesity in Shanghai, China: Contextualizing Chinese Socioeconomic and Gender Differences.

PURPOSE: Childhood overweight and obesity is on the rise in China and in Chinese cities in particular. The aim of this study is to explore the extent of income differences in childhood overweight in Shanghai, China, and examine demographic, social, and behavioral explanations for these differences. METHODS: Using the 2014 Child Well-Being Study of Shanghai, China-a survey that included extensive contextual information on children and their families in China's most populous city, prevalence rates and adjusted odds ratios of child overweight and obesity at age 7 were calculated by income tercile controlling for a wide variety of sociodemographic variables. RESULTS: District aggregate income increases the odds of child overweight/obesity, but only for boys. In contrast, rural hukou status was associated with lower odds of overweight/obesity for girls. CONCLUSIONS: Boys at age 7 are more likely to be overweight and obese than girls. District income further increases this likelihood for boys, while rural hukou status decreases this likelihood for girls, suggesting that preferences for boys and thinness ideals for girls may play a role in the income patterning of childhood overweight and obesity.

A Social Work Approach to Policy: Implications for Population Health.

The substantial disparities in health and poorer outcomes in the United States relative to peer nations suggest the need to refocus health policy. Through direct contact with the most vulnerable segments of the population, social workers have developed an approach to policy that recognizes the importance of the social environment, the value of social relationships, and the significance of value-driven policymaking. This approach could be used to reorient health, health care, and social policies. Accordingly, social workers can be allies to public health professionals in efforts to eliminate disparities and improve population health.

Low birthweight among immigrants in Australia, the United Kingdom, and the United States.

Immigrant women are less likely than their native-born counterparts to give birth to a low birthweight infant in the United States, and length of U.S. residence shrinks nativity differences in rates of low birthweight. Yet, we know little about how the U.S. context compares to immigrant low birthweight patterns in other countries. Using nationally representative data, we examine variations in the association between nativity and low birthweight in Australia, the United Kingdom, and the United States-three economically developed countries with long immigrant traditions, but different admission regimes. This study uses birth cohort data from these three destination countries to compare low birthweight between immigrant and native-born residents and then investigates how immigrant low birthweight varies by country of origin and duration in the host country. We find no significant difference in low birthweight between immigrants and native Australians, but for the United Kingdom, we find patterns of low birthweight by duration consistent with those found in the United States. Specifically, foreign-born status protects against low birthweight, though not uniformly across racial groups, except for new arrivals. The results suggest that low birthweight among immigrants is a product of several country-specific factors, including rates of low birthweight in sending countries, access to health services in host countries, and immigrant admission policies that advantage skilled migrants.

Birthing, Nativity, and Maternal Depression: Australia and the United States.

This study analyzes two birth cohort surveys, the Longitudinal Study of Australian Children (n=3944) and Early Childhood Longitudinal Study (n=7700), to examine variation in maternal depression by nativity, duration of residence, age at migration, and English proficiency in Australia and the United States. Both countries have long immigrant traditions and a common language. The results demonstrate that US immigrant mothers are significantly less depressed than native-born mothers, but maternal depression does not differ by nativity in Australia. Moreover, the association between duration of residence and maternal depression is not linear: recent arrivals and long-term residents exhibit the highest depression levels. Lack of English proficiency exacerbates maternal depression in Australia, but protects against depression in the United States. Differences in immigration regimes and welfare systems likely contribute to the differing salience of nativity for maternal depression.

The long-arm of adolescent weight status on later life depressive symptoms.

BACKGROUND: given the increase in worldwide obesity among children and adolescents, the long-term consequences of childhood obesity on the risk of adverse health outcomes in later life has garnered increased attention. Much of the work on earlier life weight status and later life health has focused on cardiovascular-related outcomes in mid- to late-adulthood; however, little is known about the later life mental health consequences of adolescent body weight. METHODS: data came from the Wisconsin Longitudinal Study. We estimated gender-stratified logistic regression models to characterise the relationship between adolescent weight status using standardised relative body mass ascertained from high school photograph portraits in 1957 and depressive symptoms at age 65 using the Center for Epidemiologic Studies Depression Scale measured in 2004. RESULTS: women who were overweight in adolescence were significantly more likely to experience depressive symptoms in later adulthood than their normal weight counterparts (odds ratio [OR] = 1.740) when the full set of controls was included. This relationship was not observed among men. The relationship between women's adolescent weight status and later life depressive symptoms was moderated by childhood socioeconomic status, and adolescent overweight was more predictive of later life depressive symptoms for women who were raised in low- and middle-income families (OR = 2.568 and OR = 2.763) than in high-income families (OR = 1.643). CONCLUSION: these findings provide further evidence for the wide range of long-term consequences of adolescent overweight on later life well-being and are notable for the gender differences in the connection between early life circumstances and later life mental health.

Socioeconomic Inequalities in Low Birth Weight in the United States, the United Kingdom, Canada, and Australia.

OBJECTIVES: To compare associations between socioeconomic status and low birth weight across the United States, the United Kingdom, Canada, and Australia, countries that share cultural features but differ in terms of public support and health care systems. METHODS: Using nationally representative data from the United States (n = 8400), the United Kingdom (n = 12 018), Canada (n = 5350), and Australia (n = 3452) from the early 2000s, we calculated weighted prevalence rates and adjusted odds of low birth weight by income quintile and maternal education. RESULTS: Socioeconomic gradients in low birth weight were apparent in all 4 countries, but the magnitudes and patterns differed across countries. A clear graded association between income quintile and low birth weight was apparent in the United States. The relevant distinction in the United Kingdom appeared to be between low, middle, and high incomes, and the distinction in Canada and Australia appeared to be between mothers in the lowest income quintile and higher-income mothers. CONCLUSIONS: Socioeconomic inequalities in low birth weight were larger in the United States than the other countries, suggesting that the more generous social safety nets and health care systems in the United Kingdom, Canada, and Australia played buffering roles.

Income disparities in cardiovascular health across the lifespan.

Using data from the 1999-2014 National Health and Nutrition Examination Survey (n ~ 46,000), this study documents income disparities in the age patterning of cardiovascular conditions across the lifespan in the U.S. The conditions were assessed from laboratory test results, self-reports of medications used to treat specific conditions, and anthropometric measurements, allowing us to capture whether individuals at given ages had developed the various conditions, regardless of previous diagnosis and treatment. We found evidence of large income disparities in the presence of cardiovascular conditions and risk factors for females, smaller disparities in the same conditions for males, and few disparities that increased with age for either gender. Results were very similar when considering disparities by education instead of income. The findings suggest that the widening socioeconomic gradients in health over the lifespan found in many previous studies-which have generally focused on self-rated health, activity limitations, or diagnosed conditions-reflect, at least to some extent, differences in diagnosis, treatment, and management of health conditions rather than age-related differences in developing them. The findings also suggest that preventive healthcare is not an important source of socioeconomic disparities in cardiovascular health in the U.S., at least for men. The observed patterns of income disparities in cardiovascular conditions over the lifespan are more consistent with theories of early life conditions and the imprinting of health endowments and susceptibilities early in life than with cumulative life exposure or stress hypotheses.

Variation in child body mass index patterns by race/ethnicity and maternal nativity status in the United States and England.

This paper examines body mass index (BMI) trajectories among children from different race/ethnic and maternal nativity backgrounds in the United States and England from early- to middle-childhood. This study is the first to examine race/ethnic and maternal nativity differences in BMI trajectories in both countries. We use two longitudinal birth cohort studies-The Fragile Families and Child Wellbeing Study (n = 3,285) for the United States and the Millennium Cohort Study (n = 6,700) for England to estimate trajectories in child BMI by race/ethnicity and maternal nativity status using multilevel growth models. In the United States our sample includes white, black, and Hispanic children; in England the sample includes white, black, and Asian children. We find significant race/ethnic differences in the initial BMI and BMI trajectories of children in both countries, with all non-white groups having significantly steeper BMI growth trajectories than whites. Nativity differences in BMI trajectories vary by race/ethnic group and are only statistically significantly higher for children of foreign-born blacks in England. Disparities in BMI trajectories are pervasive in the United States and England, despite lower overall BMI among English children. Future studies should consider both race/ethnicity and maternal nativity status subgroups when examining disparities in BMI in the United States and England. Differences in BMI are apparent in early childhood, which suggests that interventions targeting pre-school age children may be most effective at stemming childhood disparities in BMI.