Getting Rides From Others As a Coping Mechanism in the Transition to Non-Driving.

OBJECTIVES: To characterize the effect of the actual and potential ability to get rides from others on older adults' driving reduction at 3-year follow-up in the United States. METHODS: We analyzed National Health and Aging Trends Study data from community-dwelling drivers in 2015 (unweighted n = 5,102). We used weighted logistic regression models to estimate whether getting rides from others in 2015 was associated with older adults increasing the number of driving behaviors they avoided, decreasing the frequency with which they drove, or not driving at 3-year follow-up after adjusting for biopsychosocial variables. We also measured presence of social network members living nearby including household and non-household members and estimated associated odds of driving reduction at 3-year follow-up. RESULTS: Older adults who got rides from others in 2015 had greater odds of reporting no longer driving at 3-year follow-up compared to those who did not get rides (adjusted odds ratio [aOR] = 1.53, 95% confidence interval [CI]: 1.11-2.11). We found no statistically significant association between older adults living with others or having more nearby confidantes outside their household and their odds of reducing driving at 3-year follow-up. DISCUSSION: These findings suggest that getting rides from others plays an important role in the transition to non-driving for older adults. Future research should examine whether other aspects of social networks (e.g., type, quality, and closer proximity) might also be key modifiable coping factors for older adults transitioning to non-driving.

Does Subsidized Housing Prevent Health Decline and 2-Year Mortality Among Low-Income Older Renters?

BACKGROUND AND OBJECTIVES: A growing number of older adults in the United States need subsidized housing, but only 36% of eligible households receive assistance. The purpose of this study is to examine if older renters living in subsidized housing are less likely to experience health decline and mortality over 2 years compared to low-income older renters who are likely eligible, but do not receive assistance. RESEARCH DESIGN AND METHODS: Baseline data include 671 subsidized and unsubsidized low-income older renters from the 2015 National Health and Aging Trends Study. Outcomes of interest include self-rated health decline, developing a new activity limitation, or 2-year mortality between 2015 and 2017. Weighted stepwise logistic regression models test (a) if subsidized older renters were less likely to experience health decline or 2-year mortality compared to unsubsidized older renters, and (b) if housing quality and neighborhood factors mediate the association between subsidized housing and health decline/mortality. RESULTS: Subsidized older renters were less likely to develop a new activity limitation compared to unsubsidized older renters, but there was not a statistically significant difference in experiencing self-rated health decline or 2-year mortality by subsidized housing status. Housing quality and neighborhood factors did not significantly mediate this association. DISCUSSION AND IMPLICATIONS: The results provide some support that improving access to subsidized housing for low-income older renters may have additional health benefits, even in the short term. To inform program improvements and maximize potential health benefits, more research is needed to understand the specific health-promoting features of subsidized housing.

Examining Consequences Related to Unmet Care Needs Across the Long-Term Care Continuum.

OBJECTIVES: To examine how different care arrangements across the long-term care continuum are associated with experiencing unmet care need consequences (UCNCs), such as skipping meals, going without clean clothes, or taking the wrong medication. METHODS: We include older adults receiving assistance with at least one self-care, mobility, or household activity (for health/functioning reasons) in the 2015 National Health and Aging Trends Study (N = 2,388). We examine the likelihood of experiencing a UCNC across the long-term care continuum: those receiving unpaid community care only, paid community care, and residential care. Cross-sectional logistic and longitudinal multinomial logistic regression models examine if type of care arrangement in 2015 is associated with UCNCs in 2015 and change in UCNCs by 2017. RESULTS: In adjusted cross-sectional models, paid community care recipients had roughly 2 times greater odds of experiencing a UCNC in 2015 compared to those living in residential care or receiving only unpaid care. In adjusted longitudinal models, the risk of experiencing persistent UCNCs (compared to having needs met in both years) was 4.81 times higher for those receiving paid community care compared to those in residential care and 2.17 times that of those receiving unpaid care only. DISCUSSION: Older adults receiving paid care face significant and consequential gaps in care, particularly in comparison to those in other care arrangements. More attention is needed to determine how paid care arrangements can be improved and/or expanded to meet the needs of the growing number of older adults receiving paid care in the community.

Housing Cost Burden and Health Decline Among Low- and Moderate-Income Older Renters.

OBJECTIVE: To examine the association between housing cost burden (HCB) and health decline among low- and moderate-income older renters in the United States. METHOD: Baseline data include low- and moderate-income community-dwelling older renters (N = 1,064) from the nationally representative 2015 National Health and Aging Trends Study. HCB was defined as the percentage of monthly income spent on rent, categorized as "no HCB" (<30%), "moderate HCB" (30%-49%), and "severe HCB" (≥50%). We used weighted logistic regression models to estimate whether HCB status in 2015 and change in HCB between 2015 and 2017 were associated with self-rated health decline and developing a new limitation related to activities of daily living (ADL) or instrumental activities of daily living (IADL) between 2015 and 2017. RESULTS: Older renters with severe HCB in 2015 were the most likely to develop a new ADL/IADL limitation (63.4%) over time (p < .05). The association between HCB status in 2015 and self-rated health decline was not statistically significant, but older renters with persistent HCB had 1.64 times greater odds of self-rated health decline (p < .05) and 2.01 times greater odds of developing a new ADL/IADL limitation (p < .01), compared to older renters with no HCB at baseline and follow-up. DISCUSSION: Even in the short term, HCB contributes to health decline in later life. Efforts to promote equity and healthy aging in the community must consider how to best address housing affordability among the growing population of older renters.

The Effects of Housing Cost Burden and Housing Tenure on Moves to a Nursing Home Among Low- and Moderate-Income Older Adults.

BACKGROUND AND OBJECTIVES: In the United States, a growing number of older adults struggle to find affordable housing that can adapt to their changing needs. Research suggests that access to affordable housing is a significant barrier to reducing unnecessary nursing home admissions. This is the first empirical study we know of to examine whether housing cost burden (HCB) is associated with moves to nursing homes among older adults. RESEARCH DESIGN AND METHODS: Data include low- and moderate-income community-dwelling older adults (N = 3,403) from the nationally representative 2015 National Health and Aging Trends Study. HCB (≥30% of income spent on mortgage/rent) and housing tenure (owner/renter) are combined to create a 4-category housing typology. Multinomial logistic regression models test (a) if renters with HCB are most likely (compared with other housing types) to move to a nursing home over 3 years (2015-2018) and (b) if housing type interacts with health and functioning to predict moves to a nursing home. RESULTS: Across all models, renters with HCB had the greatest likelihood of moving to a nursing home. Moreover, self-rated health, physical capacity, and mental health were weaker predictors of nursing home moves for renters with HCB. DISCUSSION AND IMPLICATIONS: Results suggest that older renters with HCB are most likely to experience unnecessary nursing home placement. The growing population of older renters experiencing HCB may not only signal a housing crisis, but may also challenge national efforts to shift long-term care away from nursing homes and toward community-based alternatives.

Black-White Disparities in Moves to Assisted Living and Nursing Homes Among Older Medicare Beneficiaries.

OBJECTIVES: Investigate black-white disparities in older adults' moves to assisted living and nursing homes and draw from the Andersen Healthcare Utilization Model to test explanations for any disparities. METHODS: Data are from a nationally representative sample of older community-dwelling Medicare beneficiaries from the 2015 (N = 5,212) National Health and Aging Trends Study (NHATS). We use stepwise multinomial logistic regression to examine black-white disparities in moves out of community housing to assisted living or a nursing home over 2 years, before and after adjusting for predisposing (age, gender), enabling (income, housing tenure, Medicaid, living arrangement) and need (activities of daily living [ADL] limitation, physical capacity, self-rated health, and dementia) factors. RESULTS: Black older adults are less likely to move to assisted living and are more likely to move to a nursing home compared to white older adults. Black-white disparities in moves to nursing homes are explained by black-white differences in enabling and need factors, whereas black-white disparities in moves to assisted living remain even after adjusting for enabling and need factors. DISCUSSION: Unmeasured factors related to systemic racism (e.g., residential racial segregation, racial discrimination) and/or black-white differences in care preferences might further explain black-white disparities in moves to assisted living and warrant further investigation.

Neighborhood environments influence emotion and physiological reactivity.

Living in a disadvantaged neighborhood is associated with worse health and early mortality. Although many mechanisms may partially account for this effect, disadvantaged neighborhood environments are hypothesized to elicit stress and emotional responses that accumulate over time and influence physical and mental health. However, evidence for neighborhood effects on stress and emotion is limited due to methodological challenges. In order to address this question, we developed a virtual reality experimental model of neighborhood disadvantage and affluence and examined the effects of simulated neighborhoods on immediate stress and emotion. Exposure to neighborhood disadvantage resulted in greater negative emotion, less positive emotion, and more compassion, compared to exposure to affluence. However, the effect of virtual neighborhood environments on blood pressure and electrodermal reactivity depended on parental education. Participants from families with lower education exhibited greater reactivity to the disadvantaged neighborhood, while those from families with higher education exhibited greater reactivity to the affluent neighborhood. These results demonstrate that simulated neighborhood environments can elicit immediate stress reactivity and emotion, but the nature of physiological effects depends on sensitization to prior experience.

Associations between Food Security Status and Dietary Inflammatory Potential within Lower-Income Adults from the United States National Health and Nutrition Examination Survey, Cycles 2007 to 2014.

BACKGROUND: Evidence suggests both that chronic inflammation mediates the association of food insecurity with adverse health outcomes and that diet may be a significant source of inflammation among food insecure individuals. OBJECTIVE: To examine whether food security status is associated with dietary inflammatory potential. DESIGN AND PARTICIPANTS: Cross-sectional data came from the National Health and Nutrition Examination Survey (NHANES), cycles 2007 to 2014 (n=10,630). The analysis sample is representative of noninstitutionalized US adults with an income-to-poverty ratio ≤3.00. MAIN OUTCOME: Dietary Inflammatory Index (DII) score, calculated using the average of two 24-hour dietary recalls, was the main outcome measure. STATISTICAL ANALYSIS: Type III F tests or χ2 tests compared population characteristics by food security status, defined using the US Food Security Survey Module. Multivariable linear regression was used to estimate the association between food security status and the DII score and moderation by demographic factors. Survey weighting procedures accounted for the effects of stratification and clustering used in the NHANES study design. RESULTS: When accounting for socioeconomic status, demographic factors, and health status, DII score was higher at greater levels of food insecurity (P=0.0033). Those with very low food security had a 0.31 (95% CI=0.12 to 0.49) higher DII score than those with high food security. Age moderated the association between food security status and DII score (interaction P=0.0103), where the magnitude of the association between DII score and severity of food insecurity was higher for those >65 years than for younger age groups. CONCLUSION: Food security status may be associated with dietary inflammatory potential, which is hypothesized to play a role in multiple chronic health conditions. Further research is needed to determine the causal nature of this relationship and evaluate how best to implement programs designed to address health disparities within food insecure populations.

Participation in the Supplemental Nutrition Assistance Program and maternal depressive symptoms: Moderation by program perception.

RATIONALE: Previous studies have observed an association between participation in the Supplemental Nutrition Assistance Program (SNAP) and depression, which is contrary to SNAP's potential to alleviate food insecurity and financial strain. OBJECTIVE: This study investigated the impact of change in SNAP participation status on maternal depression, and whether perceptions of government assistance moderate this association. METHODS: Data were from the Fragile Families and Child Wellbeing Study (FFCWS). Logistic regression models with individual-specific fixed-effects, were fit to SNAP-eligible mothers who changed SNAP participation and depression status (N = 256) during waves 2 to 4. Perceptions of government assistance were defined as feelings of humiliation or loss of freedom and tested for interactions with SNAP participation. RESULTS: Perceptions of government assistance moderated the association between SNAP participation and depression (p-interaction = 0.0208). Those with positive perceptions of welfare had 0.27 (95% CI = 0.08 to 0.89) times lower odds of depression when enrolled vs. not enrolled in SNAP. Among those with negative perceptions of welfare, SNAP enrollment was not associated with depression (OR = 1.13; 95% CI = 0.85 to 1.51). CONCLUSION: Evidence suggests that SNAP mental health benefits may be context specific. SNAP's capacity to improve mental health may depend on individual perceptions of government assistance. More research is needed to determine whether interventions aimed at mitigating negative perceptions of programs like SNAP could ameliorate poor mental health among program participants.

Neighborhood SES is particularly important to the cardiovascular health of low SES individuals.

RATIONALE: Health disparities defined by neighborhood socioeconomic status (SES) are well established; it is less well understood whether neighborhood SES is differentially associated with health depending on one's own SES. OBJECTIVE: The double jeopardy hypothesis, collective resources model, fundamental cause theory, and relative deprivation hypothesis support differential patterns of association between neighborhood and individual SES with health. The first three models suggest that higher neighborhood SES predicts health more strongly among lower, as compared to higher, SES individuals. The relative deprivation hypothesis suggests that higher SES neighborhoods bring no extra health benefit to low SES individuals and could even bring a health deficit. This study examined competing hypotheses with prospective associations between cardiovascular (CV) health and individual SES, neighborhood SES, and their interaction. METHOD: Data were from two waves of the Midlife in the United States (MIDUS) Study (N = 1012), a national survey of adults ages 25 and older at baseline. Neighborhood SES was a composite of five census tract-level SES indicators from the 1990 census. Individual SES was a composite of educational attainment and household income at wave one (1995-1996). CV health at wave two (2004-2008), was computed as a composite based on smoking status, body mass index, physical activity, diet, total cholesterol, blood pressure, and glucose. RESULTS: Individual and neighborhood SES were each associated with CV health net of baseline health status and other covariates. Interactions between individual and neighborhood SES showed that higher neighborhood SES was associated with better CV health for those of lower, not higher, individual SES. CONCLUSION: Results are consistent with the double jeopardy hypothesis, the collective resources model, and the fundamental cause theory, but not with a relative deprivation hypothesis. Results suggest that additional attention to the neighborhood socioeconomic context of lower SES individuals may reduce SES disparities in cardiovascular health.

Impact of county disadvantage on behavior problems among US children with cognitive delay.

OBJECTIVES: We investigated relationships among cognitive delay, community factors, and behavior problems over 2 years in early childhood with a national sample of US families. METHODS: Data were from 3 waves of the Early Childhood Longitudinal Study, Birth Cohort (2001-2005; n = 7650). We defined cognitive delay as the lowest 10% of mental scores from the Bayley Short Form-Research Edition, administered at 9 and 24 months. At 24 months, we classified children as typically developing or as having resolved, newly developed, or persistent cognitive delays. Behavior was measured at age 4 years with the Preschool and Kindergarten Behavior Scales (range = 0-36). Community factors included perceived neighborhood safety and an index of county disadvantage. RESULTS: Behavior scores at age 4 years (mean = 12.4; SD = 4.9) were higher among children with resolved (Β = 0.70; SE = 0.20), newly developed (Β = 1.92; SE = 0.25), and persistent (Β = 2.96; SE = 0.41) cognitive delays than for typically developing children. The interaction between county disadvantage and cognitive delay status was statistically significant (P < .01), suggesting that county disadvantage was particularly detrimental for children with persistent delays. CONCLUSIONS: The community context may provide an opportunity for public health interventions to improve the behavioral health of children with cognitive delays.

Gender differences in multiple underlying dimensions of health-related quality of life are associated with sociodemographic and socioeconomic status.

PURPOSE: The purpose of the study was to examine whether gender differences in summary health-related quality of life (HRQoL) are due to differences in specific dimensions of health, and whether they are explained by sociodemographic and socioeconomic (SES) variation. METHODS: The National Health Measurement Study collected cross-sectional data on a national sample of 3648 black and white noninstitutionalized adults ages 35 to 89 years. Data included the Short Form 36-Item survey, which yielded separate Mental and Physical Component Summary scores (MCS and PCS, respectively), and five HRQoL indexes: Short Form 6 dimension, EuroQol 5 dimension, the Health Utilities Indexes Mark 2 and 3, and the Quality of Well-Being Scale Self-Administered form. Structural equation models were used to explore gender differences in physical, psychosocial, and pain latent dimensions of the 5 indexes, adjusting for sociodemographic and SES indicators. Observed MCS and PCS scores were examined in regression models to judge robustness of latent results. RESULTS: Men had better estimated physical and psychosocial health and less pain than women with similar trends on the MCS and PCS scores. Adjustments for marital status or income reduced gender differences more than did other indicators. Adjusting results for partial factorial invariance of HRQoL attributes supported the presence of gender differentials, but also indicated that these differences are impacted by dimensions being related to some HRQoL attributes differently by gender. CONCLUSIONS: Men have better estimated health on 3 latent dimensions of HRQoL-physical, psychosocial, and pain-comparable to gender differences on the observed MCS and PCS scores. Gender differences are partly explained by sociodemographic and SES factors, highlighting the role of socioeconomic inequalities in perpetuating gender differences in health outcomes across multiple domains. These results also emphasize the importance of accounting for measurement invariance for meaningful comparison of group differences in estimated means of self-reported measures of health.

Examining the Racial Crossover in Mortality between African American and White Older Adults: A Multilevel Survival Analysis of Race, Individual Socioeconomic Status, and Neighborhood Socioeconomic Context.

We examine whether individual and neighborhood socioeconomic context contributes to black/white disparities in mortality among USA older adults. Using national longitudinal data from the Americans' Changing Lives study, along with census tract information for each respondent, we conduct multilevel survival analyses. Results show that black older adults are disadvantaged in mortality in younger old age, but older black adults have lower mortality risk than whites after about age 80. Both individual SES and neighborhood socioeconomic disadvantage contribute to the mortality risk of older adults but do not completely explain race differences in mortality. The racial mortality crossover persists even after controlling for multilevel SES, suggesting that black older adults experience selective survival at very old ages. Addressing the individual and neighborhood socioeconomic disadvantage of blacks is necessary to reduce mortality disparities that culminate in older adulthood.

US opinions on health determinants and social policy as health policy.

To examine what factors the public thinks are important determinants of health and whether social policy is viewed as health policy, we conducted a national telephone survey of 2791 US adults from November 2008 through February 2009. Respondents said that health behaviors and access to health care have very strong effects on health; they were less likely to report a very strong role for other social and economic factors. Respondents who recognized a stronger role for social determinants of health and who saw social policy as health policy were more likely to be older, women, non-White, and liberal, and to have less education, lower income, and fair/poor health. Increasing public knowledge about social determinants of health and mobilizing less advantaged groups may be useful in addressing broad determinants of health.

Awareness of racial and socioeconomic health disparities in the United States: the national opinion survey on health and health disparities, 2008-2009.

INTRODUCTION: Recent initiatives aim to improve public awareness of health disparities. However, little research has actually documented the US public's awareness of racial/ethnic and socioeconomic health disparities. We sought to determine 1) whether the US public is aware of racial, educational, and income disparities in health, 2) whether awareness differs across these disparity domains, and 3) what respondent characteristics are associated with awareness of racial, educational, and income disparities in health. METHODS: We conducted the National Opinion Survey on Health and Health Disparities with 2,791 US adults. We asked respondents to answer questions about disparities in health between 1 of several pairs of population subgroups: African Americans versus whites, non-high school graduates versus high school graduates, high school graduates versus college graduates, the poor versus the middle class, or the middle class versus the rich. We used χ(2) tests and logistic regression to compare correlates of respondents' awareness of disparities across the different pairs of population subgroups. RESULTS: Most respondents were aware of health disparities between the poor and middle class (73%); fewer were aware of health disparities between African Americans and whites (46%). Although respondents recognized that education is associated with many positive life outcomes, they were less aware of the link between education and health. Respondents who were younger, less educated, lower-income, healthier, or politically conservative were less likely to be aware of health disparities. CONCLUSION: Public awareness of disparities in health differs depending on both the type of disparity and the characteristics of the individual respondent.

Racial disparities in health-related quality of life in a cohort of very low birthweight 2- and 3-year-olds with and without cerebral palsy.

We examine racial differences in health-related quality of life (HRQoL) among 2- and 3-year-olds born very low birthweight (VLBW, <1500 g). The sample included 611 children (290 males and 321 females) from the Newborn Lung Project, a cohort of VLBW infants hospitalized in Wisconsin's newborn intensive care units during 2003 to 2004. Of the 611 children, 14% (86/611) were black, non-Hispanic and 86% (525/611) were white, non-Hispanic and 4% (23/611) had cerebral palsy. HRQoL was measured using the Pediatric Quality of Life Inventory. Black children scored nearly four points lower (mean difference -3.6, 95% confidence interval [CI]: -6.9 to -0.3) on HRQoL than their white peers. Cerebral palsy is associated with lower HRQoL (mean difference -24.4, 95% CI: -29.3 to -19.5), especially among black children, but does not explain racial differences in HRQoL. Living in a neighborhood with lowest levels of female education is associated with lower HRQoL (mean difference -5.6, 95% CI: -9.2 to -2.1), but does not explain the racial difference in HRQoL.

Socioeconomic status and survival after an invasive breast cancer diagnosis.

BACKGROUND: Women who live in geographic areas with high poverty rates and low levels of education experience poorer survival after a breast cancer diagnosis than women who live in communities with indicators of high socioeconomic status (SES). However, very few studies have examined individual-level SES in relation to breast cancer survival or have assessed the contextual role of community-level SES independent of individual-level SES. METHODS: The authors of this report examined both individual-level and community-level SES in relation to breast cancer survival in a population-based cohort of women ages 20 to 69 years who were diagnosed with breast cancer in Wisconsin between 1995 and 2003 (N = 5820). RESULTS: Compared with college graduates, women who had no education beyond high school were 1.39 times more likely (95% confidence interval [CI], 1.10-1.76) to die from breast cancer. Women who had household incomes <2.5 times the poverty level were 1.46 times more likely (95% CI, 1.10-1.92) to die from breast cancer than women who had household incomes ≥5 times the poverty level. Adjusting the analysis for use of screening mammography, disease stage at diagnosis, and lifestyle factors eliminated the disparity by income, but the disparity by education persisted (hazard ratio [HR], 1.27; 95% CI, 0.99-1.61). In multilevel analyses, low community-level education was associated with increased breast cancer mortality even after adjusting for individual-level SES (HR, 1.57; 95% CI, 1.09-2.27 for ≥20% vs <10% of adults without a high school degree). CONCLUSIONS: The current results indicated that screening and early detection explain some of the disparity according to SES, but further research will be needed to understand the additional ways in which individual-level and community-level education are associated with survival.

Qualitative research about attributions, narratives, and support for obesity policy, 2008.

INTRODUCTION: Successful efforts to reduce obesity will require public policy strategies that target both individuals and external factors such as social conditions, economic circumstances, and physical environments. Public opinion data suggest that many policy changes to reduce obesity are likely to face public resistance. METHODS: We conducted 4 focus groups involving 33 adults living in or near a midsized Midwestern city in July 2008. Participants were assigned to the focus groups on the basis of self-reported political ideology. We used a semistructured discussion guide to 1) better understand public perceptions of obesity and 2) assess the promise of narratives as a strategy to stimulate meaningful discussion about obesity-related policy change. RESULTS: Participants viewed internal factors as primary causes of obesity. Despite substantial acknowledgment of external causes of obesity, many participants - particularly political conservatives - were resistant to external policy solutions for the problem. Across the political spectrum, participants responded more favorably to a short narrative emphasizing barriers to reducing adult obesity than a story emphasizing barriers to reducing childhood obesity. CONCLUSION: This study provides a deeper context for understanding public perceptions about obesity. Some types of narratives appear promising for promoting support for policy solutions to reduce obesity.

Relationship between neighborhood disadvantage and social function of Wisconsin 2- and 3-year-olds born at very low birth weight.

OBJECTIVE: To examine whether (1) neighborhood disadvantage is associated with social function in 2- and 3-year-olds born at very low birth weight (<1500 g) and (2) the association between social function and child's health-related quality of life (HRQoL) is moderated by neighborhood disadvantage. DESIGN: Cross-sectional study using the Newborn Lung Project, a cohort of infants born at very low birth weight in 2003 and 2004 in Wisconsin. SETTING: Wisconsin. PARTICIPANTS: This study includes the subgroup of 626 non-Hispanic black or white infants who were followed up at ages 24 to 43 months with parent-reported health and developmental information. MAIN EXPOSURE: An index of neighborhood disadvantage was derived by principal component analysis of 5 census tract variables (percentage of families in poverty, percentage of households with income higher than the state median, percentage of women with bachelor's degree or more, percentage of single mothers, and percentage of mothers of young children unemployed). Children were then classified (based on index tertiles) as living in either disadvantaged, middle advantage, or advantaged neighborhoods. Children's HRQoL was measured using the Pediatric Quality of Life Inventory. MAIN OUTCOME MEASURE: Social function was measured using the Pediatric Evaluation of Disability Inventory. RESULTS: Adjusting for child medical and family socioeconomic attributes, social function was lower (mean difference, -4.60; 95% confidence interval, -8.4 to -0.8) for children living in disadvantaged vs advantaged neighborhoods. We also found that the ill effects of lower HRQoL are particularly bad for children living in a disadvantaged neighborhood. CONCLUSION: Children born at very low birth weight have disparities in social function at ages 2 and 3 years that are associated with both HRQoL and neighborhood characteristics.

Gender differences in health-related quality-of-life are partly explained by sociodemographic and socioeconomic variation between adult men and women in the US: evidence from four US nationally representative data sets.

PURPOSE: The purpose of this study was to describe gender differences in self-reported health-related quality-of-life (HRQoL) and to examine whether differences are explained by sociodemographic and socioeconomic status (SES) differentials between men and women. METHODS: Data were from four US nationally representative surveys: US Valuation of the EuroQol EQ-5D Health States Survey (USVEQ), Medical Expenditure Panel Survey (MEPS), National Health Measurement Study (NHMS) and Joint Canada/US Survey of Health (JCUSH). Gender differences were estimated with and without adjustment for sociodemographic and SES indicators using regression within and across data sets with SF-6D, EQ-5D, HUI2, HUI3 and QWB-SA scores as outcomes. RESULTS: Women have lower HRQoL scores than men on all indexes prior to adjustment. Adjusting for age, race, marital status, education and income reduced but did not remove the gender differences, except with HUI3. Adjusting for marital status or income had the largest impact on estimated gender differences. CONCLUSIONS: There are clear gender differences in HRQoL in the United States. These differences are partly explained by sociodemographic and SES differentials.