Socioeconomic Inequalities in Premature Cancer Mortality Among U.S. Counties During 1999 to 2018.

BACKGROUND: This study investigated socioeconomic inequalities in premature cancer mortality by cancer types, and evaluated the associations between socioeconomic status (SES) and premature cancer mortality by cancer types. METHODS: Using multiple databases, cancer mortality was linked to SES and other county characteristics. The outcome measure was cancer mortality among adults ages 25-64 years in 3,028 U.S. counties, from 1999 to 2018. Socioeconomic inequalities in mortality were calculated as a concentration index (CI) by income (annual median household income), educational attainment (% with bachelor's degree or higher), and unemployment rate. A hierarchical linear mixed model and dominance analyses were used to investigate SES associated with county-level mortality. The analyses were also conducted by cancer types. RESULTS: CIs of SES factors varied by cancer types. Low-SES counties showed increasing trends in mortality, while high-SES counties showed decreasing trends. Socioeconomic inequalities in mortality among high-SES counties were larger than those among low-SES counties. SES explained 25.73% of the mortality. County-level cancer mortality was associated with income, educational attainment, and unemployment rate, at -0.24 [95% (CI): -0.36 to -0.12], -0.68 (95% CI: -0.87 to -0.50), and 1.50 (95% CI: 0.92-2.07) deaths per 100,000 population with one-unit SES factors increase, respectively, after controlling for health care environment and population health. CONCLUSIONS: SES acts as a key driver of premature cancer mortality, and socioeconomic inequalities differ by cancer types. IMPACT: Focused efforts that target socioeconomic drivers of mortalities and inequalities are warranted for designing cancer-prevention implementation strategies and control programs and policies for socioeconomically underprivileged groups.

The mother's risk of premature death after child loss across two centuries.

While the rare occurrence of child loss is accompanied by reduced life expectancy of parents in contemporary affluent populations, its impact in developing societies with high child mortality rates is unclear. We identified all parents in Iceland born 1800-1996 and compared the mortality rates of 47,711 parents who lost a child to those of their siblings (N = 126,342) who did not. The proportion of parents who experienced child loss decreased from 61.1% of those born 1800-1880 to 5.2% of those born after 1930. Child loss was consistently associated with increased rate of maternal, but not paternal, death before the age of 50 across all parent birth cohorts; the relative increase in maternal mortality rate ranged from 35% among mothers born 1800-1930 to 64% among mothers born after 1930. The loss of a child poses a threat to the survival of young mothers, even during periods of high infant mortality rates.

The Death of Balzac (1799-1850) and the Treatment of Heart Failure During the Nineteenth Century.

Overweight, workaholic, and a caffeine abuser, Honoré de Balzac lived a life of excess. He prematurely died at the age of 51 owing to gangrene associated with congestive heart failure. Textual sources allow us to take a glimpse into his last 3 months of life. Because of ventricular hypertrophy, Balzac's respiratory conditions were appalling and he developed severe leg edemas and possibly stasis dermatitis. Here we report on Balzac's demise and provide first evidence of a pioneering medical treatment applied to save his life: the use of a trocar to drain leg edema. Based on the empirical observation of the benefits derived from an accidental leg drainage, Balzac's physicians anticipated the invention of the "Southey tube", whose use evolved in the following century to treat obstinate edema in heart failure patients. Unfortunately, following the daily maneuvers for trocar insertion and in the absence of adequate disinfection measures and antibiotics, bacteria infected the open wound and gave rise to the gangrene, which caused the writer to die within 24 hours of its onset.

Jim Crow and premature mortality among the US Black and White population, 1960-2009: an age-period-cohort analysis.

BACKGROUND: Scant research has analyzed the health impact of abolition of Jim Crow (ie, legal racial discrimination overturned by the US 1964 Civil Rights Act). METHODS: We used hierarchical age-period-cohort models to analyze US national black and white premature mortality rates (death before 65 years of age) in 1960-2009. RESULTS: Within a context of declining US black and white premature mortality rates and a persistent 2-fold excess black risk of premature mortality in both the Jim Crow and non-Jim Crow states, analyses including random period, cohort, state, and county effects and fixed county income effects found that, within the black population, the largest Jim Crow-by-period interaction occurred in 1960-1964 (mortality rate ratio [MRR] = 1.15 [95% confidence interval = 1.09-1.22), yielding the largest overall period-specific Jim Crow effect MRR of 1.27, with no such interactions subsequently observed. Furthermore, the most elevated Jim Crow-by-cohort effects occurred for birth cohorts from 1901 through 1945 (MRR range = 1.05-1.11), translating to the largest overall cohort-specific Jim Crow effect MRRs for the 1921-1945 birth cohorts (MRR ~ 1.2), with no such interactions subsequently observed. No such interactions between Jim Crow and either period or cohort occurred among the white population. CONCLUSION: Together, the study results offer compelling evidence of the enduring impact of both Jim Crow and its abolition on premature mortality among the US black population, although insufficient to eliminate the persistent 2-fold black excess risk evident in both the Jim Crow and non-Jim Crow states from 1960 to 2009.

Morality's ugly implications in Oscar Wilde's fairy tales.

In Oscar Wilde's two volumes of fairy tales, "The Happy Prince" and Other Tales (1888) and A House of Pomegranates (1891), many central characters meet with premature death or physical disfigurement after learning a bourgeois moral lesson. In an attempt to explain this unconventional phenomenon in the fairy tale tradition, this essay examines Wilde's stories through the lens of his aesthetic ideology and demonstrates how the superficial morality of the Victorian bourgeoisie corrodes each tale's aesthetic integrity, causing the characters to either deny morality outright, assume the guise of Christian philanthropy, or die as the result of their moral reformation.