Disability Status, Unemployment, and Alcohol-Related Liver Disease (ALD) Mortality: A Large Sample Individual Level Longitudinal Study.

PURPOSE: Unlike previous research, we evaluate disability within expanded employment status factors and stratify gender, race and ethnicity in alcohol-related liver disease (ALD) mortality in a large sample individual level longitudinal study. MATERIALS AND METHODS: The National Longitudinal Mortality Study (NLMS) was used covering the period 1990-2011. Statistical analysis involved the use of proportional hazards regression on a sample of almost 1.4 million people aged 18 and older, of whom 2638 died of ALD by the end of the follow-up period. RESULTS: With expanded employment status factors, disability (HR=3.76 [95%] CI 3.22, 4.39), unemployment (HR=1.90, CI 1.56, 2.31), and those not otherwise in the labor force (HR=2.31, CI 2.08, 2.56) were strongly related to ALD mortality compared to the employed. When stratified, gender, race, and ethnicity were not important modifiers in the relationships between disability, unemployment, those not in the labor force and subsequent ALD mortality. Consistent with other studies, males, minority status, living in a highly urban area, renting as opposed to owning a home, lower educational attainment, marital statuses other than marriage, low income, and age were related to ALD mortality. CONCLUSION: In addition to unemployment which has been previously studied in a large longitudinal sample, disabled people who were unable to work and those not looking for work had a higher risk of ALD mortality. Alcohol consumption, abuse and morbidity in these populations are of considerable clinical concern.

Diabetes Mellitus and Marital Status: Evidence from the National Longitudinal Mortality Study on the Effect of Marital Dissolution and the Death of a Spouse.

PURPOSE: This study evaluates the full impact of marital status on diabetes mellitus by stratifying the analysis by gender, including socioeconomic covariates and, unlike most studies, extending marital status by separating out previously conflated status categories. METHODS: Release 5 of the National Longitudinal Mortality Study (NLMS) was used for the data. Logistic regression was applied to the data from 1990 to 2011. The effective sample size consists of 1,384,507 individuals age 18 and above recruited into the study (via the Current Population Surveys), 3,955 of whom had died of diabetes mellitus by 2011. RESULTS: For minority men and non-Hispanic white men, divorced/separated status was significantly related to diabetes mortality, respectively (OR=1.318, CI=1.010, 1.719; and OR=1.283, CI=1.054, 1.562). For minority women and non-Hispanic white women, widowed status was related to diabetes mortality, respectively (OR=1.349, CI=1.107, 1.643; and OR=1.262, CI=1.113, 1.431). CONCLUSION: Contrary to recent epidemiological studies in which divorced/separated and widowed status were combined into one covariate, this United States study finds that divorced/separated men and widowed women are at increased risk for diabetes mellitus mortality, and that among these populations at risk, minorities are at higher risk than whites. The study highlights the importance of marital status and gender differences in the risk of death from diabetes.

New Findings On Gender: The Effects Of Employment Status On Suicide.

BACKGROUND AND OBJECTIVES: The purpose of the study was to evaluate the impact of gender and employment on suicide with the use of expanded unemployment statuses as covariates. METHODS: Data were obtained from release 5 of the National Longitudinal Mortality Study, a prospective study of deaths in the United States. Proportional hazards regression models were fitted to the data based on follow-up from 1990 to 2011. RESULTS: Unemployment was significantly associated with suicide (ARR=1.628, 95% CI=1.356, 1.954), and men had suicide deaths that were five times greater than women (ARR=5.104, 95% CI=4.565, 5.707), however when the sample was stratified by sex, the impact of unemployment on suicide was much higher among women (ARR=2.988, 95% CI=2.045, 4.366) than among men (ARR=1.393, 95% CI=1.131, 1.717). CONCLUSION: Contrary to many findings and gender assumptions, unemployed women in the U.S. have higher deaths from suicide than unemployed men. Discussion focused on explanations for gender disparities in unemployment.

Religiosity,Conservatism, and Acceptability of Anti-Female Spousal Violence in Egypt.

Physical violence directed at women is a significant social and public health problem globally. Initial studies tended to concentrate on developed countries, often relying on clinical or shelter samples to assess incidence and prevalence. Although prevalence is critical, reducing or eliminating some problems also requires comprehension of cultural norms and expectations. In the present study, we use a population-based survey to understand factors contributing to attitudes in support of physical violence against married women. More specifically, the aim of the study was to investigate the impact of religiosity and social conservatism on acceptability of physical spousal violence in the Arab Republic of Egypt. Data utilized were derived from Wave 6 of the World Values Survey conducted in 2013. Bivariate and multivariate regression models were fitted to the data. It was found that religiosity was significantly associated with physical spousal violence ( b = -123, t = -4.480). Individuals who attended more often were less apt to accept physical spousal violence. Social conservatism was strongly tied to approval of physical violence ( b = .368, t = -4.115). It was concluded that culturally biased and patriarchal attitudes that devalue women in Egypt, instead of religion, may be the underlying reason for spousal abuse. It was also concluded that improving higher education for both men and women would reduce physical spousal violence.

Shifting racial hierarchies: An analysis of residential segregation among multi-racial and mono-racial groups in the United States.

Multi-racial (mixed-race) people constitute a growing percentage of the United States (US) population. The study reported in this paper used residential segregation measures as a proxy for social distance, to examine whether segregation levels of multi-racial groups differ from those of mono-racial groups in the US in 2010. First, we find that all multi-racial groups considered in the study experience lower levels of segregation at county level than their mono-racial counterparts. However, black-whites and Hispanic-whites experience higher levels of segregation than other multi-racial groups. Second, we find region and minority composition of counties are associated significantly with segregation levels for multi-racial groups, but relative income is not.

Impact of Firearm Availability and Gun Regulation on State Suicide Rates.

Past studies on suicide have investigated the association of firearm ownership and suicide risk in the United States. The aim of the present study was to build on previous work by examining the impact of firearm storage practices and the strictness of firearm regulation on suicide rates at the state level. Data were compiled from primarily three sources. Suicide and firearm ownership information was obtained from the Centers for Disease Control and Prevention. Strictness of handgun regulation was derived from figures available at the Law Center to Prevent Violence, and controls were taken from the US Bureau of the Census. Mixed models were fitted to the data. Household firearm ownership was strongly associated with both suicide by all mechanisms, and firearm suicide. Storage practices had especially elevated consequences on suicide rates. Percent with loaded guns and gun readiness increased suicide rates, and strictness of gun regulation reduced suicide rates. Ready access to firearms can make a difference between life and death. Loaded and unlocked firearms within reach become risk factors for fatal outcomes from suicidal behavior. Future research might want to examine ways of obtaining more recent data on individual firearm ownership. This study proposes several policy recommendations for suicide prevention.

Marital status and HIV/AIDS mortality: evidence from the US National Longitudinal Mortality Study.

OBJECTIVES: The purpose of the study was to examine associations between marital status groups and death from HIV/AIDS. The primary hypothesis was that divorced and single/never married individuals have a much higher risk of death than married persons. METHODS: Data were derived from the third release of the US National Longitudinal Mortality Study. Cox proportional regression models were fitted to the data. RESULTS: It was found that marital status is associated with mortality from HIV. Divorced and separated individuals were 4.3 times more likely to die of HIV/AIDS than married individuals (adjusted relative risk (aRR) 4.321, 95% confidence interval (CI) 2.978, 6.269). Single/never married persons were 13 times as likely to die of HIV/AIDS as their married counterparts (aRR 13.092, 95% CI 9.652, 17.757). When the sample was stratified by sex, however, it was observed that while marital status was associated with HIV/AIDS mortality among men, it had no significant association with death in women. However, African-American women (aRR 9.23, 95% CI 4.47, 19.03) and Hispanic women (aRR 7.06, 95% CI 3.03, 16.45) had a significantly higher risk of death than their non-Hispanic white female counterparts. CONCLUSIONS: Marital status is a significant risk factor for mortality from HIV/AIDS, but this association is only valid for men. The different gender mortality experiences suggest that for HIV/AIDS more population-based studies comprising marital status risk factor histories are needed, given the limited research on marital status and mortality from the disease.

Association of suicide rates, gun ownership, conservatism and individual suicide risk.

OBJECTIVES: The purpose of the study was to examine the association of suicide rates, firearm ownership, political conservatism, religious integration at the state level, and individual suicide risk. Social structural and social learning and social integration theories were theoretical frameworks employed. It was hypothesized that higher suicide rates, higher state firearm availability, and state conservatism elevate individual suicide risk. METHOD: Data were pooled from the Multiple Cause of Death Files. Multilevel logistic regression models were fitted to all deaths occurring in 2000 through 2004 by suicide. RESULTS: The state suicide rate significantly elevated individual suicide risk (AOR = 1.042, CI = 1.037, 1.046). Firearm availability at the state level was associated with significantly higher odds of individual suicide (AOR = 1.004, CI = 1.003, 1.006). State political conservatism elevated the odds of individual suicides (AOR = 1.005, CI = 1.003, 1.007), while church membership at the state level reduced individual odds of suicide (AOR = 0.995, CI = 0.993, 0.996). The results held even after controlling for socioeconomic and demographic variables at the individual level. CONCLUSION: It was concluded that the observed association between individual suicide odds and national suicide rates, and firearm ownership cannot be discounted. Future research ought to focus on integrating individual level data and contextual variables when testing for the impact of firearm ownership. Support was found for social learning and social integration theories.

Religion and suicide acceptability: a cross-national analysis.

Four perspectives (moral community thesis, religious integration, religious commitment, and social networks) guide the selection of variables in this study. Data are from the combined World Values/European Values Surveys for 2000 (50,547 individuals nested in 56 nations). The results of a multivariate hierarchical linear model support all four perspectives. Persons residing in nations with relatively high levels of religiosity, who are affiliated with one of four major faiths, are religiously committed, and are engaged with a religious network are found to be lower in suicide acceptability. The religious integration perspective, in particular, is empirically supported; affiliation with Islam is associated with low suicide acceptability. The findings provide strong support for an integrated model and demonstrate the usefulness of the moral community thesis in understanding suicide acceptability.

The effect of survivalism--self-expressionism culture on black male suicide acceptability: a cross-national analysis.

Cultural explanations of black suicide have focused on the US and stressed religiosity as a protective factor. This paper adds to this literature by (1) expanding the analysis of the impact of religiosity on black suicide to 10 nations, and (2) assessing the extent to which a broader cultural construct (self expressionism) affects black suicide acceptability. Data are from Wave 4 of the World Values Surveys 1991-2001 and refer to 3580 black males nested in ten countries. A hierarchical linear regression model determined that religiosity predicted black suicide acceptability across ten nations. Self expressionism was positively associated with individual level suicide acceptability. Further, a cross-level interaction was found wherein individual level and societal level self expressionism combined to affect suicide acceptability. The variability in suicide acceptability among black males is predicted, in part, by both individual and group levels of adherence to values contained in a major cultural axis of nations: self expressionism. These new found associations compliment the impact of a standard predictor, religiosity, on suicide acceptability.

Association of temporal factors and suicides in the United States, 2000-2004.

OBJECTIVE: The purpose of the study was to examine the association of temporal factors, in particular days of the week and seasons of the year and death from suicide in the United States. METHOD: Data were pooled from the Multiple Cause of Death Files. Hierarchical logistic regression models were fitted to all deaths occurring in 2000 through 2004 by suicide. RESULTS: The incidence of suicide was significantly higher on Wednesdays, compared to Sunday. Specifically, individuals were 99% more likely to kill themselves on Wednesday than on Sunday. Suicides were more prevalent in the summer months, and they were less likely to occur in winter. The state suicide rate significantly elevated individual suicide risk. The results held even after controlling for the potentially confounding effects of socio-economic and demographic variables at both the individual and state levels. CONCLUSION: It was concluded that the observed association between seasonality and suicide cannot be discounted as a mere coincidence. Future research ought to focus on integrating individual level data and contextual variables when testing for seasonality effects.

Immigration and suicide: the role of marital status, duration of residence, and social integration.

The purpose of the study was to assess the impact of immigration on suicide. An unmatched case-control design was employed. Data on cases were obtained on suicides in Riverside County, California, 1998 to 2001. Information on controls was obtained from the 2000 Census. Immigration increased suicide risk. Immigrant divorced persons were over 2 times more likely to commit suicide than natives. Single immigrants were nearly 2.6 times more likely to kill themselves than the native born. Shorter duration of residence was associated with higher suicide risk. Integration of immigrants in receiving societies is important for decreasing suicide. Policies aimed at reducing suicide should target more recent immigrants.

Gender, place, and method of suicide.

BACKGROUND: The goal of the study was to investigate whether women use less lethal methods in committing suicide than men. A related objective was to determine whether place of committing suicide influences method of suicide. METHOD: Data on all completed suicides occurring in Riverside County from 1998 to 2001 were derived from original death certificates obtained from records of the County Coroner. Descriptive statistics on method and place of suicide by sex were computed and graphically presented. Multivariate logistic regression models were fitted to data on 643 suicide victims to estimate the unique effects of sex and place of suicide on the three most common methods observed: firearms, hanging, and drug poisoning. RESULTS: Women were over 73% less likely to use firearms than men (OR = 0.267, CI = 0.172, 0.413). There were no sex differentials in hanging. Female victims were over 4 times more likely to die from drug poisoning than male victims (OR = 4.828, CI = 3.047, 7.650). When place of committing suicide was added to the equation, it was found that victims killing themselves at home were over 2.5 times as likely to use firearms as those dying in outdoor settings (OR = 2.501, CI = 1.078, 6.051). Persons committing suicide at home were over 3 times more likely to hang themselves than those killing themselves outdoors or on railway tracks (CI = 3.118, CI = 1.447, 6.718). Victims committing suicide at home were also 3 times as likely to use drugs as those dying outdoors or on railway tracks (OR = 3.118, CI = 1.242, 7.828). Hotel or motel suicides were 4.9 times more likely to use drug poisoning than outdoor or railway suicides (OR = 4.924, CI = 1.409, 17.206). CONCLUSIONS: The proposition that women use less lethal methods of committing suicide than men was only partially supported by the data. It appears that the situation is more complex than a simple dichotomy between more lethal and less lethal methods. In past research, hanging has been considered a very lethal method. However, women were just as likely to hang themselves as men. Furthermore, firearm use was the second mode of suicide among women. The overall policy implication of this study is that suicide prevention efforts should concentrate not only on dissuading potential suicide victims, but also limiting access to firearms and promoting responsible firearm storage practices.

Diskography outcomes in patients following lumbar diskectomy.

The results of lumbar diskography at post-diskectomy and nonoperative disk levels in postoperative patients and patients without prior back surgery were reviewed over 3 years. Other possible predictive factors, including disk degeneration (per the Adam's classification), end-point resistance, gender, and age, also were reviewed. The results revealed that no statistically significant association was noted between the presence of a prior diskectomy and the outcome of diskography. However, disk degeneration classified as ruptured and fissured correlated statistically with positive diskography. Additionally, age between 30 and 39 years and male gender were statistically associated with a positive diskogram. Disk levels displaying a poor end point during diskography injection (not amendable to pressurization) were statistically related to ruptured or fissured disk levels and thus positive diskography. Based on these results, the assumption that disabling low-back pain presenting after lumbar procedure is due to diskogenic disease arising from the surgical level is not supported.