State-Level Trends in Lifespan Variability in the United States, 1960-2019: A Research Note.

State-level disparities in life expectancy are wide, persistent, and potentially growing in the United States. However, the extent to which differences in lifespan variability by state have changed over time is unclear. This research note describes trends in lifespan variability for the United States overall and by state from 1960 to 2019 using period life table data from the United States Mortality Database. Lifespan disparity at birth (e0†) decreased over time in the United States overall from 14.0 years in 1960-1964 to 12.2 in 2015-2019. Lifespan variability decreased in all states, but states differed in the level and pace with which these changes occurred. Southern states and the District of Columbia exhibited consistently higher (i.e., less equitable) levels of lifespan variability than the nation overall. Conversely, lifespan variability was lower among several states in the Northeast (e.g., Connecticut and Massachusetts), Upper Midwest (e.g., Iowa, Minnesota, and Wisconsin), and West (e.g., California, Oregon, Utah, and Washington). We observe a particularly worrisome trend of increasing lifespan variability for the United States overall and for most states from 2010-2014 to 2015-2019. Monitoring state-level trends in lifespan variability has the potential to inform policies designed to ameliorate population health disparities.

Let's Drink to Being Socially Active: Family Characteristics, Social Participation, and Alcohol Abuse across Mid- and Later-life.

Researchers and practitioners often extol the health benefits of social relationships and social participation for older adults. Yet they often ignore how these same bonds and activities may contribute to negative health behaviors. Using data from the Wisconsin Longitudinal Study (16,065 observations from 7,007 respondents), we examined how family characteristics, family history, and social participation predicted three measures of alcohol abuse between ages 53 and 71. Results indicate that, generally, greater social participation is associated with increased drinking days per month. We also found that religious participation and having ever lived with an alcoholic are each associated with reporting possible alcohol dependence but not with alcohol consumption itself. Lastly, we identified gendered associations between marital dissolution and drinking behavior. These findings contextualize the increasing rates of alcohol abuse among older adults by emphasizing the possible negative consequences of "linked lives" on health via relationship stress and group norms.

Mass media exposure and maternal healthcare utilization in South Asia.

Maternal mortality remains a major population health problem in the developing world due in part to inadequate healthcare before, during, and after childbirth. Mass media has the potential to disseminate information about maternal healthcare that can improve well-being for mothers and infants, particularly among women with limited educational attainment. This study examines the impact of mass media exposure (e.g., television, radio, and newspaper) and sociodemographic factors on maternal healthcare utilization in four South Asian countries: India, Bangladesh, Nepal, and Pakistan. Analyses use 2014-2017 Demographic and Health Surveys, which are nationally representative of women aged 15-49 years. Results show that maternal healthcare utilization is significantly higher among women exposed to mass media across countries, even after controlling for mother's, husband's, and household sociodemographic factors. Women exposed to mass media are 46-86% more likely to receive antenatal care, 24-53% more likely to deliver their babies by skilled birth attendants, and 36-94% more likely to receive postpartum check-ups across countries. Mother's educational attainment moderates the association between mass media exposure and some maternal healthcare services in three of the four countries. Governments and public health organizations can consider mass media as a key intervention in promoting maternal health in developing contexts.

Lung cancer mortality among never-smokers in the United States: estimating smoking-attributable mortality with nationally representative data.

PURPOSE: Lung cancer mortality among never-smokers is an often overlooked yet important cause of adult mortality. Moreover, indirect approaches for estimating smoking-attributable mortality use never-smoker lung cancer death rates to approximate smoking burden. To date, though, most studies using indirect approaches import rates from the Cancer Prevention Study II (CPS-II), which is not representative of the U.S. METHODS: We use the nationally representative 1985-2015 National Health Interview Survey-Linked Mortality Files (NHIS-LMF) to calculate lung cancer death rates among never-smokers aged 50 years or older. We then import rates from NHIS-LMF and CPS-II into the Preston-Glei-Wilmoth indirect method to determine whether smoking-attributable fractions differ. RESULTS: Never-smokers account for 16% of U.S. lung cancer deaths among women and 11% among men. Lung cancer death rates among never-smokers are higher in NHIS-LMF than CPS-II for several age groups. Smoking-attributable fractions of mortality are slightly lower with NHIS-LMF rates (19% of male deaths and 16% of female deaths) than with CPS-II rates (21% of male deaths and 17% of female deaths). CONCLUSIONS: Fractions based on nonrepresentative CPS-II data may modestly overestimate smoking-attributable mortality. Thus, indirect methods should use never-smoker lung cancer death rates from such nationally representative datasets as NHIS-LMF.

Comparability of Mortality Estimates from Social Surveys and Vital Statistics Data in the United States.

Social surveys prospectively linked with death records provide invaluable opportunities for the study of the relationship between social and economic circumstances and mortality. Although survey-linked mortality files play a prominent role in U.S. health disparities research, it is unclear how well mortality estimates from these datasets align with one another and whether they are comparable with U.S. vital statistics data. We conduct the first study that systematically compares mortality estimates from several widely-used survey-linked mortality files and U.S. vital statistics data. Our results show that mortality rates and life expectancies from the National Health Interview Survey Linked Mortality Files, Health and Retirement Study, Americans' Changing Lives study, and U.S. vital statistics data are similar. Mortality rates are slightly lower and life expectancies are slightly higher in these linked datasets relative to vital statistics data. Compared with vital statistics and other survey-linked datasets, General Social Survey-National Death Index life expectancy estimates are much lower at younger adult ages and much higher at older adult ages. Cox proportional hazard models regressing all-cause mortality risk on age, gender, race, educational attainment, and marital status conceal the issues with the General Social Survey-National Death Index that are observed in our comparison of absolute measures of mortality risk. We provide recommendations for researchers who use survey-linked mortality files.

Smoking-attributable mortality by cause of death in the United States: An indirect approach.

More than 50 years after the U.S. Surgeon General's first report on cigarette smoking and mortality, smoking remains the leading cause of preventable death in the United States. The first report established a causal association between smoking and lung cancer, and subsequent reports expanded the list of smoking-attributable causes of death to include other cancers, cardiovascular diseases, stroke, and respiratory diseases. For a second level of causes of death, the current evidence is suggestive but not sufficient to infer a causal relationship with smoking. This study draws on 1980-2004 U.S. vital statistics data and applies a cause-specific version of the Preston-Glei-Wilmoth indirect method, which uses the association between lung cancer death rates and death rates for other causes of death to estimate the fraction and number of deaths attributable to smoking overall and by cause. Nearly all of the established and additional causes of death are positively associated with lung cancer mortality, suggesting that the additional causes are in fact attributable to smoking. I find 420,284 annual smoking-attributable deaths at ages 50+ for years 2000-2004, 14% of which are due to the additional causes. Results corroborate recent estimates of cause-specific smoking-attributable mortality using prospective cohort data that directly measure smoking status. The U.S. Surgeon General should reevaluate the evidence for the additional causes and consider reclassifying them as causally attributable to smoking.

Cigarette Smoking and All-Cause and Cause-Specific Adult Mortality in the United States.

This study illuminates the association between cigarette smoking and adult mortality in the contemporary United States. Recent studies have estimated smoking-attributable mortality using indirect approaches or with sample data that are not nationally representative and that lack key confounders. We use the 1990-2011 National Health Interview Survey Linked Mortality Files to estimate relative risks of all-cause and cause-specific mortality for current and former smokers compared with never smokers. We examine causes of death established as attributable to smoking as well as additional causes that appear to be linked to smoking but have not yet been declared by the U.S. Surgeon General to be caused by smoking. Mortality risk is substantially elevated among smokers for established causes and moderately elevated for additional causes. We also decompose the mortality disadvantage among smokers by cause of death and estimate the number of smoking-attributable deaths for the U.S. adult population ages 35+, net of sociodemographic and behavioral confounders. The elevated risks translate to 481,887 excess deaths per year among current and former smokers compared with never smokers, 14 % to 15 % of which are due to the additional causes. The additional causes of death contribute to the health burden of smoking and should be considered in future studies of smoking-attributable mortality. This study demonstrates that smoking-attributable mortality must remain a top population health priority in the United States and makes several contributions to further underscore the human costs of this tragedy that has ravaged American society for more than a century.

Black-White Disparities in Adult Mortality: Implications of Differential Record Linkage for Understanding the Mortality Crossover.

Mortality rates among black individuals exceed those of white individuals throughout much of the life course. The black-white disparity in mortality rates is widest in young adulthood, and then rates converge with increasing age until a crossover occurs at about age 85 years, after which black older adults exhibit a lower mortality rate relative to white older adults. Data quality issues in survey-linked mortality studies may hinder accurate estimation of this disparity and may even be responsible for the observed black-white mortality crossover, especially if the linkage of surveys to death records during mortality follow-up is less accurate for black older adults. This study assesses black-white differences in the linkage of the 1986-2009 National Health Interview Survey to the National Death Index through 2011 and the implications of racial/ethnic differences in record linkage for mortality disparity estimates. Match class and match score (i.e., indicators of linkage quality) differ by race/ethnicity, with black adults exhibiting less certain matches than white adults in all age groups. The magnitude of the black-white mortality disparity varies with alternative linkage scenarios, but convergence and crossover continue to be observed in each case. Beyond black-white differences in linkage quality, this study also identifies declines over time in linkage quality and even eligibility for linkage among all adults. Although linkage quality is lower among black adults than white adults, differential record linkage does not account for the black-white mortality crossover.

Hispanic-White Differences in Lifespan Variability in the United States.

This study is the first to investigate whether and, if so, why Hispanics and non-Hispanic whites in the United States differ in the variability of their lifespans. Although Hispanics enjoy higher life expectancy than whites, very little is known about how lifespan variability-and thus uncertainty about length of life-differs by race/ethnicity. We use 2010 U.S. National Vital Statistics System data to calculate lifespan variance at ages 10+ for Hispanics and whites, and then decompose the Hispanic-white variance difference into cause-specific spread, allocation, and timing effects. In addition to their higher life expectancy relative to whites, Hispanics also exhibit 7 % lower lifespan variability, with a larger gap among women than men. Differences in cause-specific incidence (allocation effects) explain nearly two-thirds of Hispanics' lower lifespan variability, mainly because of the higher mortality from suicide, accidental poisoning, and lung cancer among whites. Most of the remaining Hispanic-white variance difference is due to greater age dispersion (spread effects) in mortality from heart disease and residual causes among whites than Hispanics. Thus, the Hispanic paradox-that a socioeconomically disadvantaged population (Hispanics) enjoys a mortality advantage over a socioeconomically advantaged population (whites)-pertains to lifespan variability as well as to life expectancy. Efforts to reduce U.S. lifespan variability and simultaneously increase life expectancy, especially for whites, should target premature, young adult causes of death-in particular, suicide, accidental poisoning, and homicide. We conclude by discussing how the analysis of Hispanic-white differences in lifespan variability contributes to our understanding of the Hispanic paradox.

Hispanic older adult mortality in the United States: new estimates and an assessment of factors shaping the Hispanic paradox.

Hispanics make up a rapidly growing proportion of the U.S. older adult population, so a firm grasp of their mortality patterns is paramount for identifying racial/ethnic differences in life chances in the population as a whole. Documentation of Hispanic mortality is also essential for assessing whether the Hispanic paradox--the similarity in death rates between Hispanics and non-Hispanic whites despite Hispanics' socioeconomic disadvantage--characterizes all adult Hispanics or just some age, gender, nativity, or national-origin subgroups. We estimate age-/sex- and cause-specific mortality rate ratios and life expectancy for foreign-born and U.S.-born Hispanics, foreign-born and U.S.-born Mexican Americans, non-Hispanic blacks, and non-Hispanic whites ages 65 and older using the 1989-2006 National Health Interview Survey Linked Mortality Files. Results affirm that Hispanic mortality estimates are favorable relative to those of blacks and whites, but particularly so for foreign-born Hispanics and smoking-related causes. However, if not for Hispanics' socioeconomic disadvantage, their mortality levels would be even more favorable.

Gender, acculturation, and smoking behavior among U.S. Asian and Latino immigrants.

In this paper we examine smoking prevalence and frequency among Asian and Latino U.S. immigrants, focusing on how gender differences in smoking behavior are shaped by aspects of acculturation and the original decision to migrate. We draw on data from 3249 immigrant adults included in the 2002-2003 National Latino and Asian American Study. Findings confirm the gender gap in smoking, which is larger among Asian than Latino immigrants. While regression models reveal that gender differences in smoking prevalence, among both immigrant groups, are not explained with adjustment for measures of acculturation and migration decisions, adjustment for these factors does reduce gender differences in smoking frequency to non-significance. Following, we examine gender-stratified models and test whether aspects of migration decisions and acculturation relate more strongly to smoking behavior among women; we find that patterns are complex and depend upon pan-ethnic group and smoking measure.

Race/Ethnicity, nativity, and tobacco use among US young adults: results from a nationally representative survey.

INTRODUCTION: A growing body of research documents racial/ethnic disparities in U.S. cigarette smoking. To date, however, few studies have examined the influence of nativity, in addition to race/ethnicity, on current and ever use of cigarettes as well as other tobacco products among young adults. Here, racial/ethnic and nativity disparities in tobacco use and self-identified smoking status are documented for U.S. women and men aged 18-34, both unadjusted and adjusted for socioeconomic status. METHODS: The Legacy Young Adult Cohort Study (N = 3,696) was used to examine gender-specific tobacco use and smoking status differences among foreign-born Hispanics, U.S.-born Hispanics, U.S.-born non-Hispanic Blacks, and U.S.-born non-Hispanic Whites. Prevalence estimates and multivariable models of ever tobacco use, current tobacco use, and self-identified smoking status were calculated. RESULTS: U.S.-born Hispanics, Blacks, and Whites exhibit the highest levels of ever and current use across a range of tobacco products, whereas foreign-born Hispanics, particularly women, exhibit the lowest ever and current use of most products and are least likely to describe themselves as smokers. Controlling for socioeconomic covariates, current tobacco use is generally lower for most minority groups relative to Whites. Social or occasional smoking, however, is higher among U.S.-born Hispanics and Blacks. CONCLUSIONS: The high level of tobacco use among U.S.-born young adults foreshadows substantial tobacco-related morbidity and mortality in the coming decades. Foreign-born Hispanic young adults, particularly women, exhibit the lowest levels of tobacco use. Future studies of tobacco use must differentiate racial/ethnic groups by nativity to better understand patterns of tobacco use.

Racial/Ethnic and Nativity Patterns of U.S. Adolescent and Young Adult Smoking.

We document racial/ethnic and nativity differences in U.S. smoking patterns among adolescents and young adults using the 2006 Tobacco Use Supplement to the Current Population Survey (n=44,202). Stratifying the sample by nativity status within five racial/ethnic groups (Asian American, Mexican American, other Hispanic, non-Hispanic black, and non-Hispanic white), and further by sex and age, we compare self-reports of lifetime smoking across groups. U.S.-born non-Hispanic whites, particularly men, report smoking more than individuals in other racial/ethnic/nativity groups. Some groups of young women (e.g., foreign-born and U.S.-born Asian Americans, foreign-born and U.S.-born Mexican Americans, and foreign-born blacks) report extremely low levels of smoking. Foreign-born females in all of the 25-34 year old racial/ethnic groups exhibit greater proportions of never smoking than their U.S.-born counterparts. Heavy/moderate and light/intermittent smoking is generally higher in the older age group among U.S.-born males and females whereas smoking among the foreign-born of both sexes is low at younger ages and remains low at older ages. Taken together, these findings highlight the importance of considering both race/ethnicity and nativity in assessments of smoking patterns and in strategies to reduce overall U.S. smoking prevalence and smoking-attributable health disparities.

Differential record linkage by Hispanic ethnicity and age in linked mortality studies: implications for the epidemiologic paradox.

OBJECTIVE: This study examines how the linkage of surveys to death records differs for Hispanics and non-Hispanic Whites and how such differences affect estimates of ethnic differences in U.S. adult mortality. METHOD: I use data from the 1989-2000 National Health Interview Survey (NHIS) linked to the National Death Index (NDI) through 2002. Analyses assess how match score and match class vary by ethnicity, nativity, and age and whether mortality hazard ratios are sensitive to shifts in match criteria. RESULTS: Linkage quality is lower for Hispanic and foreign-born adults than for non-Hispanic White and U.S.-born adults. Modification of the linkage criteria determine whether the Hispanic mortality advantage is observed among middle-aged adults. DISCUSSION: The accuracy of adult mortality estimates depends on the quality of the linkage between surveys and death records.