Association of Special Supplemental Nutrition Program for Women, Infants, and Children With Preterm Birth and Infant Mortality.

Importance:Nearly 4 in 10 expectant mothers in the United States received Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits during pregnancy between 2011 and 2017. Despite public support for the program, empirical evidence of the success of the program varies substantially. Objective:To assess the association of WIC program participation during pregnancy by low-income expectant mothers covered by Medicaid with infant mortality by gestational age at birth and by maternal race/ethnicity in comparison with their counterparts who did not receive WIC benefits. Design, Setting, and Participants:This cohort study obtained data from January 1, 2011, to December 31, 2017, from US live birth certificates. Data were from 11 148 261 expectant mothers who delivered live births in states that have implemented the 2003 revision of the US live birth certificate and whose insurance coverage and receipt of WIC benefits were recorded on the birth certificates. Data analysis was performed from June 2019 to October 2019. Exposures:Receipt of WIC benefits during pregnancy. Main Outcomes and Measures:The first outcome was gestational age at birth: extremely preterm (<28 weeks), very preterm (28-32 weeks), moderate-to-late preterm (32-37 weeks), and normal term (≥37 weeks) births. The second outcome was death within the first year of life. Results:Among the 11 148 261 expectant mothers who delivered live births between 2011 and 2017 and were covered by Medicaid during pregnancy, the modal age at delivery was 20 to 24 years, the predominant race/ethnicity was non-Hispanic white (4 257 790 [38.2%]), and 8 145 770 (73.1%) received WIC benefits during pregnancy. The proportion of expectant mothers covered by Medicaid who also received WIC benefits decreased from 2011 to 2017 (79.3% to 67.9%; P < .001). The odds of preterm birth compared with normal term birth were lower among expectant mothers covered by Medicaid who received WIC benefits during pregnancy compared with their counterparts who did not receive WIC benefits during pregnancy (adjusted proportional odds ratio, 0.87; 95% CI, 0.86-0.87). The odds of mortality within 1 year of birth were lower for infants whose mothers were covered by Medicaid and received WIC benefits during pregnancy compared with those who did not receive WIC benefits during pregnancy (adjusted odds ratio, 0.84; 95% CI, 0.83-0.86). Conclusions and Relevance:This study found that receipt of WIC benefits among expectant mothers with Medicaid coverage was associated with lower risk of preterm birth and infant mortality

Prospective study of the link between overweight/obesity and diabetes incidence among Mexican older adults: 2001-2012

OBJECTIVE: To prospectively assess the relationship between overweight/obesity and incidence of type 2 diabetes mellitus (T2DM) among Mexicans aged 50+, assessing effects of age, genetic predisposition,education,physical activity,and place of residence. MATERIALS AND METHODS: The Mexican Health and Aging Study (MHAS) was used to prospectively follow respondents free of diabetes in 2001 who became diabetic by 2012. Multivariate random effects logistic regression was used to assess covariates effects on the incidence of T2DM. RESULTS: Obese or overweight individuals at baseline (2001) were about 3 and 2 times,respectively,significantly more likely to become diabetic by 2012.Genetic predisposition increases the risk of diabetes by about three times compared to those with no family history of diabetes. CONCLUSION: Overweight/obesity and genetic predisposition are the primary drivers of diabetes incidence among Mexican older adults. Reducing body weight and having access to health care may ameliorate the disease burden of T2DM

A New Method for Attributing Changes in Life Expectancy to Various Causes of Death, with Application to the United States

This article focuses on decomposition of changes in life expectancy by cause of death. We propose an alternative to Arriaga\u27s (1984) method for performing such decompositions. We apply our method to changes in life expectancy in the United States between 1970 and 2000 and compare results to those produced using Arriaga\u27s formulation. The major difference between the approaches pertains to diseases prominent at older ages such as cardiovascular disease. For applications where causes of death are the central focus, our technique appears to have a modest advantage because of its conceptual clarity and attractive byproducts in the form of cause-deleted life tables

Going beyond the disability-based morbidity definition in the compression of morbidity framework

Background: As originally proposed by Fries, conceptualizing morbidity solely through associated functional limitation/disability (FL/D) remains the most widely accepted metric to assess whether increases in longevity have been accompanied by a compression of morbidity. Objective: To propose a departure from a highly restrictive FL/D-based definition of “morbidity” to a broader view that considers the burden of chronic diseases even when no overt FL/D occur. Design: We outline three reasons why the current framework of compression of morbidity should be broadened to also consider morbidity to be present even when there are no overtly measurable FL/D. We discuss various scenarios of morbidity compression and morbidity expansion under this broader rubric of morbidity. Conclusion: The rationale to go beyond a purely FL/D-based definition of morbidity includes: (1) substantial damage from chronic disease that can develop prior to overt FL/D symptoms occurring; (2) multiple costs to the individual and society that extend beyond FL/D, including medication costs, health care visits, and opportunity costs of lifelong treatment; and (3) psychosocial and stress burden of being labeled as diseased and the consequence for overall well-being. Adopting this broader definition of morbidity suggests that increases in longevity have been possibly accompanied by an expansion of morbidity, in contrast to Fries’ original hypothesis that morbidity onset (based on only FL/D) would be delayed to a greater extent than increases in survival. There is an urgent need for better data and more research to document morbidity onset and its link with increases in longevity and assess the important question on whether populations while living longer are also healthier

Population-Level Death Rates From Novel Coronavirus (COVID-19) in South Korea

South Korea was among the first countries to report a case of the novel coronavirus (COVID-19). As of August 14, 2020, South Korea reported 14 873 confirmed cases and 305 deaths from COVID-19. We collected the number of laboratory-confirmed cases and deaths by age from the Korean Centers for Disease Control and Prevention. We estimated population-level death rates by fitting a logistic regression model using Firth’s bias reduction method. We calculated the age-standardized death rate (ASDR) varying the COVID-19 prevalence and level of death undercount. Estimated population-level death rates of COVID-19 (deaths per 100 000 person-years) increased with age: 0.1 among 30 to 39 year olds, 1.1 among 60 to 69 year olds, and 14.5 among ≥80 year olds. The ASDR (deaths per 100 000 person-years) was 0.9 based on the current deaths and population-level prevalence of 0.03%. If the prevalence increased to 0.6% and 30% of COVID-19 deaths had not been reported, the ASDR would further increase to 13.7 to become the seventh leading cause of death. Currently, the population-level mortality burden of COVID-19 in South Korea, as measured by the ASDR, was relatively low compared with other causes but could increase substantially if the prevalence increases from another outbreak or COVID-19 deaths were undercounted

An integrated approach to cause-of-death analysis: Cause-deleted life tables and decompositions of life expectancy

This article integrates two methods that analyze the implications of various causes of death for life expectancy. One of the methods attributes changes in life expectancy to various causes of death; the other method examines the effect of removing deaths from a particular cause on life expectancy. This integration is accomplished by new formulas that make clearer the interactions among causes of death in determining life expectancy. We apply our approach to changes in life expectancy in the United States between 1970 and 2000. We demonstrate, and explain analytically, the paradox that cancer is responsible for more years of life lost in 2000 than in 1970 despite the fact that declines in cancer mortality contributed to advances in life expectancy between 1970 and 2000

Adult obesity, disease and longevity in Mexico

OBJECTIVE: To obtain estimates of the effects of overweight and obesity on the incidence of type 2 diabetes (T2D) and adult mortality. MATERIALS AND METHODS: We use three waves (2000, 2002, 2012) of the Mexican Health and Aging Survey (MHAS). We employ parametric hazard models to estimate mortality and conventional logistic models to estimate incidence of T2D. RESULTS: Obesity and overweight have a strong effect on the incidence of T2D; this, combined with the large impact of diabetes on adult mortality, generates increases in mortality that translate into losses of 2 to 3 years of life expectancy at age 50. CONCLUSIONS: If increasing trends in obesity in Mexico continue as in the past, progress in adult survival may be slowed down considerably and the incidence of T2D will continue to increase

Are Differences in Disability-Free Life Expectancy by Gender, Race, and Education Widening at Older Ages?

To examine change from 1991 to 2001 in disability-free life expectancy in the age range 60-90 by gender, race, and education in the United States. Mortality is estimated over two 10-year follow-up periods for persons in the National Health Interview Surveys of 1986/1987 and 1996/1997. Vital status is ascertained through the National Death Index. Disability prevalence is estimated from the National Health and Nutrition Examination Surveys of 1988-1994 and 1999-2002. Disability is defined as ability to perform four activities of daily living without difficulty. Disability-free life expectancy increased only among white men. Disabled life expectancy increased for all groups-black and white men and women. Racial differences in disability-free life expectancy widened among men; gender differences were reduced among whites. Expansion of socioeconomic differentials in disability-free life at older ages occurred among white men and women and black women. The 1990s was a period where the increased years of life between ages 60 and 90 were concentrated in disabled years for most population groups