Utilization of maternal health-care services in Peru: the role of women's education

This article explores the hypothesis that formal education of women influences the use of maternal health-care services in Peru, net of the mother’s childhood place of residence, household socioeconomic status and access to health-care services. The findings are consistent with the hypothesis; both cross-sectional and fixed-effects logit models yield quantitatively important and statistically reliable estimates of the positive effect of maternal schooling on the use of prenatal care and delivery assistance. In addition, large differentials were found in the utilization of maternal health-care services by place of residence, suggesting that much greater efforts on the part of the government are required if modern maternal health-care services are to reach women in rural areas

Childhood Conditions and Adult Health: Evidence from the Health and Retirement Study

Poor health and premature death are direct manifestations of biological processes influenced by genetic, environmental, and life style factors. These factors operate throughout the life course and interact in complex ways to produce observed differentials in adult health and mortality. To explain these differentials, authors of most studies have typically examined the role of adult environment, employing such explanatory factors as socioeconomic status (e.g., education, income and wealth), health-related behaviors (e.g., smoking and exercise), and social support (kin and social networks and marriage) (see for example Adler et al. 1994; Feinstein 1993; House et al. 1994; Kaplan and Keil 1993; Lillard and Waite 1995; Lynch et al. 1996; Menchik 1993; Preston and Taubaman 1994; Rogers et al. 1996)

Adult Mortality Among Asian Americans and Pacific Islanders: A Review of the Evidence

Mortality estimates have consistently pointed to a sizable health advantage for Asian Americans and Pacific Islanders compared to white Americans, but a question remains as to whether mortality estimates for Asian/Pacific Islanders are reliable. This paper presents mortality estimates for Chinese, Japanese, Filipinos, Other Asian and Pacific Islanders, all Asian and Pacific Islanders combined, and for white Americans in 1989-91 based on vital statistics and census data, and for Asian and Pacific Islanders and whites based on the National Longitudinal Mortality Survey. The paper reviews evidence on data quality and discusses possible biases in estimated death rates. It ends with a brief discussion of cause specific mortality differentials. Relative to whites, Asian and Pacific Islanders are found to have lower mortality at ages 25 and above. Lower death rates from heart disease and cancer among Asian/Pacific Islanders than white Americans account for most of the all cause differentials at ages 45+. Substantial uncertainty remains, however, about the exact level of mortality among Asian Americans and Pacific Islanders residing in the United States

Consistency of Age Reporting By Cause of Death Among Elderly African-American Decedents

Because age is associated with many biological and social phenomena, accurate age data are critical for researchers exploring the societal impact of population aging and for policy makers deciding how to best allocate resources to this burgeoning group. Of particular importance is the quality of age data for the rapidly expanding elderly population. Past research has shown the quality of these data to be questionable for the U.S. elderly population, particularly for African-Americans (Hambright 1969; Kestenbaum 1992; National Center for Health Statistics [NC HS] 1968; Rosenwaike 1979; Rosenwaike and Logue 1983). A recent study comparing 1987 death certificates from Massachusetts and Texas with matched Social Security/Medicare files, for example, found exact age agreement in the two data sources for 94.6% of non-Hispanic whites aged 65 and over but only for 72. 6% of African Americans (Kestenbaum 1992: Table 4). Age agreement deteriorated more rapidly with advancing age among blacks than among whites; for those aged 85 and over, exact age agreement was found for 91.7% of non-Hispanic whites compared with only 63.2% of African Americans

Educational differences in cause-specific mortality in the United States

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Are Educational Differentials in Mortality Increasing in the United States?

Because of the value that individuals place on health and longevity, levels of mortality are among the most central indicators of social and economic well-being. Analysts are concerned not only with the average level of mortality but also with its distribution among social groups, which is a fundamental indicator of social inequality. The principal dimension on which these assessments are now made in the United States is educational attainment. The decisive shift from occupational groups, the classic dimension used by the Registrar-General of England and Wales, to educational groups as the basis for assessment occurred with the publication of Kitagawa and Hauser\u27s (1973) major study of American mortality differentials in 1960. Educational attainment has two main advantages relative to occupation and income, the other common indicators of social stratification. It is available for people who are not in the labor force; and its value is less influenced by health problems that develop in adulthood. Since health problems can lead to both high mortality and low income, comparisons of death rates of different income groups, for example, are biased by their mutual dependence on a third variable, the extent of ill health. For these reasons, educational attainment has become the principal social variable used in epidemiology as well as in demography (Liberatos et al. 1988)

Black-White Differentials in Cause-Specific Mortality in the United States during the 1980s: The Role of Medical Care and Health Behaviors

In this paper, we examine black-white differences in cause-specific mortality during the 1980s when black-white disparities in mortality widened in the United States. We group causes of death to those amenable to medical intervention, those closely linked to health behaviors or residential location, and all other causes combined. At older ages, we treat cardiovascular disease, stroke, and forms of cancer not amenable to medical or behavioral intervention as distinct causes. We conduct separate analyses by gender and age group. Causes of death amenable to medical intervention and those linked to health behaviors and residential location accounted for over 60% of the absolute black-white difference in male and female mortality at ages 25-44, male mortality at ages 45-74, but somewhat less than 50% of the black-white difference in female mortality at these older ages. The relative black excess risk was most pronounced for causes amenable to medical intervention with and without adjustment for socio-demographic characteristics

Early Life Conditions and Cause-Specific Mortality in Finland

The purpose of this study is to investigate the relationship between early life socioeconomic status, household structure and adult all cause and cause-specific mortality in Finland during the latter half of the twentieth century. We base the analyses on a 10% sample of households drawn from the 1950 Finnish Census of Population with the follow-up of household members in subsequent censuses and death records beginning from the end of 1970 through the end of 1998. The Finnish data constitute a unique register based data set that does not rely on individual recall of early life social conditions, parental educational attainment, family type, and other life course trajectories. We find significant associations between early life social and family conditions on all cause mortality as well as mortality from cardiovascular and alcohol related diseases, accidents and violence; with protective effects of higher childhood SES varying between 10% and 30%. These associations are mediated through adult educational attainment and other socio-demographic characteristics. The results imply that long-term adverse health consequences of disadvantaged early life social circumstances may be mitigated by investments in educational and employment opportunities in early adulthood

New Insights into the Far Eastern Pattern of Mortality

The Far Eastern pattern of mortality, first identified in 1980, is characterized by some of the largest sex differentials at adult ages to be found anywhere in the world. These atypically high levels of excess male mortality were present in several Far Eastern populations during the 1960s and 1970s and have progressively disappeared since that time. This study uses cause of death data to determine the diseases responsible for the existence and attenuation of these sex differences in Hong Kong, Singapore and Taiwan. The analysis focuses primarily on two hypotheses – regarding the roles of respiratory tuberculosis and liver diseases associated with hepatitis B infection – which were proposed to explain the Far Eastern pattern but were never tested. The results of our analysis indicate that respiratory tuberculosis is the single most important cause underlying the existence and attenuation of the Far Eastern pattern, that the role of liver diseases is far from clear cut, and that other causes (such as cardiovascular diseases) are important as well. Some of the risk factors which may underlie these exceptional mortality patterns are identified

The implications of changing education distributions for life expectancy gradients

Recent research has proposed that shifting education distributions across cohorts are influencing estimates of educational gradients in mortality. We use data from the United States and Finland covering four decades to explore this assertion. We base our analysis around our new finding: a negative logarithmic relationship between relative education and relative mortality. This relationship holds across multiple age groups, both sexes, two very different countries, and time periods spanning four decades. The inequality parameters from this model indicate increasing relative mortality differentials over time. We use these findings to develop a method that allows us to compute life expectancy for any given segment of the education distribution (e.g., education quintiles). We apply this method to Finnish and American data to compute life expectancy gradients that are adjusted for changes in the education distribution. In Finland, these distribution-adjusted education differentials in life expectancy between the top and bottom education quintiles have increased by two years for men, and remained stable for women between 1971 and 2010. Similar distribution-adjusted estimates for the U.S. suggest that educational disparities in life expectancy increased by 3.3 years for non-Hispanic white men and 3.0 years for non-Hispanic white women between the 1980s and 2000s. For men and women, respectively, these differentials between the top and bottom education quintiles are smaller than the differentials between the top and bottom education categories by 18% and 39% in the U.S. and by 39% and 100% in Finland. Had the relative inequality parameters of mortality governing the Finnish and U.S. populations remained constant at their earliest period values, the difference in life expectancy between the top and bottom education quintiles would - because of overall mortality reductions - have declined moderately. The findings suggest that educational expansion may bias estimates of trends in educational differences in life expectancy upwards.Peer reviewe