The Centrality of Variability: How society shapes patterns of aging

Increasing variability is a hallmark of aging populations. Although demographic trends are often described in terms of average experiences, in this paper we argue that variability in the health experiences of older men and women is key to understanding aging. The variations in outcomes among older people are not merely nuisances obscuring the more salient averages and trends. The deviations from the mean are a central part of the story: the patterning of these variations reveals factors that influence health for everyone and indicates what sort of advances in healthy aging might be possible under optimal circumstances.Aging, demography

Urban Development in Sub-Saharan Africa: Bearer of Goods and Risks

Fahad Razak and Lisa Berkman discuss the implications of the study by Riha and colleagues for research into urbanization and the development of noncommunicable diseases. Please see later in the article for the Editors' Summar

The CONSTANCES cohort, an epidemiological research infrastructure. Methods and results of the pilot phase

Background: prospective cohorts represent an essential design for epidemiological studies and allow for the study of the combined effects of lifestyle, environment, genetic predisposition, and other risk factors on a large variety of disease endpoints. The CONSTANCES cohort is intended to provide public health information and to serve as an epidemiological research infrastructure accessible to the epidemiologic research community. Although designed as a “general-purpose” cohort with very broad coverage, it will particularly focus on occupational and social determinants of health, and on chronic diseases and aging. Methods: the CON STANC ES cohort is designed as a randomly selected representative sample of French adults aged 18-69 years at inception; 200 000 subjects will be included over a five-year period. At inclusion, the selected subjects are invited to fill a questionnaire and to attend a Health Screening Center (HSC) for a comprehensive health examination: weight, height, blood pressure, electrocardiogram, vision, auditory, spirometry, and biological parameters; for those aged 45 years and older, a specific work-up of functional, physical, and cognitive capacities is performed. A biobank will be set up. The follow-up includes a yearly self-administered questionnaire, and a periodic visit to an HSC. Social and work-related events and health data are collected from the French national retirement, health and death databases. The data include social and demographic characteristics, socioeconomic status, life events, behaviors, and occupational factors. The health data cover a wide spectrum: self-reported health scales, reported prevalent and incident diseases, long-term chronic diseases and hospitalizations, sick-leaves, handicaps, limitations, disabilities and injuries, healthcare utilization and services provided, and causes of death. To take into account non-participation at inclusion and attrition throughout the longitudinal follow-up, a cohort of non-participants was set up and will be followed through the same national databases as participants. Results: a field-pilot was performed in 2010 in seven HSCs, which included about 3 500 subjects; it showed a satisfactory structure of the sample and a good validity of the collected data. Conclusions: the constitution of the full eligible sample begun in 2012 and the cohort will be completed by the end of 2017. A public call for ancillary research projects will be launched in 2014

Labor-force participation, policies & practices in an aging America: adaptation essential for a healthy & resilient population

Population aging in the United States poses challenges to societal institutions while simultaneously creating opportunities to build a more resilient, successful, and cohesive society. Work organization and labor-force participation are central to both the opportunities and challenges posed by our aging society. We argue that expectations about old age have not sufficiently adapted to the reality of aging today. Our institutions need more adaptation in order to successfully face the consequences of demographic change. Although this adaptation needs to focus especially on work patterns among the “younger elderly,” our society has to change its general attitudes toward work organization and labor-force participation, which will have implications for education and health care. We also show that work's beneficial effects on well-being in older ages are often neglected, while the idea that older workers displace younger workers is a misconception emerging from the “lump-of-labor” fallacy. We conclude, therefore, that working at older ages can lead to better quality of life for older people and to a more productive and resilient society overall

The long-run effect of maternity leave benefits on mental health: evidence from European countries

This paper examines whether maternity leave policies have an effect on women´s mental health in older age. We link data for women aged 50 years and above from countries in the Survey of Health, Ageing and Retirement in Europe (SHARE) to data on maternity leave legislation from 1960 onwards. We use a difference-in-differences approach that exploits changes over time within countries in the duration and compensation of maternity leave benefits, linked to the year women were giving birth to their first child at age 16 to 25. We compare late-life depressive symptom scores (measured with a 12-item version of the Euro-D scale) of mothers who were in employment in the period around the birth of their first child to depression scores of mothers who were not in employment in the period surrounding the birth of a first child, and therefore did not benefit directly from maternity leave benefits. Our findings suggest that a more generous maternity leave during the birth of a first child is associated with a reduced score of 0.38 points in the Euro-D depressive symptom scale in old age

The Non-Linear Risk of Mortality by Income Level in a Healthy Population: US National Health and Nutrition Examination Survey mortality Follow-up Cohort, 1988-2001

Background: An examination of where in the income distribution income is most strongly associated with risk of mortality will provide guidance for identifying the most critical pathways underlying the connections between income and mortality, and may help to inform public health interventions to reduce socioeconomic disparities. Prior studies have suggested stronger associations at the lower end of the income distribution, but these studies did not have detailed categories of income, were unable to exclude individuals whose declining health may affect their income and did not use methods to determine exact threshold points of non-linearity. The purpose of this study is to describe the non-linear risks of all-cause and cause-specific mortality across the income distribution. Methods: We examined potential non-linear risk of mortality by family income level in a population that had not retired early, changed jobs, or changed to part-time work due to health reasons, in order to minimize the effects of illness on income. We used data from the US National Health and Nutrition Examination Survey (1988–1994), among individuals age 18–64 at baseline, with mortality follow-up to the year 2001 (ages 25–77 at the end of follow-up, 106 037 person-years of time at risk). Differential risk of mortality was examined using proportional hazard models with penalized regression splines in order to allow for non-linear associations between mortality risk and income, controlling for age, race/ethnicity, marital status, level of educational attainment and occupational category. Results: We observed significant non-linear risks of all-cause mortality, as well as for certain specific causes of death at different levels of income. Typically, risk of mortality decreased with increasing income levels only among persons whose family income was below the median; above this level, there was little decreasing risk of mortality with higher levels of income. There was also some variation in mortality risk at different levels of income by cause and gender. Conclusion: The majority of the income associated mortality risk in individuals between the ages of 18–77 in the United States is among the population whose family income is below the median (equal to $20,190 in 1991, 3.2 times the poverty level). Efforts to decrease socioeconomic disparities may have the greatest impact if focused on this population

Well-Being and Social Capital on Planet Earth: Cross-National Evidence from 142 Countries

High levels of social trust and social support are associated with life satisfaction around the world. However, it is not known whether this association extends to other indicators of social capital and of subjective well-being globally. We examine associations between three measures of social capital and three indicators of subjective well-being in 142 low-, middle- and high-income countries. Furthermore, we explore whether positive and negative feelings mirror each other or if they are separate constructs that behave differently in relation to social capital. Data comes from the Gallup World Poll, an international cross-sectional comparable survey conducted yearly from 2005 to 2009 for those 15 years of age and over. The poll represents 95% of the world's population. Social capital was measured with self-reports of access to support from relatives and friends, of volunteering to an organization in the past month, and of trusting others. Subjective well-being was measured with self-reports of life satisfaction, positive affect, and negative affect. We first estimate random coefficient (multi-level) models and then use multivariate (individual-level) Ordinary Least Square (OLS) regression to model subjective well-being as a function of social support, volunteering and social trust, controlling for age, gender, education, marital status, household income and religiosity. We found that having somebody to count on in case of need and reporting high levels of social trust are associated with better life evaluations and more positive feelings and an absence of negative feelings in most countries around the world. Associations, however, are stronger for high- and middle-income countries. Volunteering is also associated with better life evaluations and a higher frequency of positive emotions. There is not an association, however, between volunteering and experiencing negative feelings, except for low-income countries. Finally, we present evidence that the two affective components of subjective well-being behave differently in relation to different indicators of social capital and social support across countries

Is Economic Growth Associated with Reduction in Child Undernutrition in India?

An analysis of cross-sectional data from repeated household surveys in India, combined with data on economic growth, fails to find strong evidence that recent economic growth in India is associated with a reduction in child undernutrition

Effect of Real-Time Surveys on Patient Satisfaction Scores in the Emergency Department

Background. Patient satisfaction surveys have become increasingly important as their results help to determine Centers for Medicare and Medicaid Services (CMS) reimbursement. However, these questionnaires have known sources of bias (self-selection, responder, attribution, and nonresponse). Objective. We developed a real-time (RT) survey delivered in the hospital ED to evaluate the effect of implementing RT patient satisfaction surveys on physician behavior and hypothesized that the timing of patient satisfaction survey delivery would significantly impact the results. Method. Data from real-time patient satisfaction surveys were collected in phases from 12/2015 to 5/2017. Hospital-sponsored (HS) surveys were administered after discharge from 12/2015 to 12/2016. Results. For RT surveys, resident physicians were significantly more likely to write their names on the whiteboard (p = 0.02) and sit down (p = 0.01) with patients. Behavior modifications by attending physicians were not significant. Patient satisfaction measures did not improve significantly between periods for RT or HS surveys; however, RT survey responders were significantly more likely to recommend the ED to others. Conclusion. The timing of survey administration did significantly alter resident physician's behavior; however, it had no effect on patient satisfaction scores. RT responders were significantly more likely to recommend the emergency department to others.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]