Racial/Ethnic Differences in Early-Life Mortality in the United States

U.S. early life (ages 1–24) deaths are tragic, far too common, and largely preventable. Yet demographers have focused scant attention on U.S. early life mortality patterns, particularly as they vary across racial and ethnic groups. We employ the restricted-use 1999–2011 National Health Interview Survey-Linked Mortality Files and hazard models to examine racial/ethnic differences in early life mortality. Our results reveal that these disparities are large, strongly related to differences in parental socioeconomic status, and expressed through different causes of death. Compared to non-Hispanic whites, non-Hispanic blacks experience 60%, and Mexican Americans 32% higher risk of death over the follow-up period, with demographic controls. Our finding that Mexican Americans experience higher early life mortality risk than non-Hispanic whites differs from much of the literature on adult mortality. We also show that these racial/ethnic differences attenuate with controls for family structure and especially with measures of socioeconomic status. For example, higher mortality risk among Mexican-Americans relative to non-Hispanic whites is no longer significant once we control for mother’s education or family income. Our results strongly suggest that eliminating socioeconomic gaps across groups is the key to enhanced survival for children and adolescents in racial/ethnic minority groups

Cultural Competence with Humility Using Interprofessional Multicultural Learning Activities: Student Perceptions

This study examined students’ perceptions of interprofessional multicultural learning activities used to develop cultural competence with humility (CCH). Limited research exists on student perceptions of learning activities for CCH in entry-level occupational therapy educational programs. This exploratory, mixed methods study used an anonymous online survey, the Learning Activities Survey (LAS), to collect student quantitative ratings and qualitative feedback about CCH learning activities and their experience within the Counselors and Occupational Therapists Professionally Engaged in the Community (COPE) program. A deductive thematic approach was used by two investigators for qualitative analyses of COPE learning activities by alignment in four a priori CCH constructs: cultural awareness, cultural knowledge, cultural skills, and cultural desire. Consensus was gained through discussion. Nineteen of 29 (65.5%) students completed the survey. The mean score on the LAS for 6 of 12 activities (50%) was at least Moderately important (mean ≥ 3.0) to student learning. Twelve of 19 students (63%) rated 11 of 12 learning activities as Moderately important (mean ≥ 3.0). Qualitatively, cognitive knowledge was the strongest reported CCH learning construct within the COPE program with a frequency of 32. The combined quantitative and qualitative responses indicated the learning activities positively influenced students’ learning of CCH. This study may inform occupational therapy curricular activities that satisfy accreditation requirements and expectations of the profession to meet the cultural needs of society. It also provides support for revisions to occupational therapy educational program standards to better align with recent literature

Comparing trends in mid-life ‘deaths of despair’ in the USA, Canada and UK, 2001–2019: is the USA an anomaly?

Objectives In recent years, ‘deaths of despair’ due to drugs, alcohol and suicide have contributed to rising mid-life mortality in the USA. We examine whether despair-related deaths and mid-life mortality trends are also changing in peer countries, the UK and Canada. Design Descriptive analysis of population mortality rates. Setting The USA, UK (and constituent nations England and Wales, Northern Ireland and Scotland) and Canada, 2001–2019. Participants Full population aged 35–64 years. Outcome measures We compared all-cause and ‘despair’-related mortality trends at mid-life across countries using publicly available mortality data, stratified by three age groups (35–44, 45–54 and 55–64 years) and by sex. We examined trends in all-cause mortality and mortality by causes categorised as (1) suicides, (2) alcohol-specific deaths and (3) drug-related deaths. We employ several descriptive approaches to visually inspect age, period and cohort trends in these causes of death. Results The USA and Scotland both saw large relative increases and high absolute levels of drug-related deaths. The rest of the UK and Canada saw relative increases but much lower absolute levels in comparison. Alcohol-specific deaths showed less consistent trends that did not track other ‘despair’ causes, with older groups in Scotland seeing steep declines over time. Suicide deaths trended slowly upward in most countries. Conclusions In the UK, Scotland has suffered increases in drug-related mortality comparable with the USA, while Canada and other UK constituent nations did not see dramatic increases. Alcohol-specific and suicide mortalities generally follow different patterns to drug-related deaths across countries and over time, questioning the utility of a cohesive ‘deaths of despair’ narrative

Stochastic boundary conditions in the deterministic Nagel-Schreckenberg traffic model

We consider open systems where cars move according to the deterministic Nagel-Schreckenberg rules and with maximum velocity ${v}_{max} > 1$, what is an extension of the Asymmetric Exclusion Process (ASEP). It turns out that the behaviour of the system is dominated by two features: a) the competition between the left and the right boundary b) the development of so-called "buffers" due to the hindrance an injected car feels from the front car at the beginning of the system. As a consequence, there is a first-order phase transition between the free flow and the congested phase accompanied by the collapse of the buffers and the phase diagram essentially differs from that of ${v}_{max} = 1$ (ASEP).Comment: 29 pages, 26 figure

Dyck Paths, Motzkin Paths and Traffic Jams

It has recently been observed that the normalization of a one-dimensional out-of-equilibrium model, the Asymmetric Exclusion Process (ASEP) with random sequential dynamics, is exactly equivalent to the partition function of a two-dimensional lattice path model of one-transit walks, or equivalently Dyck paths. This explains the applicability of the Lee-Yang theory of partition function zeros to the ASEP normalization. In this paper we consider the exact solution of the parallel-update ASEP, a special case of the Nagel-Schreckenberg model for traffic flow, in which the ASEP phase transitions can be intepreted as jamming transitions, and find that Lee-Yang theory still applies. We show that the parallel-update ASEP normalization can be expressed as one of several equivalent two-dimensional lattice path problems involving weighted Dyck or Motzkin paths. We introduce the notion of thermodynamic equivalence for such paths and show that the robustness of the general form of the ASEP phase diagram under various update dynamics is a consequence of this thermodynamic equivalence.Comment: Version accepted for publicatio

“Outside the Skin”: The Persistence of Black–White Disparities in U.S. Early-Life Mortality

Research on Black&ndash;White disparities in mortality emphasizes the cumulative pathways through which racism gets &ldquo;under the skin&rdquo; to affect health. Yet this framing is less applicable in early life, when death is primarily attributable to external causes rather than cumulative, biological processes. We use mortality data from the National Vital Statistics System Multiple Cause of Death files and population counts from the Surveillance, Epidemiology, and End Result Program to analyze 705,801 deaths among Black and White males and females, ages 15&ndash;24. We estimate age-standardized death rates and single-decrement life tables to show how all-cause and cause-specific mortality changed from 1990 to 2016 by race and sex. Despite overall declines in early-life mortality, Black&ndash;White disparities remain unchanged across several causes&mdash;especially homicide, for which mortality is nearly 20 times as high among Black as among White males. Suicide and drug-related deaths are higher among White youth during this period, yet their impact on life expectancy at birth is less than half that of homicide among Black youth. Critically, early-life disparities are driven by preventable causes of death whose impact occurs &ldquo;outside the skin,&rdquo; reflecting racial differences in social exposures and experiences that prove harmful for both Black and White adolescents and young adults. &nbsp;</p

Exact stationary state for a deterministic high speed traffic model with open boundaries

An exact solution for a high speed deterministic traffic model with open boundaries and synchronous update rule is presented. Because of the strong correlations in the model, the qualitative structure of the stationary state can be described for general values of the maximum speed. It is shown in the case of $v_{\rm max}=2$ that a detailed analysis of this structure leads to an exact solution. Explicit expressions for the stationary state probabilities are given in terms of products of $24\times 24$ matrices. From this solution an exact expression for the correlation length is derived.Comment: 20 pages, LaTeX, typos corrected and references adde

Exact solution of a partially asymmetric exclusion model using a deformed oscillator algebra

We study the partially asymmetric exclusion process with open boundaries. We generalise the matrix approach previously used to solve the special case of total asymmetry and derive exact expressions for the partition sum and currents valid for all values of the asymmetry parameter q. Due to the relationship between the matrix algebra and the q-deformed quantum harmonic oscillator algebra we find that q-Hermite polynomials, along with their orthogonality properties and generating functions, are of great utility. We employ two distinct sets of q-Hermite polynomials, one for q1. It turns out that these correspond to two distinct regimes: the previously studied case of forward bias (q1) where the boundaries support a current opposite in direction to the bulk bias. For the forward bias case we confirm the previously proposed phase diagram whereas the case of reverse bias produces a new phase in which the current decreases exponentially with system size.Comment: 27 pages LaTeX2e, 3 figures, includes new references and further comparison with related work. To appear in J. Phys.

Asymmetric exclusion process with next-nearest-neighbor interaction: some comments on traffic flow and a nonequilibrium reentrance transition

We study the steady-state behavior of a driven non-equilibrium lattice gas of hard-core particles with next-nearest-neighbor interaction. We calculate the exact stationary distribution of the periodic system and for a particular line in the phase diagram of the system with open boundaries where particles can enter and leave the system. For repulsive interactions the dynamics can be interpreted as a two-speed model for traffic flow. The exact stationary distribution of the periodic continuous-time system turns out to coincide with that of the asymmetric exclusion process (ASEP) with discrete-time parallel update. However, unlike in the (single-speed) ASEP, the exact flow diagram for the two-speed model resembles in some important features the flow diagram of real traffic. The stationary phase diagram of the open system obtained from Monte Carlo simulations can be understood in terms of a shock moving through the system and an overfeeding effect at the boundaries, thus confirming theoretical predictions of a recently developed general theory of boundary-induced phase transitions. In the case of attractive interaction we observe an unexpected reentrance transition due to boundary effects.Comment: 12 pages, Revtex, 7 figure