43 research outputs found
Short- and long-term associations between widowhood and mortality in the United States: longitudinal analyses
Background
Past research shows that spousal death results in elevated mortality risk for the surviving spouse. However, most prior studies have inadequately controlled for socioeconomic status (SES), and it is unclear whether this âwidowhood effectâ persists over time.
Methods
Health and Retirement Study participants aged 50+ years and married in 1998 (n = 12 316) were followed through 2008 for widowhood status and mortality (2912 deaths). Discrete-time survival analysis was used to compare mortality for the widowed versus the married.
Results
Odds of mortality during the first 3 months post-widowhood were significantly higher than in the continuously married (odds ratio (OR) for men = 1.87, 95% CI: 1.27, 2.75; OR for women = 1.47, 95% CI: 0.96, 2.24) in models adjusted for age, gender, race and baseline SES (education, household wealth and household income), behavioral risk factors and co-morbidities. Twelve months following bereavement, men experienced borderline elevated mortality (OR = 1.16, 95% CI: 1.00, 1.35), whereas women did not (OR = 1.07, 95% CI: 0.90, 1.28), though the gender difference was non-significant.
Conclusion
The âwidowhood effectâ was not fully explained by adjusting for pre-widowhood SES and particularly elevated within the first few months after widowhood. These associations did not differ by sex
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Validation of a theoretically motivated approach to measuring childhood socioeconomic circumstances in the Health and Retirement Study
Childhood socioeconomic status (cSES) is a powerful predictor of adult health, but its operationalization and measurement varies across studies. Using Health and Retirement Study data (HRS, which is nationally representative of community-residing United States adults aged 50+ years), we specified theoretically-motivated cSES measures, evaluated their reliability and validity, and compared their performance to other cSES indices. HRS respondent data (N = 31,169, interviewed 1992â2010) were used to construct a cSES index reflecting childhood social capital (cSC), childhood financial capital (cFC), and childhood human capital (cHC), using retrospective reports from when the respondent was 0.05 vs. < 0.04) than alternative indices. Our cSES measures use latent variable models to handle item-missingness, thereby increasing the sample size available for analysis compared to complete case approaches (N = 15,345 vs. 8,248). Adopting this type of theoretically motivated operationalization of cSES may strengthen the quality of research on the effects of cSES on health outcomes
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Are There Spillover Effects from the GI Bill? The Mental Health of Wives of Korean War Veterans
Background: The Korean War GI Bill provided economic benefits for veterans, thereby potentially improving their health outcomes. However potential spillover effects on veteran wives have not been evaluated. Methods: Data from wives of veterans eligible for the Korean War GI Bill (N = 128) and wives of non-veterans (N = 224) from the Health and Retirement Study were matched on race and coarsened birth year and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78) were assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale. Regression analyses were stratified into low (mother < 8 years schooling / missing data, N = 95) or high (mother ⼠8 years schooling, N = 257) childhood socio-economic status (cSES) groups, and were adjusted for birth year and childhood health, as well as respondentâs educational attainment in a subset of analyses. Results: Husbandâs Korean War GI Bill eligibility did not predict depressive symptoms among veteran wives in pooled analysis or cSES stratified analyses; analyses in the low cSES subgroup were underpowered (N = 95, β = -0.50, 95% Confidence Interval: (-1.35, 0.35), p = 0.248, power = 0.28). Conclusions: We found no evidence of a relationship between husbandâs Korean War GI Bill eligibility and wivesâ mental health in these data, however there may be a true effect that our analysis was underpowered to detect
Outcomes of the Botswana national HIV/AIDS treatment programme from 2002 to 2010: a longitudinal analysis
Background Short-term mortality rates among patients with HIV receiving antiretroviral therapy (ART) in sub-
Saharan Africa are higher than those recorded in high-income countries, but systematic long-term comparisons have
not been made because of the scarcity of available data. We analysed the eff ect of the implementation of Botswanaâs
national ART programme, known as Masa, from 2002 to 2010.
Methods The Masa programme started on Jan 21, 2002. Patients who were eligible for ART according to national
guidelines had their data collected prospectively through a clinical information system developed by the Botswana
Ministry of Health. A dataset of all available electronic records for adults (âĽ18 years) who had enrolled by April 30,
2010, was extracted and sent to the study team. All data were anonymised before analysis. The primary outcome was
mortality. To assess the eff ect of loss to follow-up, we did a series of sensitivity analyses assuming varying proportions
of the population lost to follow-up to be dead.
Findings We analysed the records of 126 263 patients, of whom 102 713 had documented initiation of ART. Median
follow-up time was 35 months (IQR 14â56), with a median of eight follow-up visits (4â14). 15 270 patients were
deemed lost to follow-up by the end of the study. 63% (78 866) of the study population were women; median age at
baseline was 34 years for women (IQR 29â41) and 38 years for men (33â45). 10 230 (8%) deaths were documented
during the 9 years of the study. Mortality was highest during the fi rst 3 months after treatment initiation at 12¡8 deaths
per 100 person-years (95% CI 12¡4â13¡2), but decreased to 1¡16 deaths per 100 person-years (1¡12â1¡2) in the second
year of treatment, and to 0¡15 deaths per 100 person-years (0¡09â0¡25) over the next 7 years of follow-up. In each
calendar year after the start of the Masa programme in 2002, average CD4 cell counts at enrolment increased (from
101 cells/ÎźL [IQR 44â156] in 2002, to 191 cells/ÎźL [115â239] in 2010). In each year, the proportion of the total enrolled
population who died in that year decreased, from 63% (88 of 140) in 2002, to 0¡8% (13 of 1599) in 2010. A sensitivity
analysis assuming that 60% of the population lost to follow-up had died gave 3000 additional deaths, increasing
overall mortality from 8% to 11â13%.
Interpretation The Botswana national HIV/AIDS treatment programme reduced mortality among adults with HIV to
levels much the same as in other low-income or middle-income countries
Undergoing Transformation to the Patient Centered Medical Home in Safety Net Health Centers: Perspectives from the Front Lines
ObjectivesâSafety Net Health Centers (SNHCs), which include Federally Qualified Health Centers (FQHCs) provide primary care for underserved, minority and low income patients. SNHCs across the country are in the process of adopting the Patient Centered Medical Home (PCMH) model, based on promising early implementation data from demonstration projects. However, previous demonstration projects have not focused on the safety net and we know little about PCMH transformation in SNHCs. DesignâThis qualitative study characterizes early PCMH adoption experiences at SNHCs.
Setting and ParticipantsâWe interviewed 98 staff,(administrators, providers, and clinical
staff) at 20 of 65 SNHCs, from five states, who were participating in the first of a five-year PCMH
collaborative, the Safety Net Medical Home Initiative.
Main MeasuresâWe conducted 30-45 minute, semi-structured telephone interviews. Interview
questions addressed benefits anticipated, obstacles encountered, and lessons learned in transition
to PCMH.
ResultsâAnticipated benefits for participating in the PCMH included improved staff
satisfaction and patient care and outcomes. Obstacles included staff resistance and lack of
financial support for PCMH functions. Lessons learned included involving a range of staff,
anticipating resistance, and using data as frequent feedback.
ConclusionsâSNHCs encounter unique challenges to PCMH implementation, including staff
turnover and providing care for patients with complex needs. Staff resistance and turnover may be
ameliorated through improved healthcare delivery strategies associated with the PCMH. Creating
predictable and continuous funding streams may be more fundamental challenges to PCMH
transformation
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Changes to the Social Patterning of Economic Resources and the Distribution of Mental and Biological Health Markers
This dissertation examines the relationship between life course social mobility and socio-economic disparities in health using data from the Health and Retirement Study. Chapter 1 explores how eligibility for the Korean War GI Bill, which provided socio-economic benefits to veterans, impacted the mental health of veterans compared to non-veterans. Using coarsened exact matching (CEM) to rigorously control for selection into the military, Korean War era veterans were matched to non-veterans. Regression models were used to predict number of depressive symptoms (NDS) and an indicator for depression. Pooled results were null, however veterans from low socio-economic backgrounds benefited from military service while veterans from high socio-economic backgrounds did not, resulting in a reduction in socio-economic disparities in NDS and depression prevalence. Chapter 2 examines if the benefits from Korean War era military service had a spillover effect to wives of veterans. Using CEM, veteran wives were matched to wives of non-veterans. Pooled results were null, however, among women from high socio-economic backgrounds, veteran wives had fewer NDS than non-veteran wives; there was no effect of husbandâs military service among wives from low socio-economic backgrounds.
Chapter 3 examines the relationship between life course social mobility and markers for stress (C-reactive protein), blood sugar (hemoglobin A1c), cholesterol (high density lipoprotein), and kidney function (Cystatin C). Results from linear regression models indicate that all outcomes followed a social gradient whereby individuals who experienced high SES at both time points had the best biomarker levels, while individuals who experienced low SES at both time points had the worst biomarker levels. Individuals who experienced upward mobility over the life course had statistically equivalent biomarker levels as individuals who experienced high SES at both time points, while individuals who experienced downward mobility had statistically equivalent biomarker levels as individuals who experienced low SES at both time points. These results suggest that the deleterious effects of a low SES childhood may be ameliorated or eliminated by upward social mobility in adulthood for these outcomes
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Does the âWidowhood Effectâ Precede Spousal Bereavement? Results from a Nationally Representative Sample of Older Adults
ObjectiveIncreased mortality risk following spousal bereavement (often called the "widowhood effect") is well documented, but little prior research has evaluated health deteriorations preceding spousal loss.DesignData are from the Health and Retirement Study, a nationally representative sample of Americans over 50 years old.MethodIndividuals who were married in 2004 were considered for inclusion. Outcome data from 2006 on mobility (walking, climbing stairs), number of depressive symptoms, and instrumental activities of daily living (IADLs) were used. Exposure was characterized based on marital status at the time of outcome measurement: "recent widows" (N=396) were bereaved between 2004 and 2006, before outcomes were assessed; "near widows" (N=380) were bereaved between 2006 and 2008, after outcomes were assessed; "married" individuals (N=7,330) remained married from 2004 to 2010, the follow-up period for this analysis. Linear regression models predicting standardized mobility, depressive symptoms, and IADLs, were adjusted for age, race, gender, birthplace, socio-economic status, and health at baseline.ResultsCompared to married individuals, recent widows had worse depressive symptoms (β=0.71, 95% confidence interval (CI): [0.57, 0.85]). Near widows had worse depressive symptoms (β=0.21, 95% CI: [0.08, 0.34]), mobility (β=0.14, 95%CI: [0.01, 0.26]), and word recall (β=-0.13, 95%CI: [-0.23, -0.02]) compared to married individuals.ConclusionsHealth declines before spousal death suggests some portion of the "widowhood effect" may be attributable to experiences that precede widowhood and interventions prior to bereavement might help preserve the health of the surviving spouse