Projecting the Effect of Changes in Smoking and Obesity on Future Life Expectancy in the United States

We estimate the effects of declining smoking and increasing obesity on mortality in the United States over the period 2010–2040. Data on cohort behavioral histories are integrated into these estimates. Future distributions of body mass indices are projected using transition matrices applied to the initial distribution in 2010. In addition to projections of current obesity, we project distributions of obesity when cohorts are age 25. To these distributions, we apply death rates by current and age-25 obesity status observed in the National Health and Nutrition Examination Survey, 1988–2006. Estimates of the effects of smoking changes are based on observed relations between cohort smoking patterns and cohort death rates from lung cancer. We find that changes in both smoking and obesity are expected to have large effects on U.S. mortality. For males, the reductions in smoking have larger effects than the rise in obesity throughout the projection period. By 2040, male life expectancy at age 40 is expected to have gained 0.83 years from the combined effects. Among women, however, the two sets of effects largely offset one another throughout the projection period, with a small gain of 0.09 years expected by 2040.     

Cigarette Smoking and All-Cause and Cause-Specific Adult Mortality in the United States

This study illuminates the association between cigarette smoking and adult mortality in the contemporary United States. Recent studies have estimated smoking-attributable mortality using indirect approaches or with sample data that are not nationally representative and that lack key confounders. We use the 1990–2011 National Health Interview Survey Linked Mortality Files to estimate relative risks of all-cause and cause-specific mortality for current and former smokers compared with never smokers. We examine causes of death established as attributable to smoking as well as additional causes that appear to be linked to smoking but have not yet been declared by the U.S. Surgeon General to be caused by smoking. Mortality risk is substantially elevated among smokers for established causes and moderately elevated for additional causes. We also decompose the mortality disadvantage among smokers by cause of death and estimate the number of smoking-attributable deaths for the U.S. adult population ages 35+, net of sociodemographic and behavioral confounders. The elevated risks translate to 481,887 excess deaths per year among current and former smokers compared with never smokers, 14 % to 15 % of which are due to the additional causes. The additional causes of death contribute to the health burden of smoking and should be considered in future studies of smoking-attributable mortality. This study demonstrates that smoking-attributable mortality must remain a top population health priority in the United States and makes several contributions to further underscore the human costs of this tragedy that has ravaged American society for more than a century.     

Mortality Attributable to Cigarette Smoking in the United States

Cigarette smoking is an especially pernicious behavior because of its high prevalence and mortality risk. We use the powerful methodology of life tables with covariates and employ the National Health Interview Survey‐Multiple Cause of Death file to illuminate the interrelationships of smoking with other risk factors and the combined influences of smoking prevalence and population size on mortality attributable to smoking. We find that the relationship between smoking and mortality is only modestly affected by controlling for other risk factors. Excess deaths attributable to smoking among adults in the United States in the year 2000 were as high as 340,000. Better knowledge of the prevalence and mortality risk associated with different cigarette smoking statuses can enhance the future health and longevity prospects of the population.     

Adult mortality differentials associated with cigarette smoking in the USA

Although cigarette smoking has been extensively researched, surprising little knowledge has been produced by demographers using demographic perspectives and techniques. Thus, this paper contributes to the literature by extending a demographic framework to an important behavior for mortality research: cigarette smoking. In earlier works, the authors used nationally-representative data to show that cause of death patterns varied by smoking status and that multiple causes of death characterized smokers moreso than non-smokers. The present work extends previous analysis by estimating smoking status mortality differentials by underlying and multiple causes of death and by age and sex. Data from the 1986 National Mortality Followback Survey are related to data from the 1985 and 1987 National Health Interview Survey supplements to assess the smoking-related mortality differentials. We find that cigarette smoking is associated with higher mortality for all population categories studied, that the smoking mortality differentials vary across the different smoking status categories and by demographic group, and that the mortality differentials vary according to whether underlying cause or multiple cause patterns of death are examined. Moreover, the multiple cause analysis highlights otherwise obscured smoking-mortality relations and points to the importance of respiratory diseases and cancers other than lung cancer for cigarette smoking research.     

Obesity and excess mortality among the elderly in the United States and Mexico

Increasing levels of obesity could compromise future gains in life expectancy in low-and high-income countries. Although excess mortality associated with obesity and, more generally, higher levels of body mass index (BMI) have been investigated in the United States, there is little research about the impact of obesity on mortality in Latin American countries, where very the rapid rate of growth of prevalence of obesity and overweight occur jointly with poor socioeconomic conditions. The aim of this article is to assess the magnitude of excess mortality due to obesity and overweight in Mexico and the United States. For this purpose, we take advantage of two comparable data sets: the Health and Retirement Study 2000 and 2004 for the United States, and the Mexican Health and Aging Study 2001 and 2003 for Mexico. We find higher excess mortality risks among obese and overweight individuals aged 60 and older in Mexico than in the United States. Yet, when analyzing excess mortality among different socioeconomic strata, we observe greater gaps by education in the United States than in Mexico. We also find that although the probability of experiencing obesity-related chronic diseases among individuals with high BMI is larger for the U. S. elderly, the relative risk of dying conditional on experiencing these diseases is higher in Mexico.     

US mortality in an international context: age variations

Compared to other developed countries, the United States ranks poorly in terms of life expectancy at age 50. We seek to shed light on the US's low life expectancy ranking by comparing the age-specific death rates of 18 developed countries at older ages. A striking pattern emerges: between ages 40 and 75, US all-cause mortality rates are among the poorest in the set of comparison countries. The US position improves dramatically after age 75 for both males and females. We consider four possible explanations of the age patterns revealed by this analysis: (1) access to health insurance; (2) international differences in patterns of smoking; (3) age patterns of health care system performance; and (4) selection processes. We find that health insurance and smoking are not plausible sources of this age pattern. While we cannot rule out selection, we present suggestive evidence that an unusually vigorous deployment of life-saving technologies by the US health care system at very old ages is contributing to the age-pattern of US mortality rankings. Differences in obesity distributions are likely to be making a moderate contribution to the pattern but uncertainty about the risks associated with obesity prevents a precise assessment.     

Migration Selection, Protection, and Acculturation in Health: A Binational Perspective on Older Adults

In this article, we test for four potential explanations of the Hispanic Health Paradox (HHP): the “salmon bias,” emigration selection, and sociocultural protection originating in either destination or sending country. To reduce biases related to attrition by return migration typical of most U.S.-based surveys, we combine data from the Mexican Health and Aging Study in Mexico and the U.S. National Health Interview Survey to compare self-reported diabetes, hypertension, current smoking, obesity, and self-rated health among Mexican-born men ages 50 and older according to their previous U.S. migration experience, and U.S.-born Mexican Americans and non-Hispanic whites. We also use height, a measure of health during childhood, to bolster some of our tests. We find an immigrant advantage relative to non-Hispanic whites in hypertension and, to a lesser extent, obesity. We find evidence consistent with emigration selection and the salmon bias in height, hypertension, and self-rated health among immigrants with less than 15 years of experience in the United States; we do not find conclusive evidence consistent with sociocultural protection mechanisms. Finally, we illustrate that although ignoring return migrants when testing for the HHP and its mechanisms, as well as for the association between U.S. experience and health, exaggerates these associations, they are not fully driven by return migration-related attrition.     

Child mortality in rural India

This paper focuses on infant and child mortality in rural areas of India. We construct a flexible duration model, which allows for frailty at multiple levels and interactions between the child’s age and individual, socioeconomic, and environmental characteristics. The model is estimated using the Indian National Family and Health Survey 1998/1999. The estimation results show that socioeconomic and environmental characteristics have significantly different impacts on mortality rates at different ages. These are particularly important immediately after birth. The parameter estimates indicate that child mortality can be reduced substantially, particularly by improving the education of women, providing safe water, and reducing indoor air pollution caused by dirty cooking fuels. Finally, we still found substantial differences in mortality rates between states, which are associated with differences in schooling expenditures, female immunization, and poverty rates.     

The Nonlinear Relationship Between Education and Mortality: An Examination of Cohort, Race/Ethnic, and Gender Differences

Researchers investigating the relationship between education and mortality in industrialized countries have consistently shown that higher levels of education are associated with decreased mortality risk. The shape of the education–mortality relationship and how it varies by demographic group have been examined less frequently. Using the U.S. National Health Interview Survey-Linked Mortality Files, which link the 1986 through 2004 NHIS to the National Death Index through 2006, we examine the shape of the education–mortality curve by cohort, race/ethnicity, and gender. Whereas traditional regression models assume a constrained functional form for the dependence of education and mortality, in most cases semiparametric models allow us to more accurately describe how the association varies by cohort, both between and within race/ethnic and gender subpopulations. Notably, we find significant changes over time in both the shape and the magnitude of the education–mortality gradient across cohorts of women and white men, but little change among younger cohorts of black men. Such insights into demographic patterns in education and mortality can ultimately help increase life expectancies.     

The effects of race,ethnicity, and age on obesity

About 30% of Americans are obese, which is roughly a 100% increase from 25 years ago. This study examines the effects of changes in the racial/ethnic composition and age distribution on the prevalence of obesity, identifies the portion of the increase in obesity caused by these changes, and projects the effects of future racial/ethnic and age changes on obesity using National Health and Nutrition Examination Survey data. Results indicate that racial/ethnic composition changes and age distribution changes have accounted for about 10% of the increase in obesity over the last 25 years. However, future racial/ethnic and age changes are not projected to increase obesity substantially.      

Infant mortality in the Marshall Islands

Levy and Booth present previously unpublished infant mortality rates for the Marshall Islands. They use an indirect method to estimate infant mortality from the 1973 and 1980 censuses, then apply indirect and direct methods of estimation to data from the Marshall Islands Women's Health Survey of 1985. Comparing the results with estimates of infant mortality obtained from vital registration data enables them to estimate the extent of underregistration of infant deaths. The authors conclude that 1973 census appears to be the most valid information source. Direct estimates from the Women's Health Survey data suggest that infant mortality has increased since 1970-1974, whereas the indirect estimates indicate a decreasing trend in infant mortality rates, converging with the direct estimates in more recent years. In view of increased efforts to improve maternal and child health in the mid-1970s, the decreasing trend is plausible. It is impossible to estimate accurately infant mortality in the Marshall Islands during 1980-1984 from the available data. Estimates based on registration data for 1975-1979 are at least 40% too low. The authors speculate that the estimate of 33 deaths per 1000 live births obtained from registration data for 1984 is 40-50% too low. In round figures, a value of 60 deaths per 1000 may be taken as the final estimate for 1980-1984.     

Exploring Child Mortality Risks Associated with Diverse Patterns of Maternal Migration in Haiti

Internal migration is a salient dimension of adulthood in Haiti, particularly among women. Despite the high prevalence of migration in Haiti, it remains unknown whether Haitian women’s diverse patterns of migration influence their children’s health and survival. In this paper, we introduce the concept of lateral (i.e., rural-to-rural, urban-to-urban) versus nonlateral (i.e., rural-to-urban, urban-to-rural) migration to describe how some patterns of mothers’ internal migration may be associated with particularly high mortality among children. We use the 2006 Haitian Demographic and Health Survey to estimate a series of discrete-time hazard models among 7,409 rural children and 3,864 urban children. We find that compared with their peers with nonmigrant mothers, children born to lateral migrants generally experience lower mortality, whereas those born to nonlateral migrants generally experience higher mortality. Although there are important distinctions across Haiti’s rural and urban contexts, these associations remain net of socioeconomic factors, suggesting they are not entirely attributable to migrant selection. Considering the timing of maternal migration uncovers even more variation in the child health implications of maternal migration; however, the results counter the standard disruption and adaptation perspective. Although future work is needed to identify the processes underlying the differential risk of child mortality across lateral versus nonlateral migrants, the study demonstrates that looking beyond rural-to-urban migration and considering the timing of maternal migration can provide a fuller, more complex understanding of migration’s association with child health.     

Life Course Changes in Smoking by Gender and Education: A Cohort Comparison Across France and the United States

Widening of educational disparities and a narrowing female advantage in mortality stem in good part from disparities in smoking. The changes in smoking and mortality disparities across cohorts and countries have been explained by an epidemic model of cigarette use but are also related to life course changes. To better describe and understand changing disparities over the life course, we compare age patterns of smoking in three cohorts and two nations (France and the US) using smoking history measures from the 2010 French health barometer (N = 20,940) and the 2010 US National Health Interview Survey Sample Adult File (N = 20,444). The results demonstrate statistically significant widening of gender and educational differences from adolescence to early and middle adulthood, thus accentuating the disparities already emerging during adolescence. In addition, the widening disparities over the life course have been changing across cohorts: age differences in educational disparities have grown in recent cohorts (especially in France), while age differences in gender disparities have narrowed. The findings highlight the multiple sources of inequality in smoking and health in high-income nations.     

Neighborhood Concentrated Disadvantage and Adult Mortality: Insights for Racial and Ethnic Differences

While racial and ethnic differences in mortality are pervasive and well documented, less is known about how mortality risk varies by neighborhood socioeconomic status across racial and ethnic identity. We conducted a prospective analysis on a sample of adults living at or below 300% poverty with 8 years of the National Health Interview Survey (N = 159,400) linked to 11,600 deaths to examine the association between neighborhood disadvantage and mortality for non-Hispanic whites, non-Hispanic blacks, and U.S.- and foreign-born Hispanics. Using multilevel logistic regression, we find that the probability of death from any cause for lower-income adults is higher in more-disadvantaged neighborhoods, compared to less-disadvantaged neighborhoods, but only for whites. The adjusted likelihood of death for blacks and foreign-born Hispanics is not associated with neighborhood disadvantage, and the likelihood of death for U.S.-born Hispanics is lower in more-disadvantaged neighborhoods. While future research and policy should focus on improving health-promoting resources in all communities, care should be given to better understanding why race/ethnic groups have differential mortality returns with respect to area-specific socioeconomic conditions.     

Decomposing Trends in Child Obesity

We unravel the absolute level and relative prominence of two demographic processes that are relevant for childhood obesity, and that will ultimately determine the long-term course and pace of change in child obesity rates. We leverage data from the National Health and Nutrition Examination Survey to decompose change in child obesity from 1971 to 2012. We partition change into that attributable to (1) healthier, more nutritionally and economically advantaged cohorts in the population being replaced by cohorts of children who are less advantaged (between-cohort change), and (2) the health habits, nutrition, and social and economic circumstances of all cohorts of children worsening over time (within-cohort change). The rise in obesity among children aged 2 to 19 years is solely due to intracohort change driven by variation in food security composition and in the diet of the population over time. Child obesity in the population rose largely because of individual increases in weight status that are broadly distributed across age and cohort groups. Smaller but significant cohort replacement effects slightly attenuated these intracohort change effects over the study period, leading to a more gradual increase in obesity. Our results provide some reasons for optimism. Given that population estimates of child obesity rose because the typical member of all cohorts became heavier over time at all stages of the early life course, successful policy and health interventions that focus on changing health habits across all ages and generations have the potential to quickly slow or reverse the upward trend in child obesity.

     

Religious involvement and U.S. adult mortality

We use recently released, nationally representative data from the National Health Interview Survey-Multiple Cause of Death linked file to model the association of religious attendance and sociodemographic, health, and behavioral correlates with overall and cause-specific mortality. Religious attendance is associated with U.S. adult mortality in a graded fashion: People who never attend exhibit 1.87 times the risk of death in the follow-up period compared with people who attend more than once a week. This translates into a seven-year difference in life expectancy at age 20 between those who never attend and those who attend more than once a week. Health selectivity is responsible for a portion of the religious attendance effect: People who do not attend church or religious services are also more likely to be unhealthy and, consequently, to die. However, religious attendance also works through increased social ties and behavioral factors to decrease the risks of death. And although the magnitude of the association between religious attendance and mortality varies by cause of death, the direction of the association is consistent across causes.     

Uncrossing the U.S. Black-White Mortality Crossover: The Role of Cohort Forces in Life Course Mortality Risk

In this article, I examine the black-white crossover in U.S. adult all-cause mortality, emphasizing how cohort effects condition age-specific estimates of mortality risk. I employ hierarchical age-period-cohort methods on the National Health Interview Survey-Linked Mortality Files between 1986 and 2006 to show that the black-white mortality crossover can be uncrossed by factoring out period and cohort effects of mortality risk. That is, when controlling for variations in cohort and period patterns of U.S. adult mortality, the estimated age effects of non-Hispanic black and non-Hispanic white U.S. adult mortality risk do not cross at any age. This is the case for both men and women. Further, results show that nearly all the recent temporal change in U.S. adult mortality risk was cohort driven. The findings support the contention that the non-Hispanic black and non-Hispanic white U.S. adult populations experienced disparate cohort patterns of mortality risk and that these different experiences are driving the convergence and crossover of mortality risk at older ages.     

Modelling Marital Fertility by Age and Duration: An Empirical Appraisal of the Page Model

Page's model of marital fertility by age and duration is fitted by maximum likelihood techniques to data from 38 of the 41 developing countries that participated in the World Fertility Survey. The results indicate that the model does an excellent job of capturing variations in fertility patterns, with only two parameters. Moreover, national-level estimates of the parameter representing the degree of control of marital fertility correlate reasonably well with the proportion using contraception. On the other hand, estimates of the parameter representing the level of natural fertility correlate well with the duration of breastfeeding and with a measure of contraceptive use for spacing, but also show substantial regional variation. The paper closes with comments on several extensions and applications of the model.     

An age–period–cohort analysis of cancer incidence among the oldest old,Utah 1973–2002

We used age–period–cohort (APC) analyses to describe the simultaneous effects of age, period, and cohort on cancer incidence rates in an attempt to understand the population dynamics underlying their patterns among those aged 85+. Data from the Utah Cancer Registry (UCR), the US Census, the National Center for Health Statistics (NCHS), and the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) programme were used to generate age-specific estimates of cancer incidence at ages 65–99 from 1973 to 2002 for Utah. Our results showed increasing cancer incidence rates up to the 85–89 age group followed by declines at ages 90–99 when not confounded by the separate influences of period and cohort effects. We found significant period and cohort effects, suggesting the role of environmental mechanisms in cancer incidence trends between the ages of 85 and 100.     

The Effects of Allostatic Load on Racial/Ethnic Mortality Differences in the United States

This study expands on previous findings of racial/ethnic and allostatic load (AL) associations with mortality by addressing whether differential AL levels by race/ethnicity may explain all-cause mortality differences. This study used data from the third National Health and Nutrition Survey public-use file, gathered between 1988 and 1994, with up to 18 years of mortality follow-up (n = 11,733). AL scores were calculated using a 10-biomarker algorithm based on clinically determined thresholds. Results of discrete-time hazard models suggest that AL is associated with increased mortality risks, independent of other factors, including race/ethnicity and SES. The results also suggest that the AL–mortality association is stronger for non-Hispanic blacks than for non-Hispanic whites, and that at low levels of AL observed mortality differences between non-Hispanic blacks and non-Hispanic whites are non-significant. These findings suggest that mortality differences between non-Hispanic blacks and non-Hispanic whites may be the result of how early life exposure causes premature aging and increased mortality risks. More attention to resource allocation and local environments is needed to understand why non-Hispanic blacks experience premature aging that leads to differential mortality risks compared to non-Hispanic whites.