Sex role effects on female response to illness

This study of sex differentials in health behavior and health service choice among the Korean rural population is based on 1421 individuals aged 14 and over who received medical care at hospitals or clinics, pharmacies, a government health center, or through Chinese medical practices. Logistic regression is used to explore the relationship between the dichotomous variable, the log of the odds of the probability of using formal health care services, and the independent variables (sex, age, education, marital status, perceived health status, perceived medical care need, illness days in bed, limited activity days, total sick days, date of illness). A profile of rural Korea shows for all ages fewer adult females than males, but more females 65 years who have been previously married, which suggests higher male mortality rates in the middle ages. Health service usage is higher among the elderly. Higher level of education is associated with greater use of formal medical service. The results of binomial and multinomial analysis indicate that women receive less medical care from the formal system in spite of complaints and restricted activity, and least of all from health centers. It is suggested that personnel at health centers may reduce the desire for care because of incompatible social backgrounds (young single males who are inexperienced, city bred, and completing required service). A woman must carefully choose from the formal system and may more easily use the informal system of pharmacies and Chinese medicine practice. The responses to self rated health showed many differences; males report better health than females and older people consider themselves more unhealthy than young or adult groups. Those with lower educational attainment also consider themselves unhealthy, and indicate greater need for health services. Females and older age groups also stated their need for professional medical care for an illness within 15 days prior to the survey. The mean number of bed days followed a similar pattern as the perceived need and self rated health. However, women had a lower volume of bed days than men in contrast to typical Western trends. Females reported more restricted days of activity. The old age group had the same restricted days but more bed days than the adult group. Reported chronic diseases were greater for lower socioeconomic groups.     

Understanding the “Russian Mortality Paradox” in Central Asia: Evidence from Kyrgyzstan

In the former Soviet republics of central Asia, ethnic Russians have exhibited higher adult mortality than native ethnic groups (e.g., Kazakh, Kyrgyz, Uzbek) in spite of the higher socioeconomic status of ethnic Russians. The mortality disadvantage of ethnic Russians at adult ages appears to have even increased since the breakup of the Soviet Union. The most common explanation for this “Russian mortality paradox,” is that deaths are better reported among ethnic Russians. In this study, we use detailed mortality data from Kyrgyzstan between 1959 and 1999 to evaluate various explanations for the Russian mortality paradox: data artifacts, migration effects, and cultural effects. We find that the most plausible explanation is the cultural hypothesis because the personal behaviors that appear to generate a large part of the observed mortality differences (alcohol consumption, in particular) seem to be closely tied to cultural practices. We examine the implications of this finding for understanding the health crisis in post-Soviet states.     

The Contribution of Health Care and Other Interventions to Black–White Disparities in Life Expectancy, 1980–2007

Black–white mortality disparities remain sizable in the United States. In this study, we use the concept of avoidable/amenable mortality to estimate cause-of-death contributions to the difference in life expectancy between whites and blacks by gender in the United States in 1980, 1993, and 2007. We begin with a review of the concept of “avoidable mortality” and results of prior studies using this cause-of-death classification. We then present the results of our empirical analyses. We classified causes of death as amenable to medical care, sensitive to public health policies and health behaviors, ischemic heart disease, suicide, HIV/AIDS, and all other causes combined. We used vital statistics data on deaths and Census Bureau population estimates and standard demographic decomposition techniques. In 2007, causes of death amenable to medical care continued to account for close to 2 years of the racial difference in life expectancy among men (2.08) and women (1.85). Causes amenable to public health interventions made a larger contribution to the racial difference in life expectancy among men (1.17 years) than women (0.08 years). The contribution of HIV/AIDS substantially widened the racial difference among both men (1.08 years) and women (0.42 years) in 1993, but its contribution declined over time. Despite progress observed over the time period studied, a substantial portion of black–white disparities in mortality could be reduced given more equitable access to medical care and health interventions.     

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.     

Socioeconomic Inequalities in Infant Mortality in Egypt: Analyzing Trends Between 1995 and 2014

This paper analyses the trend of the socioeconomic inequalities in infant mortality rates in Egypt over the period 1995–2014, using repeated cross-sectional data from the National Demographic and Health Survey. A multivariate logistic regression and concentration indices are used to examine the demographic and socioeconomic correlates of infant mortality, and how the degree of socioeconomic disparities in child mortality rates has evolved over time. We find a significant drop in infant mortality rates from 63 deaths per 1000 live births in 1995 to 22 deaths per 1000 live births in 2014. However, analyzing trends over the study period reveals no corresponding progress in narrowing the socioeconomic disparities in childhood mortality. Infant mortality rates remain higher in rural areas and among low-income families than the national average. Results show an inverse association between infant mortality rates and living standard measures, with the poor bearing the largest burden of early child mortality. Though the estimated concentration indices show a decline in the degree of socioeconomic inequality in child mortality rates over time, infant mortality rate among the poor remains twice the rate of the richest wealth quintile. Nonetheless, this decline in the degree of socioeconomic inequality in child mortality is not supported by the results of the multivariate logistic regression model. Results of the logistic model show higher odds of infant mortality among rural households, children who are twins, households with risky birth intervals. We find no statistically significant association between infant mortality and child’s sex, access to safe water, mothers’ work, and mothers’ nutritional status. Infant mortality is negatively associated with household wealth and regular health care during pregnancy. Concerted effort and targeting intervention measures are still needed to reduce the degree of socioeconomic and regional inequalities in child health, including infant mortality, in Egypt.     

城乡差异、就医惯性与老年人卫生服务利用

现有对城乡老年人卫生服务利用不公平的研究多忽略了长期的城乡差异所导致的隐性的农村老年人就医惯性的存在。本研究在控制了收入、医疗保障和就医可及性等因素的条件下,发现就医惯性的存在;并运用集中指数分解法发现,卫生服务的利用存在不公平,偏向于富人,而就医惯性在两种卫生服务利用中的贡献度分别为12%和5%。这种城乡固定差异造成了农村老年人在身体健康、心理健康和自我照料能力上都显著地低于城市老年人。     

Development,inequality, health care,and mortality at the older ages: a cross-national analysis

We examine mortality at ages 50 and above in female populations of 38 countries and control for variation in quality of the mortality data. We find that economic development, economic distributional inequality, and basic primary health care have independent cross-national effects on cause of death structures and that these effects are not uniform across the age intervals of interest. As improvements occur in level of living and heath care, age-specific death rates decline except at the oldest ages, at which point they may increase. Our results are interpreted in terms of their relevance for mortality research, theory, and policy.     

Economic and cultural influences on the decision to leave home in Peninsular Malaysia

Although the departure of children from the parental home is an important life-cycle event, few studies have investigated nest-leaving in developing countries. Using retrospective data from the Second Malaysian Family Life Survey, we estimate hazard models of nest-leaving in Peninsular Malaysia. We find that the departure of children, especially sons, responds to economic incentives, including housing costs, family businesses, education, and economic growth, and that ethnic differences in nest-leaving are important. We also find that the median age of departure from home has declined sharply over the past 40 years, a period of rapid social and economic change in Malaysia.     

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.     

Erosion of Advantage: Decomposing Differences in Infant Mortality Rates Among Older Non-Hispanic White and Mexican-Origin Mothers

We build on findings from recent research showing an erosion of infant survival advantage in the Mexican-origin population relative to non-Hispanic whites at older maternal ages, with patterns that differ by nativity. This runs counter to the well-documented Hispanic infant mortality paradox and suggests that weathering and/or other negative health selection mechanisms may contribute to increasing disadvantage at older maternal ages. Using the National Center for Health Statistics (NCHS) cohort-linked birth and infant death files, we decompose the difference in Mexican-origin non-Hispanic white infant mortality at older maternal ages to better understand the contribution of selected medical and social risk factors to components of the difference. We find differences in the distribution and effects of risk factors across the three populations of interest. The infant mortality rate (IMR) gap between Mexican-origin women and non-Hispanic whites can be attributed to numerous offsetting factors, with inadequate prenatal care standing out as a major contributor to the IMR difference. Equalizing access to and utilization of prenatal care may provide one possible route to closing the IMR gap at older maternal ages.     

The Contribution of Smoking to Black-White Differences in U.S. Mortality

Smoking has significantly impacted American mortality and remains a major cause of morbidity and mortality. No previous study has systematically examined the contribution of smoking-attributable deaths to mortality trends among blacks or to black-white mortality differences at older ages over time in the United States. In this article, we employ multiple methods and data sources to provide a comprehensive assessment of this contribution. We find that smoking has contributed to the black-white gap in life expectancy at age 50 for males, accounting for 20 % to 48 % of the gap between 1980 and 2005, but not for females. The fraction of deaths attributable to smoking at ages above 50 is greater for black males than for white males; and among men, current smoking status explains about 20 % of the black excess relative risk in all-cause mortality at ages above 50 without adjustment for socioeconomic characteristics. These findings advance our understanding of the contribution of smoking to contemporary mortality trends and differences and reinforce the need for interventions that better address the needs of all groups.     

The labor supply of Latinas in the USA: Comparing labor force participation, wages, and hours worked with Anglo and Black women

This study explores the determinants of labor supply patterns among Latinas in the USA. We use recent microeconomic data from the Panel Study on Income Dynamics/Latino National Political Survey (PSID-LNPS) to estimate models of labor force participation, wages, and hours worked for a sample of Cuban, Mexican, and Puerto Rican women. We estimate the same models for Anglo and Black women in order to explore ethnic differences in the impact of characteristics affecting both the reservation and the market wage. We find that differences exist in the return to characteristics, such as education, but that there are also substantial differences in the levels of those characteristics across ethnic groups. The low wage rates and labor market activity of Latinas relative to Anglo and Black women are thus likely to be the combined result of lower investments in human capital and larger family size, the greater negative impact of macroeconomic conditions, and a stronger responsiveness to wages. Among Latinas, we find that there are differences in labor market outcomes between national origin and nativity groups. We also find that age at arrival and years in the USA play a role in labor supply, and that this is particularly true for Puerto Rican women.     

Investigating the mechanism of marital mortality reduction: The transition to widowhood and quality of health care

While it is well known that the widowed suffer increased mortality risks, the mechanism of this survival disadvantage is still under investigation. In this article, we examine the quality of health care as a possible link between widowhood and mortality using a unique data set of 475,313 elderly couples who were followed up for up to nine years. We address whether the transition to widowhood affects the quality of care that individuals receive and explore the extent to which these changes mediate the elevated mortality hazard for the widowed. We analyze six established measures of quality of health care in a fixed-effect framework to account for unobserved heterogeneity. Caregiving and acute bereavement during the transition to widowhood appear to distract individuals from taking care of their own health care needs in the short run. However, being widowed does not have long-term detrimental effects on individuals’ ability to sustain contact with the formal medical system. Moreover, the short-run disruption does not mediate the widowhood effect on mortality. Nevertheless, long after spousal death, men suffer from a decline in the quality of informal care, coordination between formal and informal care, and the ability to advocate and communicate in formal medical settings. These findings illustrate women’s centrality in the household production of health and identify important points of intervention in optimizing men’s adjustment to widowhood.     

Mobile Internet Use and Multidimensional Poverty: Evidence from A Household Survey in Rural China

The impact of specific living conditions on the population of geographically and socially segregated Roma settlements in Eastern Slovakia is considerable. They are characterized by high unemployment, lower education, poor housing and sanitary conditions, a poor quality of life, which all affects significantly their higher mortality rates and worse health status. In this paper we try to approach the problem of adverse mortality conditions and health with a deeper demographic insight. The fundamental goal of the paper is to analyse mortality in the population from Roma settlements over the past two decades using complex demographic methods such as life tables, direct standardization with the objective of eliminating differences in the age structure, single and multi-dimensional decomposition of age, sex and causes of death. We also analyse mortality using the concept of avoidable mortality. The results obtained from Roma settlements confirmed significantly worse mortality rates for both sexes. In addition, it appears that the disparities between them and the majority population are growing over time. The primary reason is the higher mortality of the youngest children and persons at post-reproductive age. Basically, all main chapters of the causes of death shorten the life expectancy of persons from Roma settlements, but cardiovascular diseases have the greatest negative impact. Conclusions obtained from the avoidable mortality analysis point to problems related to the accessibility and quality of health care, as well as the lack of interest of population from Roma settlements in their own health, along with the need for more targeted prevention and screening campaigns in this environment. Although the answers of respondents from Roma settlements to their own health confirm the deteriorating quality of health, increasing morbidity and the degree of restriction of normal daily activities with increasing age, they also point to some problems associated with the use of this approach.

     

Does the Hispanic Paradox in U.S. Adult Mortality Extend to Disability?

Studies consistently document a Hispanic paradox in U.S. adult mortality, whereby Hispanics have similar or lower mortality rates than non-Hispanic whites despite lower socioeconomic status. This study extends this line of inquiry to disability, especially among foreign-born Hispanics, since their advantaged mortality seemingly should be paired with health advantages more generally. We also assess whether the paradox extends to U.S.-born Hispanics to evaluate the effect of nativity. We calculate multistate life tables of life expectancy with disability to assess whether racial/ethnic and nativity differences in the length of disability-free life parallel differences in overall life expectancy. Our results document a Hispanic paradox in mortality for foreign-born and U.S.-born Hispanics. However, Hispanics’ low mortality rates are not matched by low disability rates. Their disability rates are substantially higher than those of non-Hispanic whites and generally similar to those of non-Hispanic blacks. The result is a protracted period of disabled life expectancy for Hispanics, both foreign- and U.S.-born.     

Racial differences in physician usage among the elderly poor in the United States

Despite the rapidly growing ranks of the elderly in America, the increasing racial and ethnic diversity of this population, and the large number of seniors who are poor, there are relatively few systematic investigations that examine the causes of racial differences in health care use specifically among elders living in poverty. This article addresses this issue by examining differences in patterns of having and using a physician among the elderly poor, the role that race plays and what might explain it. We demonstrate that even within this disadvantaged and medically engaged population there are persistent and significant racial differences in having and using a doctor. Specifically, we show: (1) Whites and women are more likely to have a regular doctor than men and African Americans; (2) Among those who have a doctor, whites and women also visit the doctor with greater frequency than other groups even at the same levels of health or illness; (3) After accounting for the varying levels and effects of social connectedness, racial differences in having a doctor essentially disappear; and (4) While differences in having a regular doctor can be accounted for using measures of social connectedness, substantial and robust racial and gender differences in doctor use remain. In the end, we provide an analysis that examines typical factors known to influence health care use, and find that while need, structural factors, perceptions of care, and social connectedness have a powerful effect on doctor visits, the racial variation in using a doctor cannot be explained away with the available measures.     

Implications of socio-economic differentials in mortality for the health system

The premise of this discussion is that a systematic and continuous monitoring system is required to assemble data on the social indicator "socio-economic differences in mortality." Attention is directed to 5 particular types of data: secular trends; class differentials and age; linearity versus dichotomy; cross-cutting variables; and downward mobility and biological selection. The following 2 basic questions are examined and answered with a qualified "yes:" 1) does the health care system have any relevance to mortality differentials; and 2) can a health care system have any degree of meaninful autonomy from the overall social system. The policy implications of this analysis are reviewed in terms of the value content of medical education, the organization of the health care system, the emphasis on health, and the focus on the community. The concepts of control and power are analyzed as the key to socioeconomic differentials. Emphasis on differential exposures to "stressors" is rejected for what is termed "a sense of coherence" -- a global orientation which emerges, or fails to emerge among the lower classes, against the background of a high level of generalized resistance resources. Essentially the problem is that the constricted, emergency, powerless, and unpredictable character of lower social class existence prevents individuals of lower class and groups from being able to cope with stressors. Ways that the health care system can strengthen the sense of coherence of the lower classes include the following: a formal monitoring system in each society; caution in assuming that technological advances, environmental control, and health education are egalitarian in their consequences; and the need to identify high-risk groups within the lower classes.     

Trends in Functional and Activity Limitations among Chinese Oldest‐Old, 1998 to 2008

China has the world's largest oldest‐old population, but information on trends in late‐life disability is lacking. We use data from the Chinese Longitudinal Healthy Longevity Survey for 1998 to 2008 to determine whether prevalence of limitations with physical functions and daily activities has changed recently among the Chinese population aged 80 to 105 and, if so, to investigate the factors associated with the change. We find that prevalence of need for assistance with activities of daily living and inability to independently conduct instrumental activities of daily living declined substantially. Males did not experience improvement in ability to carry out underlying physical functions over the same period, but females did. Variables associated with trends in one or more of these outcomes were adequacy of medical care as a child, childhood hunger, father's occupation in agriculture, main occupation before age 60 in agriculture, adequacy of current medical care, and body weight.     

Ethnic dimensions of gender differentials in mortality in Malaysia

Higher mortality rates among males are a common occurrence across different cultures and countries. The causes of this higher mortality can be biological as well as behavioural in nature. The biological evidence applies across all nations and communities, but the behavioural causes, arising from the decision processes and communication strategies of individuals, will necessarily have cultural and environmental dimensions that change with time. This study examines gender disparities in mortality across ethnicity and time in Malaysia. The study shows that there is a consistent gender differential across time but it has widened for the Malays and the Indians and narrowed for the Chinese. Most importantly, it has widened considerably for young adults. Analysis of the leading causes of death show that young adult males are more likely to engage in risk-taking behaviour, and that the related causes and the extent of such causes vary across the ethnic groups.