Understanding the twentieth-century decline in chronic conditions among older men

I argue that the shift from manual to white-collar jobs and reduced exposure to infectious disease were important determinants of declines in chronic disease rates among older men from the early 1900s to the 1970s and 1980s. The average decline in chronic respiratory problems, valvular heart disease, arteriosclerosis, and joint and back problems was about 66%. Occupational shifts accounted for 29% of the decline; the decreased prevalence of infectious disease accounted for 18%; the remainder are unexplained. The duration of chronic conditions has remained unchanged since the early 1900s, but when disability is measured by difficulty in walking, men with chronic conditions are less disabled now than they were in the past.     

Effects of dependency among causes of death for cause elimination life table strategies

A study is made of the effects of associated causes of death, and of dependency among causes of death, by observing the relative importance of one cause of death when another is eliminated under various competing risk models. Two disease pairs, cancer and infectious disease and stroke and ischemic heart disease, are selected for analysis because they represent different types of disease dependence. Crude probabilities of death for each disease are calculated for the U.S. white male population in 1969. Next, the effects of the complementary disease in a pair are hypothetically eliminated in one of three ways: (a) a standard competing risk adjustment for cause elimination when deaths are singly caused (Chiang, 1968), (b) lethal defect-pattern of failure computations for multiply caused death when no causal order is inferred (Manton et al., 1976), and (c) relative susceptibility, computations for multiply caused deaths when causes are ordered (Wong, 1977). The paper closes with a discussion of the relative merits of the three types of adjustments.     

Epidemiologic transition in the United States: the health factor in population change

The general theory of epidemiologic transition is explained. The theory hypothesizes that long-term changes in health and disease patterns in any society are related to the demographic and social conditions in that country. Mortality is considered to be the major factor in population change. The theory is illustrated by a detailed consideration of birth and death trends in the U.S. Mortality decline began in the U.S. in the middle of the nineteenth century. Associated with this decline was a gradual shift from death due to infectious disease to mortality caused by degenerative, man-made, and stress-related diseases. The transition favored women, children, and whites. Medical progress was less responsible for the change than were improvement in living conditions and changes in the nature of certain diseases. The magnitude of this decline in mortality is illustrated by an analysis of 5 specific indicators of mortality. Changes in the U.S. fertility patterns were also unplanned and attributable to socioeconomic factors rather than to medical advances. Comparison of the transition in the U.S. with the same movement in England shows that the U.S. experience fits the Western or Clasical Model of the epidemiologic transition theory. This experience cannot be used as a model for the transition occurring now in the Third World. In those countries, programs organized in the context of general social development projects could be expected to influence trends in mortality and fertility.     

Dynamics of Mixed Coalitions Under Social Cohesion Constraints

ABSTRACT

Parameters for the birth and death diffusion life table model subject to downward jumps randomly occurring at a constant rate are estimated. The jump magnitudes have a beta distribution with support [0, l_x ], where l_x is the total number of survivors prior to the jump. The estimation method is maximum likelihood. The Cramer–Rao Lower bound and the asymptotic distribution for the MLE are derived. The model is applied to the U.S. men′s population from 1900 to 1999.     

The fall in household size and the rise of the primary individual in the United States

The long-term fall in household size in the United States is discussed within the framework of the aging of the population, continuing as the effects of fertility and mortality decline accumulate. Using distributions of households by size from U.S. census data 1790–1970 and a components of change analysis on primary individuals for 1950–1974, household changes are related to demographic change for the periods 1790–1900, 1900–1950, and 1950–1974. Fertility and mortality declines have unambiguous impact on household size until the increases in primary individuals begin. But these, too, have a theoretically interesting, if indirect relationship to population structure.     

Age reporting among white Americans aged 85+: Results of a record linkage study

This study investigates age reporting on the death certificates of older white Americans. We link a sample of death certificates for native-born whites aged 85+ in 1985 to Social Security Administration records and to records of the U.S. censuses of 1900, 1910, and 1920. When ages in these sources are compared, inconsistencies are found to be minimal, even beyond age 95. Results show little distortion and no systematic biases in the reported age distribution of deaths. To explore the effect of age misreporting on old-age mortality, we estimate "corrected" age-specific death rates by the extinct-generation method for the U.S. white cohort born in 1885. With few exceptions, corrected and uncorrected rates in single years differ by less than 3% and are not systematically biased. When we compare corrected rates with those for the same birth cohort in France, Japan, and Sweden, we find that white American mortality at older ages is exceptionally low.     

Accuracy of death certificate ages for the extreme aged

This study attempts to verify age reporting on the death certificate for the “extreme aged” population and to evaluate the accuracy of recent death rates for this group in light of the findings. In addition, methods used and problems encountered in carrying out a record linkage study, particularly a low match rate, are identified. A sample of more than three thousand death records was selected from those filed for decedents age 85 and over in Pennsylvania and New Jersey in the 1968 to 1972 period. Death certificates of 53 percent of whites and 30 percent of nonwhites were linked to the 1900 U.S. Census. A comparison of age on the death certificate with the age reported for the same individual in the census record showed a high level of agreement for whites, except at ages 100 and over; for nonwhites, however, age agreement levels were substantially lower. Within racial groups, there was little difference by sex in agreement on age. These results, corroborating those of earlier studies, make it clear that nonwhite mortality at the oldest ages has been consistently understated in official statistics.     

Trends in U.S. adult chronic disease mortality, 1960–1999: age,period, and cohort variations

In this paper, I examine temporal changes in U.S. adult mortality by chronic disease cause of death and by sex over a 40-year period in the second half of the twentieth century. I apply age-period-cohort (APC) analyses that combine conventional approaches and a new method of model estimation to simultaneously account for age, period, and cohort variations in mortality rates for four leading causes of deaths, including heart disease, stroke, lung cancer, and breast cancer. The results show that large reductions in mortality since the late 1960s continued well into the late 1990s and that these reductions were predominately contributed by cohort effects. Cohort effects are found to differ by specific causes of death examined, but they generally show substantial survival improvements. Implications of these results are discussed with regard to demographic theories of mortality reductions, differential cohort accumulation of health capital and lifetime exposures to socioeconomic and behavioral risk factors, and period changes in diagnostic techniques and medical treatment.     

Mortality of the chronically impaired

An analysis of the effects of diabetes and generalized atherosclerosis on death due to ischemic heart disease or stroke was conducted using multiple cause mortality statistics. Specifically, all U.S. deaths in 1969 were classified into two groups on the basis of whether diabetes or generalized atherosclerosis was mentioned anywhere on the death certificate. Then race and sex specific analyses were made of ischemic heart disease deaths (or alternately of stroke deaths) using modified life table techniques for each group (one with the specified chronic disease and one without). Comparisons were made of mortality due to the acute circulatory events (ischemic heart disease or stroke) in the two groups to determine the implications of the chronic disease for the progression of the circulatory disease events. It was found, according to expectations, that diabetes and generalized atherosclerosis play very different roles in deaths due to stroke and ischemic heart disease.     

Racial/Ethnic and Nativity Patterns of U.S. Adolescent and Young Adult Smoking

We document racial/ethnic and nativity differences in U.S. smoking patterns among adolescents and young adults using the 2006 Tobacco Use Supplement to the Current Population Survey (n = 44,202). Stratifying the sample by nativity status within five racial/ethnic groups (Asian American, Mexican–American, other Hispanic, non-Hispanic black, and non-Hispanic white), and further by sex and age, we compare self-reports of lifetime smoking across groups. U.S.-born non-Hispanic whites, particularly men, report smoking more than individuals in other racial/ethnic/nativity groups. Some groups of young women (e.g., foreign-born and U.S.-born Asian Americans, foreign-born and U.S.-born Mexican–Americans, and foreign-born blacks) report extremely low levels of smoking. Foreign-born females in all of the 25–34 year old racial/ethnic groups exhibit greater proportions of never smoking than their U.S.-born counterparts. Heavy/moderate and light/intermittent smoking is generally higher in the older age group among U.S.-born males and females, whereas smoking among the foreign-born of both sexes is low at younger ages and remains low at older ages. Taken together, these findings highlight the importance of considering both race/ethnicity and nativity in assessments of smoking patterns and in strategies to reduce overall U.S. smoking prevalence and smoking-attributable health disparities.     

Race/Ethnicity/Nativity Differentials and Changes in Cause-Specific Infant Deaths in the Context of Declining Infant Mortality in the U.S.: 1989–2001

Using data from the national linked birth/infant death cohort files, we examined race/ethnicity/nativity disparities and changes in infant mortality due to the five leading causes of infant death between 1989 and 2001. Our results indicate substantial decreases in infant mortality from three causes (congenital anomalies, sudden infant death syndrome, and respiratory distress syndrome) for which specific perinatal health innovations emerged or were expanded. However, for these three causes, the relative disparities in infant mortality between infants born to U.S.-born black women as compared to infants of U.S.-born white women increased following the introduction (or expansion) of beneficial interventions. Among infants of U.S.-born Mexican American mothers, the findings differed. In the static comparisons, our results show the often-reported similarity in the risk of death of these babies compared to those born to non-Hispanic white mothers. However, when changes over time were modeled, there was an erosion of the relatively favorable survival chances of Mexican American infants. Our models show little change in the relative risk of death for infants of immigrant women. Regarding the other two causes (disorders relating to short gestation and unspecified low birth weight and maternal complications) for which no efficacious innovations occurred, either little change or actual increases in risks were observed. Future studies and health policy efforts should be geared toward further understanding and aggressively working to close infant mortality gaps, especially for infants of U.S.-born black mothers—an effort that will be facilitated by research focused on cause-specific infant mortality.     

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.     

African-american mortality at older ages: Results of a matching study

In this paper we investigate the quality of age reporting on death certificates of elderly African-Americans. We link a sample of death certificates of persons age 65+ in 1985 to records for the same individuals in U.S. censuses of 1900, 1910, and 1920 and to records of the Social Security Administration. The ages at death reported on death certificates are too young on average. Errors are greater for women than for men. Despite systematic underreporting of age at death, too many deaths are registered at ages 95+. This excess reflects an age distribution of deaths that declines steeply with age, so that the base for upward transfers into an age category is much larger than the base for transfers downward and out. When corrected ages at death are used to estimate age-specific death rates, African-American mortality rates increase substantially above age 85 and the racial “crossover” in mortality disappears. Uncertainty about white rates at ages 95+, however, prevents a decisive racial comparison at the very oldest ages.     

Do Marriage and Cohabitation Provide Benefits to Health in Mid-Life? The Role of Childhood Selection Mechanisms and Partnership Characteristics Across Countries

Extensive research has found that marriage provides health benefits to individuals, particularly in the U.S. The rise of cohabitation, however, raises questions about whether simply being in an intimate co-residential partnership conveys the same health benefits as marriage. Here, we use OLS regression to compare differences between partnered and unpartnered, and cohabiting and married individuals with respect to self-rated health in mid-life, an understudied part of the lifecourse. We pay particular attention to selection mechanisms arising in childhood and characteristics of the partnership. We compare results in five countries with different social, economic, and policy contexts: the U.S. (NLSY), U.K. (UKHLS), Australia (HILDA), Germany (SOEP), and Norway (GGS). Results show that living with a partner is positively associated with self-rated health in mid-life in all countries, but that controlling for children, prior separation, and current socio-economic status eliminates differences in Germany and Norway. Significant differences between cohabitation and marriage are only evident in the U.S. and the U.K., but controlling for childhood background, union duration, and prior union dissolution eliminates partnership differentials. The findings suggest that cohabitation in the U.S. and U.K., both liberal welfare regimes, seems to be very different than in the other countries. The results challenge the assumption that only marriage is beneficial for health.     

Acculturation and Self-rated Health Among Asian Immigrants: The Role of Gender and Age

Using the 2002–2003 National Latino and Asian American Study (NLAAS), we examine the relationship between acculturation and poor-to-fair self-rated health (SRH) among Asian immigrants (N?=?1639). Using latent class analysis, we construct a multidimensional measure of acculturation that considers dimensions of involvement in U.S. culture as well as attachment to Asian ethnic cultures and identify three classes of Asian immigrants: the assimilated, who most strongly adhere to U.S. culture; the integrated, who align with both U.S. and Asian ethnic cultures; and the separated, who are almost exclusively attached to Asian ethnic cultures. Logistic regression results revealed that among the pooled sample of Asian immigrant adults, the separated are significantly more likely to report poor-to-fair SRH than the assimilated. We then tested for gender and age differences in the acculturation–SRH relationship, and found that stratifying by gender yields noticeably different patterns. Among Asian immigrant women, the probability of reporting poor-to-fair SRH increases with age for the separated and the integrated, while it declines with age for the assimilated. Conversely, among Asian immigrant men, the probability of reporting poor-to-fair SRH increases most steeply with age for the assimilated, while it is shallower for the separated and the integrated. Future research should continue to develop a dynamic understanding of acculturation and examine its association with other health outcomes, including how these relationships differ across subsets of immigrant groups.

     

The Decline of Fertility in Los Angeles,California, 1880–1900

Data from the 1900 U.S. Census of Population show that fertility in Los Angeles California, declined by more than 50 per cent between 1880 and 1900. Women's mean age at first marriage, which rose by approximately three years, contributed to the decline, but change in marital fertility was more important than change in nuptiality. Although the fertility of in-migrating U.S.-born women was lower than that of California-born women, the decline was not explained by in-migration. The emergence of a class differential in fertility, with couples of higher status having fewer children than those of lower status, and the simultaneous weakening of class differentials in secondary-school attendance, together suggest that the rise of universal secondary schooling probably did not account for the marital fertility decline experienced in middle- and upper-status families.     

Estimates of early twentieth-century U.S. homicide rates: An econometric forecasting approach

Bureau of the Census death registration records, as reported in Mortality Statistics, are a primary source for early twentieth-century U.S. homicide statistics. Those data appear to show a massive rise in homicide during the first decade of the century, with a continuing increase through 1933. This increase is quite at variance with the trend away from violence in other industrialized societies. During the first one-third of the century, however, death registration was incomplete; it occurred only in an expanding “registration area” that was composed, in the earlier years, primarily of states with typically low rates of homicide. Further, in the first decade of the century homicides within the registration area often were reported as accidental deaths. As a result, apparent increases in rates of homicide in the United States between 1900 and 1933 may be illusory. I use a two-step process to address these problems. Drawing on internal evidence and commentaries in early volumes of Mortality Statistics, I use GLS regression to estimate the prevalence of undercounts. Then I create a series of GLS models that use registration area data to estimate early twentieth-century national rates. These estimates call into question the extent of homicide change early in the century.     

Job loss and health in the U.S. labor market

While U.S. unemployment rates remain low, rates of job loss are high and rising. Job loss is also becoming increasingly common in more advantaged, white-collar occupations. This article is concerned with how these patterns impact the health of U.S. workers. Drawing on recent data from the U.S. Panel Study of Income Dynamics, I find that job loss harms health, beyond sicker people being more likely to lose their jobs. Respondents who lost jobs but were reemployed at the survey faced an increased risk of developing new health conditions; they were not, however, more likely to describe their health in negative terms. This suggests that recent job “churning” within the United States (i.e., high rates of job loss but low unemployment) may impact certain health outcomes but not others. I find no evidence that the health consequences of job loss differ across white- and blue-collar occupations, although health-related selection out of jobs appears stronger within the blue-collar category.