Changing chronic disease rates and longterm declines in functional limitation among older men

Functional limitation (difficulty walking, difficulty bending, paralysis, blindness in at least one eye, or deafness in at least one ear) in the United States fell at an average annual rate of 0.6% among men aged 50 to 74 from the early twentieth century to the early 1990s. Twenty-four percent of this decline is attributable to reductions in the debilitating effects of chronic conditions, 37% is attributable to reduced rates of chronic diseases, and the remainder is unexplained. The findings have implications for theories of the impact of declining mortality rates on the health of elderly people.     

The pursuit of health

This paper delineates health legislation through a review of the literature as it relates to the cost of medical care; it also demonstrates a death-coding system that would be compatible with the cause of death and not the disease. Three tables and ten figures depict the leading causes of death by number and rate for Georgia and the U.S., 1900–1973; infectious and chronic disease death rates, U.S., 1900–70; cycles of infectious and chronic disease patterns; health expenditures, U.S., 1930–75, per capita and percent of GNP; an epidemiological model for health policy analysis; and sample certificates of death.     

Communicating population and family planning

This thorough look at the change in the American family 1900-1700 finds that 40% of marriages among women now in their late 20s may end in divorce, that the divorce rate is stabilizing, that between 1-4% of unrelated men and women are living together in informal unions (the figure made difficult to obtain by the difficulty in framing the question), that 15 million adults live alone, and that only 67% of children live with their own once-married parents. About 33% of births are premaritally conceived. The median age for mothers at birth of last child has moved downward from 33 years in the early 1900s to about 30 years. Childbearing has declined from 3.9 children per mother in the early 1900s to 2.5. The period of childbearing has been compressed to about 7 years, between ages 23-30. 10% of remarried women's children are born between marriages. 50% of pregnancies end in abortion. It was found that persons who had completed an educational level, whether it be high school or college, generally had more stable marriages; those who had not completed a level were more likely to get divorced. Despite changes in lifestyle, however, some typical family situations are experienced by most Americans. 2 of 3 marriages will last until death of 1 of the partners and most young women questioned in census surveys expect 2 children.     

The narrowing sex differential in life expectancy in high-income populations: Effects of differences in the age pattern of mortality

Using data from the Human Mortality Database for 29 high-income national populations (1751–2004), we review trends in the sex differential in e(0). The widening of this gap during most of the 1900s was due largely to a slower mortality decline for males than females, which previous studies attributed to behavioural factors (e.g., smoking). More recently, the gap began to narrow in most countries, and researchers tried to explain this reversal with the same factors. However, our decomposition analysis reveals that, for the majority of countries, the recent narrowing is due primarily to sex differences in the age pattern of mortality rather than declining sex ratios in mortality: the same rate of mortality decline produces smaller gains in e(0) for women than for men because women's deaths are less dispersed across age (i.e., survivorship is more rectangular).     

Women, aging, and schizophrenia

Schizophrenia is a psychiatric disorder of unknown etiology that typically has an onset in early adulthood and persists for the remainder of the lifespan. For most affected individuals, the illness is recurrent with psychotic symptoms that tend to be episodic in nature. The illness has pervasive and disruptive effects on many life domains; for example, women with schizophrenia are less likely to marry, bear children, and raise their own children than are women in the general population. The age of onset of schizophrenia is later on average in women then men, and women are over-represented among those who develop the illness after the age of 45. Among younger patients with schizophrenia, women tend to have less severe symptoms than men and better outcomes; however, there are fewer gender differences among older patients with schizophrenia. Older women with schizophrenia are vulnerable to problems of both schizophrenia and aging. Schizophrenia symptoms typically continue in later years and include ongoing psychotic symptoms. Problems of aging such as cognitive decline and chronic medical conditions may be exacerbated by schizophrenia and the disorder is associated with premature mortality. Older women with schizophrenia are at risk for neglect of psychiatric and other health needs that are further compounded by limited social support and low socioeconomic status. More research and clinical attention is needed to the problems of older women with schizophrenia.     

Sex differences in morbidity and mortality

Women have worse self-rated health and more hospitalization episodes than men from early adolescence to late middle age, but are less likely to die at each age. We use 14 years of data from the U.S. National Health Interview Survey to examine this paradox. Our results indicate that the difference in self-assessed health between women and men can be entirely explained by differences in the distribution of the chronic conditions they face. This is not true, however, for hospital episodes and mortality. Men with several smoking-related conditions--including cardiovascular disease and certain lung disorders--are more likely to experience hospital episodes and to die than women who suffer from the same chronic conditions, implying that men may experience more-severe forms of these conditions. While some of the difference in mortality can be explained by differences in the distribution of chronic conditions, an equally large share can be attributed to the larger adverse effects of these conditions on male mortality. The greater effects of smoking-related conditions on men's health may be due to their higher rates of smoking throughout their lives.     

Women,Aging, and Schizophrenia

SUMMARY

Schizophrenia is a psychiatric disorder of unknown etiology that typically has an onset in early adulthood and persists for the remainder of the life span. For most affected individuals, the illness is recurrent with psychotic symptoms that tend to be episodic in nature. The illness has pervasive and disruptive effects on many life domains; for example, women with schizophrenia are less likely to marry, bear children, and raise their own children than are women in the general population. The age of onset of schizophrenia is later on average in women than men, and women are overrepresented among those who develop the illness after the age of 45. Among younger patients with schizophrenia, women tend to have less severe symptoms than men and better outcomes; however, there are fewer gender differences among older patients with schizophrenia. Older women with schizophrenia are vulnerable to problems of both schizophrenia and aging. Schizophrenia symptoms typically continue in later years and include ongoing psychotic symptoms. Problems of aging such as cognitive decline and chronic medical conditions may be exacerbated by schizophrenia and the disorder is associated with premature mortality. Older women with schizophrenia are at risk for neglect of psychiatric and other health needs that are further compounded by limited social support and low socioeconomic status. More research and clinical attention is needed for the problems of older women with schizophrenia.     

The narrowing sex differential in life expectancy in high-income populations: effects of differences in the age pattern of mortality

Using data from the Human Mortality Database for 29 high-income national populations (1751-2004), we review trends in the sex differential in e(0). The widening of this gap during most of the 1900s was due largely to a slower mortality decline for males than females, which previous studies attributed to behavioural factors (e.g., smoking). More recently, the gap began to narrow in most countries, and researchers tried to explain this reversal with the same factors. However, our decomposition analysis reveals that, for the majority of countries, the recent narrowing is due primarily to sex differences in the age pattern of mortality rather than declining sex ratios in mortality: the same rate of mortality decline produces smaller gains in e(0) for women than for men because women's deaths are less dispersed across age (i.e., survivorship is more rectangular).     

The demography of the unrelated individual: 1900–1950

This article is an analysis of the frequency and characteristics of unrelated individuals between 1900 and 1950. The much-heralded rise of the primary individual during the 20th century has been offset by a decline in the frequency of secondary individuals. The overall percentage of persons residing without family did not exceed turn-of-the-century levels until the 1970s. Using data from national micro data samples of the census for 1900, 1940, and 1950, the study applies decomposition techniques and life-course analysis to investigate these patterns. The results show that the decline of the secondary individual from 1900 to 1950 was largely a function of changing demographic composition, but the increase of primary individuals is linked to changing residential preferences.     

Relative Trends In Mortality From Related Respiratory and Airborne Infectious Diseases

Poor living conditions and inadequate diet were undoubtedly major contributors to high infectious disease death rates in Britain during the nineteenth century, but improvements were not necessarily the precondition for mortality decline. Evidence of consistent improvements is far from conclusive, while different trends for different diseases have to be explained. Scarlet fever and whooping cough death rates did not decline until the last few decades of a century in which measles mortality was continuing high Respiratory and gastro-intestinal complications are frequently involved in conditions of overcrowding and poverty. Death rates for recorded respiratory diseases themselves reveal a downturn at the end of the century, but respiratory tuberculosis mortality declined throughout and smallpox was virtually eliminated through vaccination measures. The interrelated nature and aetiology of these diseases has implications for changes in mortality, while population variables and other transmission factors including social behaviour patterns are probably crucial for an understanding of historical and contemporary trends.     

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.     

Fertility Decline in Czechoslovakia During the Last Two Centuries

The decline of fertility in Czechoslovakia on the territory of the Czech Socialist Republic began with a rise in the age at marriage; the decline of marital fertility began only after 1860. On the territory of the Slovak Socialist Republic marital fertility began to decline after 1900 without previous significant changes in the age at marriage. The differences between the demographic behaviour in the two parts of Czechoslovakia have persisted, although they are now gradually disappearing. There are other significant regional differences in the fertility decline caused by the overall process of economic and social development. The end of the demographic transition in the Czech Socialist Republic came during the 1930's and in the Slovak Socialist Republic during the 1960's.     

Risk Exposure in Early Life and Mortality at Older Ages: Evidence from Union Army Veterans

This study examines the relation between risk exposures in early life and hazard of mortality among 11,978 Union Army veterans aged 50 and over in 1900. Veterans' risk exposures prior to enlistment—as approximated by birth season, country of birth, residential region, city size, and height at enlistment—significantly influenced their chance of survival after 1900. These effects are robust irrespective of whether socioeconomic well‐being in 1900 has been taken into account; however, they are sensitive to the particular age periods selected for survival analysis. Whereas some of the effects such as being born in Ireland and coming from large cities became apparent in the first decade after 1900 and then dissipated over time, the effects of birth season, being born in Germany, residential region in the United States, and height at enlistment were more salient in the post‐1910 periods. Height at enlistment shows a positive association with risk of mortality in the post‐1910 periods. Compared to corresponding findings from more recent cohorts, the exceptional robustness of the effects of risk exposures prior to enlistment on old‐age mortality among the veterans highlights the harshness of living conditions early in their lives.     

Gender differences in the link between childhood socioeconomic conditions and heart attack risk in adulthood

A growing body of evidence shows that childhood socioeconomic status (SES) is predictive of disease risk in later life, with those from the most disadvantaged backgrounds more likely to experience poor adult-health outcomes. Most of these studies, however are based on middle-aged male populations and pay insufficient attention to the pathways between childhood risks and specific adult disorders. This article examines gender differences in the link between childhood SES and heart attack risk trajectories and the mechanisms by which early environments affect future disease risk. By using methods that model both latent and path-specific influences, we identify heterogeneity in early life conditions and human, social, and health capital in adulthood that contribute to diverse heart attack risk trajectories between and among men and women as they age into their 60s and 70s. We find that key risk factors for heart attack operate differently for men and women. For men, childhood SES does not differentiate those at low, increasing, and high risk for heart attack. In contrast, women who grew up without a father and/or under adverse economic conditions are the most likely to experience elevated risk for heart attack, even after we adjust for the unequal distribution of working and living conditions, social relationships, access to health care, and adult lifestyle behaviors that influence health outcomes.     

The impact of changes in child support policy

This paper measures the impact of child support reforms on payments to divorced mothers and welfare participation rates among them. A Stackelberg model of divorced parents’ behavior is calibrated to data from Wisconsin, where child support payments increased from $2,175.35 to $3,431.77 and welfare participation rates decreased from 33.5% to 9% between 1981 and 1992. Results show that new guidelines accounted for 24.4% and improved enforcement for 74% of the increase in payments. Higher payments accounted for a 3.9-percentage-point decline, decreasing welfare benefits an 8.4-percentage-point decline, and the two combined a 15-percentage-point decline in the welfare participation rate.      

Family planning in India]

India, one of the 1st countries to develop family planning, had a 19.9% decline in its birth rate from 1965-80. This, however, is not adequate in degree or speed. India's 1st private family planning clinic was established in 1925. A government sponsored family planning clinic was built 5 years later. By the early 1950s, governmental support for family planning included 6 5-year plans (1951-83), the target of which was to limit the birth rate to 25/1000 by 1984, and 21/1000 by 2001. A mortality rate of 9/1000 by 2001 was also targeted. By 1979, there were 51,972 Health Centers and Stations in rural areas, all manned by 2-3 physicians, and 50-80 support staff. In urban areas, there were over 1900 family welfare centers. But these do not meet the needs of the entire populace. As early as the 1950s incentives were given to those practicing birth control (e.g., free birth control operations, or priority in housing and jobs). A system of fines was instituted in 1976 for those refusing to participate in family planning, resulting in an increased use of contraceptives. For the years 1956-81, 80,000,000 women used some form of birth control. The percentage of married women practicing birth control jumped from 12% in 1970 to 28% in 1981. Of those successful in family planning, 20.2% were sterilized. But the rate of effective use of birth control varies greatly from area to area, ranging from 1% to 35%. Family planning work in India is hindered by a complex political system, religious beliefs, traditional customs, and illiteracy. By 2000, India's population might increase by 40% to 961,000,000.     

The Relationship Between Body Image and Sexual Functioning Among Gay and Bisexual Men

ABSTRACT

Gay and bisexual men report high body dissatisfaction compared to heterosexual counterparts, but no studies to date have examined how this may impact their sexual functioning. The present study investigated body image domains as predictors of sexual functioning problems (inhibited desire, erectile dysfunction, and premature ejaculation) among an online community sample of 185 gay and bisexual men, ages 18–40. Participants reported moderate to high body image satisfaction and sexual functioning consistent with previous literature with nonclinical male samples. Overall, the total variance accounted for by regression models was low. Body image variables were not predictive of sexual desire. However, increased drive for muscularity and lower affective body esteem were predictive of erectile difficulties. Additionally, negative behavioral body image in sexual situations and evaluative body dissatisfaction were associated with premature ejaculation. Understanding this relationship may have implications for gay and bisexual men’s health and wellbeing. Future research directions are discussed.     

提前退休模式与行为及其影响因素——基于中国综合社会调查数据的分析

文章基于2008年中国综合社会调查数据,对城镇人口提前退休模式与行为及其影响因素进行了分析。主要结论是:(1)提前退休模式与行为存在显著的性别差异,女性比男性距离法定退休年龄更近时退休,表现出较为明显的集聚特征,法定退休年龄对女性退休模式与行为的影响更大;(2)随着中国家庭子女数量的减少,劳动力市场灵活性的逐步增强,人们劳动参与意愿和可能性都会显著提升,提前退休的可能性越来越小,而且不断提高的受教育程度也会使女性提前退休的可能性减小;(3)中国的社会保障制度对男性提前退休有显著影响,对女性则不显著。与养老保险制度相比,医疗保险与失业保险制度对男性提前退休的影响更大,基本医疗保险制度的完善会增加提前退休的可能性,失业保险制度的完善更有可能增强男性的工作意愿,降低提前退休的可能性。     

Socio-economic Differentials in Infant and Child Mortality during Mortality Decline: England and Wales, 1890–1911

In this paper data from the 1911 Census of the Fertility of Marriage of England and Wales are used to study patterns of mortality decline by socio-economic characteristics, principally the occupation of husband. That census reported data on number of wives, children ever born, and children dead by marriage-duration cohorts for 190 non-overlapping occupations of husband. These results, along with those on number of rooms in the dwelling of the family are used to make indirect estimates of childhood mortality using the techniques described in United Nations, Manual X. These procedures produce values of q(a), the probability of dying before reaching some exact age ‘a’. Estimates for q(2), q(3), q(5), q(10), q(15), and q(20) are derived from data on women married 0–4, 5–9, 10–14, 15–19, 20–24, and 25–29 years, respectively. These estimates can also be dated to a point in the past. These values can also be converted to a corresponding level of a Model West life table, which describes the ‘average’ mortality regime which the children of those women experienced. This furnishes a basis to look at mortality decline for various social classes and occupational groups. Ordinary least squares regressions of the levels of Model West life tables implied by the 1(a) values on time give one measure of mortality decline. Another is the absolute amount of the increase in the level of the Model West life tables from marriage-duration cohort 20–24 years to 0–4 years. The aggregate results indicate that social class in England and Wales during the 1890s and 1900s tended to be related to the speed of mortality decline: childhood mortality declined more rapidly in the higher and more privileged social class groups. But the results were neither nearly as strong nor as regular as those which predicted the level of mortality within any marriage-duration cohort. These outcomes are not particularly sensitive to the three different social-class stratification schemes used: the 1911 English Registrar General's classification; the 1951 English Registrar General's classification; and the 1950 U.S. Census classification. There was also a fairly regular and predictable gradient for the number of rooms in the home: child mortality was higher in families who lived in larger dwellings. Analysis of 190 detailed male occupational groups revealed that considerably more of the variation in mortality levels than of trends could be explained by social-class categories. Between 20 and 40 per cent of variation in mortality trend could be accounted for by social class alone, as opposed to 50 to 80 per cent of mortality levels for different marriage-duration cohorts. Results for a more restricted sample of 116 occupations for which income estimates could be made revealed a similar pattern. In addition, income was virtually unrelated to the pattern of mortality decline, and improvement was more rapid in groups who were more urban. This reflects the role of rapidly improving urban sanitation in the late nineteenth and early twentieth centuries in England. In contrast, income was significantly related to childhood morality levels for various marriage-duration cohorts (with higher income associated with lower mortality), while urbanization was inversely correlated with mortality levels (more urban groups experienced higher mortality). Overall, social class (or occupation group), income, and urbanization were more successful in explaining mortality levels than time trends across occupations, although social class and the extent of urbanization did reasonably well in accounting for trends. Over a longer period, the transition in child mortality was under way by the 1890s, but its pace and timing varied in different occupations and social class groupings. Although absolute differences in infant mortality were reduced after about 1911, relative inequality persisted even as infant and child survival improved for all groups.